Care Home: Cranmore House

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What the care home does well The home has a good pre admission system enabling people to visit the home and an assessment is undertaken to ensure that their needs can be met on moving into the home. People living in the home have access to a range of Health and Social Care Professionals and this ensures that any health care needs are met. People are cared for in a respectful manner by staff and this ensures that their self- esteem and dignity are maintained. People are involved in making decisions and are able to exercise control over their daily lives. This promotes their independence and individuality. People are supported in forming friendships with each other, which enhances their quality of life in the home. Arrangements are made for people living in the home to practice their chosen religion, so their religious needs are met. Visiting is flexible enabling people to maintain relationships that are important to them. Visitors are made to feel welcome and a good rapport had built up between people using the service, staff and their visitors. One visitor met during the visit said, "The staff always ask if we would like a drink". There is a choice of wholesome meals which meet any dietary needs for reasons of health, taste, culture or religion. All people spoken to stated they enjoyed the meals. People living in the home had no complaints and stated, "They tell you if you have any problems to go and see them". This provides confidence to people that they will be listened to and taken seriously. The environment was homely, clean and well maintained, so providing a pleasant place for people to live. They are able to personalise their bedrooms to reflect their individual tastes, age, gender and culture so that they feel comfortable in their surroundings. Aids and adaptations are provided so that people`s independence is maintained and promoted whilst maintaining their safety. Staff have the appropriate skills and knowledge to work safely and effectively and provide a good standard of care to residents. Robust systems were in place to ensure money held on behalf of people living in the home was safeguarded. The home has a quality assurance system, which seeks views form people who live in the home, relatives and visiting professionals, to determine areas of good practice and areas that need improvement. What has improved since the last inspection? An activity coordinator has been employed since the last inspection and this has lead to an improvement in activities for people living in the home. A deputy manager has been recruited in order to support the manager in the day-to-day running of the home. Improvements have been made to the building, which includes bathing facilities; grab rails, ramps, flooring etc. improving the environment for people so they are able to maintain their independence. The medication systems have improved ensuring that people receive the medication prescribed for them at appropriate times. The recruitment of new staff has improved ensuring the people living in the home are protected by staff who are suitable to work with vulnerable people. What the care home could do better: The manager has identified that they would like to develop activities further and include more outings. They are also looking at further staff training to develop staff further in areas that impact on people living in the home e.g. tissue viability, continence care etc. They have also identified that care plans need further development and to be more detailed. They also hope to develop systems for care staff to become more involved in the care planning process. They also plan to upgrade the ground floor bathroom in order to improve facilities for people who live in the home. They hope to have staff meetings and meetings with people living in the home more frequently and introduce meetings with relatives, so improving their involvement with decisions and control over their lives. CARE HOMES FOR OLDER PEOPLE Cranmore House 107 Sutton Road Erdington Birmingham West Midlands B23 5XB Lead Inspector Ann Farrell Key Unannounced Inspection 10th June 2008 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Cranmore House DS0000064262.V366024.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cranmore House DS0000064262.V366024.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cranmore House Address 107 Sutton Road Erdington Birmingham West Midlands B23 5XB 0121 373 9784 F/P 0121 373 9784 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) none Dr Jayshree N Patel Mrs Hemlata Patel, Mr Ullas Ambalal Patel, Mr Mukesh Patel, Mrs Dipika Patel, Mr Kirit Patel, Dr Jivantika Patel, Mr Narendra Patel Mrs Tina Joyce Boyland Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places Cranmore House DS0000064262.V366024.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. That the home can accommodate up to 22 residents for reasons of old age (OP). The home may accommodate two named service users under 65 years of age. The home may accommodate three named service users who have dementia. 