CARE HOMES FOR OLDER PEOPLE
Crown Hills Nursing Home Radstone Walk Rowlatts Hill Leicester LE5 4UH Lead Inspector
Lesley Allison-White Key Unannounced Inspection 12th April 2007 10:00 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 Crown Hills Nursing Home DS0000001897.V335952.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. Crown Hills Nursing Home DS0000001897.V335952.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Crown Hills Nursing Home Address Radstone Walk Rowlatts Hill Leicester LE5 4UH 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) 0116 2760600 0116 2761428 GB Care Ltd Mrs Sadie Jane Green Care Home 49 Category(ies) of Dementia - over 65 years of age (49), Learning registration, with number disability over 65 years of age (1), Mental of places Disorder, excluding learning disability or dementia - over 65 years of age (49) Crown Hills Nursing Home DS0000001897.V335952.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. To be able to admit the named person of category LD named in variation application number V8757 dated 11/6/04 To be able to admit the named person of category DE as identified in variation application No. V7975 dated 2 June 2004 for periods of respite care. 12th April 2006 Date of last inspection Brief Description of the Service: Crown Hills Nursing and Residential Home is a care home offering accommodation for up to forty-nine older people. The home is registered to admit older people with dementia and/or mental disorders. The home is located in a residential area to the east of Leicester. It is easily accessed by road using the outer ring road. The centre of Leicester is approximately fifteen minutes away by car and there are adequate car parking spaces. A bus service is available from outside the home with more frequent bus services available near to the home. The buses Number 54 and Number 16 supply a service passing every ten minutes. The building itself is a purpose built modern property offering accommodation on three levels. The majority of rooms available are situated on the ground and first floors. The home is equipped with a slow moving lift. There is a large garden to the rear of the property with a lawned area, established plants and trees and a patio area with seating. All areas of the home and outside areas are accessible for people with mobility impairments. Fees range from £ 280.00 per week to £481.00 per week Crown Hills Nursing Home DS0000001897.V335952.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is on outcomes for residents and their views of the service provided. An unannounced inspection was undertaken. The inspection took place on a Thursday. It took seven hours to complete. Preparation for the inspection included review of the previous inspection report, service history, questionnaires returned by residents and relatives. The primary method of inspection used was “case tracking”. This involved speaking with the residents who use the service provided, looking at three residents’ care plans, making observations, talking with two residents and observing care practices. Two relatives spoke with the inspector. Three members of staff were spoken with. The following documents were looked at during the inspection: medication records, a sample of policies were reviewed, staff rotas, quality assurance records, accident records, fire records. The inspector also looked around the communal areas of the home. All the required key standards were inspected during this visit. There were no requirements from the previous inspection but during this inspection requirements have been made. The Registered Person facilitated the inspection. What the service does well:
Assessments for planned care are well documented. A comment from residents included ‘I am very happy here, my health has improved greatly and I believe this is partly owing to the good standards of care I receive.’ ‘ The staff are very caring.’ ‘ If ever they are slow to respond to my bell, I know that it is only because they have so many to look after and most of the other residents need more help than I do’. ‘ Crown Hills Nursing Home DS0000001897.V335952.R01.S.doc Version 5.2 Page 6 ‘I have no complaints to make about the care staff who are kind, helpful and very good in every way’. Relatives’ comments included ‘The staff look after my relatives physical and mental needs very well. My relative is always clean, tidy and well nourished.’ ‘I visit my relative many times a week. I think the care at Crown Hills is much better than at a home that my relative was at previously.’ ‘My dad is always warm and his room is kept clean and tidy’’. ‘I do not know what goes on behind the scenes but the staff are lovely to all the residents very caring. I notice by the notice board that they receive a lot of training and everyone communicates any problems they have with my relative.’ ‘I am very pleased with the way that the staff have treated my relative since being at the home.’ ‘From my relatives point of view the care home takes care of all my relatives needs extremely well.’ ‘I think the staff at Crown Hills are very good’ Relatives and visitors are welcome at the home and a family room is provided for privacy when visiting residents. One resident told the inspector that she received a free newspaper every day as did other residents, she liked it very much and was kept informed in this way. What has improved since the last inspection?