12th June 2007 Date of last inspection Brief Description of the Service: Cranmore House is registered to provide residential care for up to twenty two people for reasons of old age and this includes three people who are under sixty five years of age and three people for reasons of dementia care. It is situated on a main road in Erdington close to a shopping centre and public house. Public bus services run past the home and a railway station is within easy walking distance. The Home is within a large Victorian property and an extension has been added. Accommodation is provided on the ground and first floor and the second floor is used for administration purposes. A passenger lift provides access to all floors used by people who live there. Bedrooms are of varying sizes offering both single and shared occupancy and none of the bedrooms have en suite facilities. There are currently three bathing facilities provided at the Home and two have been upgraded in the last year improving facilities for people who live there. There are two lounges on the ground floor and smoking is permitted within one of these. Off road parking is available at the front of the building, and a large secure garden is situated to the rear, and this is accessible to wheelchair users and people with physical disabilities. There are notice boards throughout the Home displaying any forthcoming events and other information of interest to people who live in the home and their visitors. A copy of the most recent CSCI report was on display in the Home for residents and other interested parties to refer to. Service user guides had been updated and were available. The weekly fee to live at the Home at the time of visiting was between £322 and £395 per week. Items excluded from this fee include personal toiletries, hairdressing, private chiropody and dry cleaning. Cranmore House DS0000064262.V366024.R01.S.doc Version 5.2 Page 5 Cranmore House DS0000064262.V366024.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 the Commission for Social Care Inspection (CSCI) is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. Prior to the fieldwork visit taking place a range of information was gathered to plan the inspection, which included notifications received from the home or other agencies and an Annual Quality Assurance Assessment (AQAA). This is a questionnaire that was completed by the manager and it gave us information about the home, staff, people who live there, any developments since the last inspection and there plans for the future. In addition, random surveys were sent out people who live in the home, relatives and health professionals before the inspection in order to gain their views about the service. One survey was returned by a health professional, which gave very positive comments about the management/care of people who live in the home and he stated, ”I am very pleased with the current management”. Two inspectors undertook this fieldwork visit over one day. The registered manager and deputy were available for the duration of the inspection and two of the proprietors visited during the course of the inspection. The home did not know that we were visiting on that day. At the time of inspection twenty two people were living in the home and information was gathered from speaking to and observing people who lived at the home. Three people were “case tracked” and this involves discovering their experiences of living at the home by meeting or observing them, looking at medication and care files and reviewing areas of the home relevant to these people, in order to focus on outcomes. Case tracking helps us to understand the experiences of people who use the service. Staff files, training records and health and safety files were also reviewed. At the time of inspection six people who live in the home, two visitors and four staff were spoken to in order to gain comments. The feedback was very positive and comments included; “The staff are so helpful in every way”. “The staff are always considerate to residents who live here, they have lots of patience”. Cranmore House DS0000064262.V366024.R01.S.doc Version 5.2 Page 7 “I am always offered a cup of tea when I visit”. “The manager is excellent; staff are never too busy to answer questions from the manager down”. “I could not fault anything”. “They tell you if you have any problems to go and see them”. “They keep the place clean”. “The food is good and you get a choice”. What the service does well: The home has a good pre admission system enabling people to visit the home and an assessment is undertaken to ensure that their needs can be met on moving into the home. People living in the home have access to a range of Health and Social Care Professionals and this ensures that any health care needs are met. People are cared for in a respectful manner by staff and this ensures that their self- esteem and dignity are maintained. People are involved in making decisions and are able to exercise control over their daily lives. This promotes their independence and individuality. People are supported in forming friendships with each other, which enhances their quality of life in the home. Arrangements are made for people living in the home to practice their chosen religion, so their religious needs are met. Visiting is flexible enabling people to maintain relationships that are important to them. Visitors are made to feel welcome and a good rapport had built up between people using the service, staff and their visitors. One visitor met during the visit said, “The staff always ask if we would like a drink”. There is a choice of wholesome meals which meet any dietary needs for reasons of health, taste, culture or religion. All people spoken to stated they enjoyed the meals. People living in the home had no complaints and stated, “They tell you if you have any problems to go and see them”. This provides confidence to people that they will be listened to and taken seriously. The environment was homely, clean and well maintained, so providing a pleasant place for people to live. They are able to personalise their bedrooms to reflect their individual tastes, age, gender and culture so that they feel comfortable in their surroundings. Aids and adaptations are provided so that people’s independence is maintained and promoted whilst maintaining their safety. Cranmore House DS0000064262.V366024.R01.S.doc Version 5.2 Page 8 Staff have the appropriate skills and knowledge to work safely and effectively and provide a good standard of care to residents. Robust systems were in place to ensure money held on behalf of people living in the home was safeguarded. The home has a quality assurance system, which seeks views form people who live in the home, relatives and visiting professionals, to determine areas of good practice and areas that need improvement. What has improved since the last inspection? What they could do better: The manager has identified that they would like to develop activities further and include more outings. They are also looking at further staff training to develop staff further in areas that impact on people living in the home e.g. tissue viability, continence care etc. They have also identified that care plans need further development and to be more detailed. They also hope to develop systems for care staff to become more involved in the care planning process. They also plan to upgrade the ground floor bathroom in order to improve facilities for people who live in the home. They hope to have staff meetings and meetings with people living in the home more frequently and introduce meetings with relatives, so improving their involvement with decisions and control over their lives. Cranmore House DS0000064262.V366024.R01.S.doc Version 5.2 Page 9 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Cranmore House DS0000064262.V366024.R01.S.doc Version 5.2 Page 10 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 Cranmore House DS0000064262.V366024.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information is made available to people before they move into the home enabling them to make and informed decision about moving into the home. People’s needs are assessed before they move in, so they can be confident their needs will be met upon moving into the home. EVIDENCE: The home has a service user guide and statement of purpose, which have been updated recently to accurately reflect the services and facilities available in the home. The service user guide was accessible, in a large font, mainly in plain English, welcoming and informative on their facilities, services, staff & proprietors & their qualifications, processes and philosophy of care (based upon equality, individualised care and key working to enable fulfilment for people’s potential and autonomy, privacy and encouraging contact with family Cranmore House DS0000064262.V366024.R01.S.doc Version 5.2 Page 12 and friends). Pets are not excluded and staff would assess each individual case and make a decision based on risks to people based in the home. It also provides a section about advocacy and this could be improved to explain that advocates help people to make decisions, and may be required under law for the Home to arrange to contribute to best interest decisions to move when a person has no effective representatives and is unable to decide themselves. The information in the documents enables people to make an informed choice about moving into the home and these were available to people in their bedrooms. The home provides care for people who require long term or respite care. People are encouraged to visit the home before moving in to view facilities, meet staff and other people who live there in order to sample what it would be like to live there. At this time it also enables staff to undertake an assessment of the persons needs to determine if they are able to meet them appropriately. On inspection of the records for some people who had moved into the home recently it was found that a good assessment had been completed by staff and in one case a person had visited the home three times before a decision was made about moving in. The manager should also consider obtaining a copy of the social workers assessment where possible to further improve the process. This process ensures the person is happy to move into the home and the staff are able to meet their needs. In addition, there is a trail period of one month, which provides further opportunity to discuss whether the person would like to continue living there and if their care needs were being met or any changes that are required. On discussion with the manager she stated that they did not routinely confirm admission to people in writing following assessment. It is recommended that this process be undertaken as it provides confidence to the person that their needs will be met when they move into the home. Cranmore House DS0000064262.V366024.