Each of the bedroom doors had a photograph of the resident and a named Nurse and a space for the key worker. This is a new development that the Registered Manager will continue with. This will help residents and their relatives to identify the staff that regularly provides care to a particular resident. The deputy manager has now attained her managers’ award and has been appointed the Registered Manager with CSCI. A new deputy has been appointed. Carpets are being replaced in the four lounges and the lounges have either been decorated or are in the process of doing so. The visitors/ family room is clean, bright and well kept.Some of the bedrooms have been redecorated. The driveway and parking area has been tarmaced and the front and rear doors have been replaced.
Crown Hills Nursing Home DS0000001897.V335952.R01.S.doc Version 5.2 Page 7 There is now an information board opposite the Registered Managers office. Important information about which staff are on duty and what activities are taking place are announced on it. What they could do better: 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. Crown Hills Nursing Home DS0000001897.V335952.R01.S.doc Version 5.2 Page 8 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 Crown Hills Nursing Home DS0000001897.V335952.R01.S.doc Version 5.2 Page 9 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): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their relatives are given information about the home in order to make an informed decision about whether the service is right for them. EVIDENCE: Assessments for the planned care needs of residents were well documented in all cases. The planned care needs were clear with visual aids to make it easy to understand in the area of moving and handling. A copy of the Service User Guide is available for prospective residents and also a copy of the Statement of Purpose. A copy of the Commission of Social Care Inspection report is available on request. Crown Hills Nursing Home DS0000001897.V335952.R01.S.doc Version 5.2 Page 10 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 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Appropriate care for residents living at Crown Hills cannot always be guaranteed. EVIDENCE: Care plans identified the residents’ needs and the care that they receive is evaluated on a regular basis. All residents have access to care from the community including Doctors, Chiropodists, Opticians and District Nurses. Medications were checked and were satisfactory. On the medicine recording sheet is the residents photograph, room number, General Practitioner and any allergies. The senior carer was able to demonstrate that a good standard of practice is operated; when medicines are opened they are signed and dated so that if they should go over their use by dates they will be discarded. There were no controlled drugs on the premises at inspection. None of the residents that the inspector spoke to were responsible for taking their own medications and there are no residents currently doing so.
Crown Hills Nursing Home DS0000001897.V335952.R01.S.doc Version 5.2 Page 11 Residents and relatives who spoke with the inspector felt that they were treated with respect. There was evidence of family involvement at reviews. In the upstairs dining room after lunchtime the inspector noticed that four residents were being moved from the dining room to the lounge or to other places in the lounge chairs that had wheels on them. The residents were pulled backwards in these chairs; there was no obvious means of protection for the residents’ legs or feet. Different care staff were seen to carry out this activity. There are two issues here moving and handling and the safe movement of residents from one place to another. This was discussed with the Registered Manager and changes to practice are to be implemented. Requirements will be issued for this. One of the bathrooms was found to be in an unsatisfactory state containing a soiled bedpan, un-flushed toilet and uncovered bin, this could lead to cross infection this was shown to the Registered Manager. It was dealt with immediately. A requirement will be issued for this. A comment from a resident included ‘I am very happy here, my health has improved greatly and I believe this is partly owing to the good standards of care I receive. Any problems I have are caused by the confused residents waking me at night and continually opening my door during the day’. Relatives’ comments included ‘The staff look after my relatives physical and mental needs very well. My relative is always clean, tidy and well nourished.’ ‘I visit my relative many times a week. I think the care at Crown Hills is much better that at a home that my relative was at previously.’ Crown Hills Nursing Home DS0000001897.V335952.R01.S.doc Version 5.2 Page 12 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 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements are being made so that activities within the home will succeed in meeting the identified daily and social needs of residents then the outcome will be positive for the residents. EVIDENCE: A new activities coordinator has been recently employed and will be undertaking a review of each residents activity plan. The coordinator will do four hours of activity four days a week in the afternoon with the residents as this is considered to be the best time of the day for residents and staff to take part in the Registered Manager explained. An information board has been provided opposite the Registered Managers office. It gives information about the staff on duty, activities for the day and any other information that a visitor or resident at the home may need. However, until the necessary checks are ready the Registered Manager explained that she will ask the care staff to spend more time talking with the residents during this period of short coming. Crown Hills Nursing Home DS0000001897.V335952.R01.S.doc Version 5.2 Page 13 Relatives and visitors are welcome at the home and a family room is provided for privacy when visiting residents. Family and friends of residents were seen visiting during the day. One resident told the inspector that she received a free newspaper every day, as did other residents, she liked it very much as she enjoyed being kept informed in this way. The religious need of any individual resident is met on an individual basis. ‘My father chooses when he wants to stay in his room or socialise with other residents, no one forces my relative to do anything that he does not wish to do. Excellent care is given.’ At meal times it was noticed that some residents had to wait for a while whilst the care staff assisted other residents. It was also noticed that a few residents who were often more independent, sometimes had a ‘not so good day’ and needed help. It did not seem that the care staff were able to dedicate sufficient time to those residents. The meals were kept warm in the food trolley. Meals served looked pleasant and residents said that they enjoyed the meals provided by the home. Special diets such diabetic diets are provided at Crown Hills. Crown Hills Nursing Home DS0000001897.V335952.R01.S.doc Version 5.2 Page 14 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 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are policies and procedures for dealing with complaints and protection thereby giving protection to the residents. EVIDENCE: The Commission of Social Care Inspection has received complaints about Crown Hills since the last inspection. Complaints and concerns are well managed. The person who has raised a concern or made a complaint is notified of the outcome. One relative who spoke with the inspector praised the Registered Manager at the home for dealing with racist behaviour that occurred. He felt very able and very strongly that he would have no hesitation to seek the help of the management team if he or his relative had a problem. Complaints are well documented and dealt with. The Registered Manager was able to show the inspector the staff training records. On the issue of the Protection of Vulnerable Adults (POVA) training records indicate that the majority of staff have received and have their training updated. Staff who spoke with the inspector were aware of the training. The staff members were able to describe their induction process and training received whist working at Crown Hills. They felt able to deal with most care
Crown Hills Nursing Home DS0000001897.V335952.R01.S.doc Version 5.2 Page 15 situations. There are policies and procedures for dealing with complaints and protection. This protects residents. Relatives who spoke with the inspector and completed the questionnaires felt happy to express their concerns or complaints and knew that the Registered Manager would address them. Crown Hills Nursing Home DS0000001897.V335952.R01.S.doc Version 5.2 Page 16 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 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are provided with a safe and comfortable environment. EVIDENCE: The upstairs corridor lights were on and the corridor was less dark than at the last inspection it was a nice bright day. A maintenance person is employed and was seen on the day of inspection working. The carpets are being replaced in the four lounges and a process of re decorating has begun at the home. The visitors/ family room is clean, bright and well kept. Residents and relative comments included ‘The general cleanliness of the rooms could be improved’
Crown Hills Nursing Home DS0000001897.V335952.R01.S.doc Version 5.2 Page 17 ‘My dad is always warm and his room is kept clean and tidy’’. ‘Floors and sinks (communal areas) are not as clean as they could be. I came from a residential home which was much cleaner but I am very happy here and you cannot have everything.’ The inspector also found that one of the communal bathrooms needed some improvement. This has been discussed under the ‘Health and Personal Care’ section of this report. On discussion with the Registered Manager she explained that up to five domestic staff are employed and there can be up to three staff members on duty for cleaning. Recently however, staff have been off sick and this may have caused a perception of there being a shortage of staff. The cleanliness of the home is something that the Registered Manager will continue to monitor. Bedrooms seen were clean and tidy. Bedroom doors were locked during the day as a result of some of the residents wandering into other residents’ rooms. Each of the bedrooms had a photograph of the resident and a named Nurse and a space for the key worker. This is a new development that the Registered Manager will continue with. This will help residents and their relatives to identify the main staff who regularly provide care. It is also useful for new or temporary staff, as the photographs will assist them to identify the resident during the night. Crown Hills Nursing Home DS0000001897.V335952.R01.S.doc Version 5.2 Page 18 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 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are well trained and supported however, they must consider the implication of their actions before they carry them out. In this way the residents will be fully protected and not put at risk. EVIDENCE: The previous deputy manager has now attained her managers’ award and has been appointed the Registered Manager at Crown Hills and has been approved by the Commission of Social Care Inspection (CSCI). A new deputy has been appointed. The skill mix of the staff remains good at the home with further and continual improvement in the area of training. However on inspection, it was noticed that moving and handling training should be given further consideration by the care staff in their daily practice. They must remember to consider the safety and well being of residents when they pull the armchairs with wheels from one place to another with a resident in them. They must also consider their own health needs. Staff records were checked and any anomalies discussed at inspection. Comments from residents included ‘ Staff are very caring’
Crown Hills Nursing Home DS0000001897.V335952.R01.S.doc Version 5.2 Page 19 ‘ If ever they are slow to respond to my bell, I know that it is only because they have so many to look after and most of the other residents need more help than I do’. ‘ ‘I have no complaints to make about the care staff who are kind, helpful and very good in every way’. Relatives’ comments ‘I do not know what goes on behind the scenes but the staff are lovely to all the residents very caring. I notice by the notice board that they receive a lot of training and everyone communicates any problems they have with my relative to me.’ ‘I am very pleased with the way that the staff have treated my relative since being at the home.’ ‘From my relatives point of view the care home takes care of all my relatives needs extremely well.’ ‘I think the staff at Crown Hills are very good’ Crown Hills Nursing Home DS0000001897.V335952.R01.S.doc Version 5.2 Page 20 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, 31, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Registered Provider ensures that the home is being run in the best interests of residents. EVIDENCE: The Registered Manager was able to provide evidence of good financial practice relating to residents living at the home. Residents’ personal finances are managed by residents who are able, by their relatives or by the Registered Manager. Records relating to Health and Safety are kept up to date. Crown Hills Nursing Home DS0000001897.V335952.R01.S.doc Version 5.2 Page 21 A sample of the home’s quality assurance questionnaire of the service done in March 2007 was seen. Comments from different medical staff included ‘A member of staff will pass on the history of the presenting problems.’ ‘A medical room or the clients bedroom is offered for private consultations’. ‘Yes staff are always polite and helpful, never had any complaints from the partners.’ ‘The management team are keen to take on the information that we give them’. ‘Despite the obvious pressures in this busy home, the home does appear to be in good order.’ Crown Hills Nursing Home DS0000001897.V335952.R01.S.doc Version 5.2 Page 22 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 1 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Crown Hills Nursing Home DS0000001897.V335952.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? None 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 13 (5) Requirement The Registered Manager must ensure that a review of current practice is made to ensure that when residents are being transported it is done in the safest possible manner avoiding any potential of risk or harm to any resident. The Registered Manger must seek advice on the correct use of equipment with particular regard to the armchairs with wheels on them. The Registered Manager must ensure that public places are kept in a clean and safe manner. Bins should be kept closed and the contents of bedpans discarded of appropriately to avoid the possibility of cross infection. The Registered Manager must be able to to demonstrate that the current staffing levels can meet the changing needs of the residents. Timescale for action 31/07/07 2 OP22 13 (b) 31/08/07 3 OP26 13 (4) (c) 31/07/07 4 OP27 14 (2) (b) 31/07/07 Crown Hills Nursing Home DS0000001897.V335952.R01.S.doc Version 5.2 Page 24 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. Refer to Standard OP22 OP15 Good Practice Recommendations To review moving and handling procedures as operated in the home. To consider employing staff at critical times of the day when more help may be required. Crown Hills Nursing Home DS0000001897.V335952.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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
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