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are good systems in place to ensure people’s health and personal care needs are met. The medication system is well managed ensuring people receive medication that is prescribed for them. People are supported in a respectful manner by staff ensuring their dignity and self-esteem are maintained. EVIDENCE: Each person living in the home had a care plan. This is a document that is developed by staff following an assessment of individuals needs. It outlines what they can do independently, the activities people require assistance with and the actions staff need to provide in order to support them. Three peoples care files were looked at in detail. There was evidence of a further assessment on admission to the home, which included physical health assessment, mental health assessment, behaviour assessment plus risk assessments. Risk assessments were completed in a number of areas with the exception of nutrition. Risk assessment are completed in order to determine Cranmore House DS0000064262.V366024.R01.S.doc Version 5.2 Page 14 any areas of risk in respect of health and to promote independence, so that people live a meaningful life, risks are reduced and well being promoted. The file was made up of a range of documents and the information required by staff to support people was available, but the care plan referred to other documents and risk assessments and the information had not routinely been recorded in the plan of care. This means that staff would need to look through the whole file to find the information they require to support people in order to meet their needs. It is recommended that this process be reviewed and the plan of care consolidated to provide all the information required by staff to support people, so that information is easily accessible. Staff record peoples care, activities and any changes on a daily basis and these records were of a good standard. In one case it showed that staff were very aware of changes in a persons condition and had responded appropriately in order to maintain their health status. In addition, a monthly evaluation was undertaken and recorded by staff, which gave an overview of the person’s condition and any intervention during that period, highlighting any changes. People living in the home stated, “Staff are very attentive and would call the Dr if there were any problems”. This ensures peoples health care needs are met appropriately. All people were registered with a local GP who visits the home and there was evidence of people receiving visits from chiropodist, optician, dentist, district nurse, and physiotherapist ensuring peoples health care needs are met appropriately. Staff had recently referred one person to the occupational therapist and was waiting for an assessment to be undertaken to determine if there was any additional equipment available to support them. There was evidence of pressure relieving equipment in the form of mattresses and cushions in use to reduce the risk of pressure sores for people who had been identified to be at risk. However, it was noted that when one person was transferred from a lounge chair to a wheelchair without a pressure-relieving cushion. All staff must ensure that the cushion is used on all seating to prevent the risk of pressure sore. It was stated; “The staff have always been decent to me”. “The home is very flexible allowing people to move around”. “The manager and staff have a good understanding about the needs of people with memory difficulties”. “The manager and staff are very keen to try psychological means to treat behavioural difficulties. This is highly commendable. I am very pleased with the current management”. Staff encourage people who live in the home to maintain their independence and mobility, so they maintain their abilities and promote well being. They were well presented with clothing appropriate for the time of year reflecting individual culture, gender and personal preferences. Cranmore House DS0000064262.V366024.R01.S.doc Version 5.2 Page 15 The homes medication system consisted of a blister and box system with printed Medication Administration Record (MAR) sheets being supplied by the dispensing pharmacist on a monthly basis. The home had copies of the original prescription (FP10’s) for repeat medication, so they were able to check the prescribed medication against the MAR chart when it entered the home. Medication is stored correctly and adequate stocks maintained, which ensures a robust system for ordering medication. A fridge is used for some medication and one temperature is recorded daily. However, it recommended that the minimum, maximum and current temperature be recorded to ensure any medications stored within the correct temperature at all times during the day. On inspection of the medication for the current month it was found that all the audits were correct and on discussion with senior staff they had a good knowledge of the medication in use. People who live in the home are consulted on admission if they wish to give their own medication in order to maintain their independence and in some cases this was occurring. A risk assessment had been completed to ensure that they had the abilities to undertake the process, however the document will need developing further to ensure it is robust as it did not assess areas such as dexterity, mental capacity etc. There is a public telephone in the reception area for people living in the home to make calls and the homes portable phone can be used where privacy is required. Bedrooms were provided with locks on doors and lockable facilities, so enhancing the arrangements for privacy and security of valuables etc. During the inspection staff were noted to be caring and respectful to people living in the home ensuring their dignity and self-esteem was maintained. There was also noted to be good interaction between staff and visitors making them feel welcome. Cranmore House DS0000064262.V366024.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live in the home are able to exercise some control over their lives and there is a range of activities they can partake in, so they experience a meaningful lifestyle. There is a choice of healthy meals that meets the dietary needs of people living in the home. EVIDENCE: There was no evidence of any rigid rules or routines in the home and people who live there can go outside on their own or with friends and family as they choose, depending on their abilities. It was noted that one person had been out to do some shopping unaccompanied. Visiting was flexible enabling people to visit at a time that suited them, so people living in the home could maintain contact with fiends and family. This was confirmed on discussion with people who were visiting the home. They stated the home was always clean and warm and staff were excellent. Other comments included; “The staff are so helpful in every way”. Cranmore House DS0000064262.V366024.R01.S.doc Version 5.2 Page 17 “The staff are always considerate with residents, they have lots of patience and they are never to busy to answer questions from the manager down”. “They always offer me a cup of tea when I come”. “I could not fault anything”. People living in the home confirmed they could choose the times they get up and go to bed. People are able to bring personal items of small furniture, pictures, ornaments etc. into the home providing a home from home atmosphere reflecting their personality. The home provides the opportunity for people to follow their own religion ensuring their religious needs are met. A bible group is held in the home each week and communion monthly. One person who has recently moved into the home wishes to visit the church they previously attended and the manager is trying to make arrangements for this to occur. Good practice was noted regarding one person living in the home who leads on “pastoral care”. He spends timing talking to people moving into the home and those who do not wish to attend activities if they wish, so improving their quality of life in the home. Since the last inspection it was clear that activities had been prioritised and a part time activities coordinator has been employed, so the range and variety of activities is improved to people living in the home. At the time of inspection she was meeting with a group of people living in the home for a life story game. Other activities included thera-pets, progressive mobility, crosswords, bingo, pamper day, aerobics of the mind, sing along and one to one sessions. On discussion with her she stated she tries to see everyone each week either in a group or one to one session and records were available to demonstrate this. Some people also visited a local day centre and the manager stated more places available. A trip had been organised for people to visit and have lunch to see if they wished to attend on a regular basis. Questionnaires recently returned by a people living in the home indicated the entertainment was good and the activities were the type they could take part in. The manager is hoping to develop the activities further. Recently there has been a clothes show in the home and some female residents have been out on a shopping trip to a local dress shop, which they enjoyed. The activities coordinator stated they were in the process of organising a trip out for the men. A notice was on the notice board advertising a strawberry cream tea at the weekend and relatives had been invited. The home have recently purchased a lap top computer and this is to be set up for the use of people living in the home. A library service visits regularly providing a range of books and the hairdresser visits on a regular basis. The manager Cranmore House DS0000064262.V366024.R01.S.doc Version 5.2 Page 18 stated they hope to improve activities to include more trips out to improve the quality of life for people living in the home. A varied and nutritious diet is provided on a flexible four weekly rotated menu, and people are able to choose of meals and where they eat. The menus are also changes according to the season, so providing more variety. The cook explained that the Manager identifies preferences of people newly admitted and informs her. Special diets are catered for: at present these include a weight reduction and diabetic menu. Brief discussion with people in the home, the cook, and quality assurance questionnaires by relatives indicated satisfaction with the food and particular delight at relatives being invited for Xmas dinner. One questionnaire noted a comment: “My mother has been in and out of hospital in short time here; we are very pleased with her support and treatment. She is not the easiest person to get to eat, but Tina and her staff have accommodated her requests for certain food where possible…always seems well run, atmosphere very good…” The dinging room was pleasant, tables were laid appropriately and meals were well presented, so providing a relaxed social environment. Cranmore House DS0000064262.V366024.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are appropriate systems in place so people are protected from harm. People living in the home are confident their views are listened to action taken where appropriate. EVIDENCE: A copy of the complaints procedure was available on the notice board in the home advising people of the procedure if they wished to raise any concerns, which was satisfactory. People living in the home were aware of how to raise concerns. A record of any complaints or concerns raised is kept in the home and this showed there had been no complaints since the last inspection. We had not received any complaints about the home and on discussion with people living and visiting the home they stated they did not have any complaints. One visitor stated, “I could not fault anything”. A person living in the home stated, “They tell you if you have any problems to go and see them”. The Manager clearly knew people well and we observed they initiated conversation with her, indicating she was approachable. The service user guide appeared to have made use of learning from previous complaints/safeguarding matters, which is positive. Cranmore House DS0000064262.V366024.R01.S.doc Version 5.2 Page 20 The home has policies and procedures in respect of safeguarding and whistle blowing, which provide guidance to staff about recognition and prevention of abuse and the action to take in the event of any allegation. Records indicated that the majority of staff had undertaken training in this area. On discussion with staff they were aware of the policies and procedures and what to do in the event of any allegation of abuse ensuring that people living in the home are protected from harm. On discussion with the manager it was stated that staff had not received training respect of the Mental Capacity Act. It is recommended that this training be provided to all staff, so that they are aware of the procedures for supporting people who lack capacity to make decisions. There was information about an advocacy service on the notice board if anyone in the home required support enabling them to have control over personal matters. The manager stated the service had been used in the past by some people, but was not currently being used. However, it is good that staff are aware of the service and can contact them if required so that people in the home have someone independent to support them. Cranmore House DS0000064262.V366024.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20,21,22, 24,26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People live in a homely, clean and comfortable environment where they feel safe and secure and their privacy is maintained. EVIDENCE: The home is a detached three-storey building with adequate off road parking for visitors. The exterior is fairly well maintained, but the exterior would benefit from painting to improve the appearance. It is within easy access of shops and bus services enabling people who live in the home and visitors to use them if required. The interior is generally well maintained, clean and odour free with a homely atmosphere. There is an enclosed well maintained garden to the rear with patio, and seating that can be used when the weather permits. Since the last inspection a ramp and handrail have been fitted enabling easy access to reduce the risks of falls when moving from the patio to the garden. Cranmore House DS0000064262.V366024.R01.S.doc Version 5.2 Page 22 Accommodation is provided for twenty two people over the ground and first floor. Corridors are rather narrow and storage space is limited. Shared space consists of two separate lounges, one of which is a smoker’s lounge plus a dining room. This enables people to choose where they spend time. Flooring has been replaced and some new chairs had been provided in the shared areas, so improving the environment. However, the dining room and smokers lounge would benefit from re-decoration to improve the environment for people who live there. There are fourteen single bedrooms and four double bedrooms and all are provided with a wash hand basin and a call bell to enable assistance to be summoned when required. Bedroom doors had locks and lockable facilities were in place, so enhancing the arrangements for privacy and security. Some screening has been provided in double bedrooms to improve privacy, but this will need to be reviewed as it does not guarantee privacy if the wash hand basin is being used. Bedrooms are individually and naturally ventilated and windows are provided with restrainers for safety and security reasons. Radiators and the temperature of water from hot water outlets were controlled to reduce the risk of scalding to people who live in the home. People are encouraged to personalise their bedrooms and can take their own belongings in to their bedrooms to reflect their individual tastes, age, gender and culture, so meeting their needs and providing a more homely environment. Two assisted bathing facilities have been upgraded on the first floor providing a choice of a bath or shower for people who live in the home. Toilets were strategically placed around the home, but some were rather small and the toilet frame in one was unsteady and will need to be addressed to reduce the risk of accident. The manager stated the bathing facility on the ground floor is to be upgraded and toilets re-decorated later in the year to further improve facilities. A new sluice facility has been fitted since the last inspection improving the arrangements for infection control. There were a number of aids and adaptations provided that were fit for purpose and suitable for the needs of the people living in the home. A number of people had been assessed for walking aids, so that their independence was promoted whilst maintaining their safety. Raised toilet seats, grab rails and handrails were provided in corridors to encourage mobility safely. There is also a portable hoist for anyone who has difficulties standing and wheelchairs for those who have difficulties mobilizing, but one person’s wheelchair was not suitable for them and staff were waiting for a visit from the occupational therapist to review equipment for them. Staff must ensure that a competent person assesses anyone requiring a wheelchair, so that the wheelchair is Cranmore House DS0000064262.V366024.R01.S.doc Version 5.2 Page 23 suitable for their needs. Access to the first floor is by a passenger lift enabling everyone to access all areas of the home. The home had achieved a recent award from Safer Food Better Business for food hygiene in the kitchen. In light of achieving “very good” by the regulator, and logged evidence the Manager is involved in food hygiene audits. An improved system for food stock control linked to menus is needed in light of minor out-of-date food items found during the inspection. Cranmore House DS0000064262.V366024.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a robust recruitment system for employing new staff for the protection of the people who live there. People are supported by staff who are trained and have the knowledge and skills to meet their needs effectively. EVIDENCE: At the time of inspection there were adequate staff on duty to meet people’s needs. The duty rota indicated there were three care staff on duty at all times throughout the day with two care staff overnight. This was confirmed with staff and appeared adequate to meet people’s needs. In addition, to the care staff the manager works Monday to Friday during the day and a deputy manager has recently been appointed and they provide appropriate support for the care staff. There is also a housekeeper, catering and domestic staff. People who live in the home stated, “We are looked after well”. A visitor stated, “Excellent; the staff are always considerate with residents; they have lots of patience”. Feedback from a professional recently was, “ appears to provide very thoughtful care…good to see familiar carers when I visit. I assume this means there is not a high turnover of staff.” Cranmore House DS0000064262.V366024.R01.S.doc Version 5.2 Page 25 There have been some staff absences recently due to various reasons and the manager has used agency staff to ensure there are adequate numbers of staff on duty at all times to meet peoples needs. She stated that the same agency staff are used to ensure consistency of care. They are currently in the process of recruiting new staff in order to have a permanent work force. Recruitment records sampled showed that appropriate checks had been made to make sure that staff were suitably experienced and qualified to work with vulnerable adults. Criminal Records Bureau checks had been made and written references received before the employee began work, so that people were protected from the risk of having unsuitable staff work in the home with them. It was noted that there was no evidence of visa/work permit for overseas staff. On discussion with one of the staff they stated that they did have the relevant documents at home. Copies of these documents should be retained in individual staff files. The manager may wish to consider the involvement of people living in the home in the recruitment process to enhance the process. Following employment new staff undertake the homes induction training and records were available to demonstrate this and some new staff were in the process of completing the Social Skills Council induction standards. This ensures that all new staff have the knowledge and skills to care for people initially. There is a rolling programme of basic training that includes fire safety, manual handling, health and safety, food hygiene etc. Records indicated a number of the staff had completed the training or were in the process of undertaking it, so they have the basic knowledge and skills to care for people living in the home. The manager stated that she is hoping to introduce other training that is more specific to people’s needs and conditions such as tissue viability, continence etc. This will improve staff knowledge and improve outcomes for people living in the home. Records indicated that over 50 of staff had completed NVQ 2 training or above in care and five staff had completed NVQ 2 in dementia care. This training improves staff knowledge and skills and leads to improved outcomes for people living in the home. Cranmore House DS0000064262.V366024.R01.S.doc Version 5.2 Page 26 Cranmore House DS0000064262.V366024.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed and run in the best interests of the people living there. Systems are in place to ensure the health, safety and protection of people living in the home. EVIDENCE: The home’s manager is registered with us, she has completed the Registered Managers Award and has a number of years experience working in a managerial position. A deputy manager has recently been employed and this strengthens the management support in the home, so that systems are further developed and implemented to improve outcomes for people living there. Staff spoken to during the inspection were enthusiastic about their job. They felt they worked well together and provided good care to people who lived in Cranmore House DS0000064262.V366024.R01.S.doc Version 5.2 Page 28 the home. They had a good knowledge of the people’s individual care needs, which ensures their needs are met effectively. Meetings with people living in the home and staff have occurred intermittently in the past, enabling them to discuss any issues or concerns and have a say in the running of the home. Staff stated they are able to raise any issues and managers listen to suggestions providing staff with ownership. The manager stated now the deputy is in post she hopes to have the meetings more regularly and also introduce meetings with relatives, which will improve their involvement in decision making and enable them to have more control over their lives. There is a robust quality assurance system in place, and was recently used to update policies, procedures, the service user guide, contract, and staff practice. Policies and procedures were updated in April 08. They are concise and in plain English. Outstanding requirements have been actioned. Questionnaires returned from health professionals included comments such as; “Impressed by the staff…their professionalism & keenness to try psychological intervention rather than resort to pharmaceutical means…” “Overall standards of care …(etc)…has greatly improved since manager appointed” “Very open and friendly home, nice to see a hands on manager too…also a good training programme.” “Vast improvement… efficient, courteous, helpful. “Special credit to the Manager, who has made a significant contribution to the overall change…” Relative’s questionnaires commented: “Staff are very hard working, providing all the needs to the residents – highly commend…. settled down now & I think he is happy in your care…he is a bit untidy at times but I think you handle him well.” “I am happy that dad is well cared for & happy, has made friends… I hope he lives out the rest of his days in Cranmore”. “Very well organised home in every way…always ready to help, friendly, caring, professional” The manager a most pleasant, caring & helpful person…excellent job managing…with one aim, the welfare of all her resides.” One of the proprietors visits the home on a monthly basis to report on the standard of care and reports of the visits were available for inspection. They stated they take the audits seriously and ensure the Manager attends to their observations. They made one recommendation (curry night) to improve the quality of lifestyle, and clearly the preferences of some people who were living in the home and this had been addressed. Prior to the inspection an Annual Quality Assurance Assessment was completed. The document gave good information about the home, staff, Cranmore House DS0000064262.V366024.R01.S.doc Version 5.2 Page 29 people who live there and the improvements over the past year. It also gave information about the plans and areas of development for the future. The manager’s vision for the future is to improve the quality of life for people living in the home, to improve activities and empower people to have more control over their lives. The senior staff do manage personal money for some people who live in the home, but do not act as appointee of power of attorney. On inspection of the system it was found to be satisfactory with two signatures and receipts for all transactions, ensuring a robust system to safeguard peoples money. Health and safety maintenance checks had been undertaken in the home to ensure that the equipment was in safe and full working order. Maintenance checks were completed on the fire system and equipment, so that people are safe in the event of a fire occurring. Checks were made on hot water outlets to ensure it maintained at a satisfactory temperature to prevent scalding. Cranmore House DS0000064262.V366024.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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 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 3 17 X 18 3 3 2 2 2 X 2 X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Cranmore House DS0000064262.V366024.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 12(1) Requirement Staff must ensure that pressure relieving equipment is used at all times where it has been deemed necessary to reduce the risk of pressure sores. Timescale for action 12/06/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP3 OP7 OP7 Good Practice Recommendations Staff should confirm admission to the home in writing following assessment. This will provide confidence to the person that their needs will be met on entering the home The information in peoples care plans should be made more accessible to enable easier retrieval of information. A nutritional risk assessment should be undertaken for all people living in the home. This will identify any risks and lead to more timely interventions if required to maintain people’s health status. The minimum, maximum and current temperature of the medication fridge should be recorded regularly to ensure medication is stored at the correct temperature at all times. DS0000064262.V366024.R01.S.doc Version 5.2 Page 32 4. OP9 Cranmore House 5 6 7 8 9 10 11 OP9 OP18 OP19 OP21 OP22 OP24 OP29 The risk assessment for self-medication procedure should be reviewed and developed to provide a more robust procedure. All staff should undertake training in respect of the Mental Capacity Act so that they have the knowledge of how to support people in making decisions if they lack capacity. The exterior of the building would benefit from painting to improve the appearance of the home. Review the toilet frames to ensure they are fit for purpose. Where anyone living in the home requires a wheelchair they should be assessed by an appropriately trained person to ensure it is suitable to meet their needs. Review the privacy curtains in double bedrooms to improve arrangements in respect of privacy. A copy of work permit/visa should be kept with staff recruitment files to demonstrate staff are eligible to work in the country. Cranmore House DS0000064262.V366024.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Cranmore House DS0000064262.V366024.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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