Inspection on 20/10/06 for Crabwall Hall

This inspection was carried out on 20th October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Crabwall Hall 06/03/06

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Crabwall Hall Parkgate Road Mollington Chester Cheshire CH1 6NE Lead Inspector Paul Ramsden Key Unannounced Inspection 20th and 26th October 2006 10:25 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 Crabwall Hall DS0000065424.V310653.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. Crabwall Hall DS0000065424.V310653.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Crabwall Hall Address Parkgate Road Mollington Chester Cheshire CH1 6NE 01244 851202 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) Avery Healthcare Limited Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (32) of places Crabwall Hall DS0000065424.V310653.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for a maximum of 32 service users in the category OP (Old age, not falling within any other category) 6th March 2006 Date of last inspection Brief Description of the Service: Crabwall Hall is a two-storey care home owned by Avery Healthcare Limited, a privately owned company. It stands in extensive grounds and enjoys a rural setting off the A540 in the village of Mollington. It is approximately 2 miles from Chester city centre. There are adequate car parking facilities available. Residents are accommodated on both floors. Access between floors is via the shaft lift or the stairs. Residents accommodation currently consists of 32 single bedrooms all of which have en-suite facilities, telephone sockets, call points and an internal telephone. The majority of bedrooms meet or exceed the room size standards. There is a large lounge/dining room and separate lounge on the ground floor, and a library/study on the first- floor. Additionally, there is another small sitting area by the lift on the first-floor. Communal toilet/bathroom facilities comprise 5 toilets, 4 bathrooms, one shower-room and a hairdressing salon. The home has extensive gardens and grounds that are fully accessible to residents. There is also a large patio area adjacent to, and accessible from, the home’s ground-floor lounge and dining areas. The current fee range for the home is £343.34 - £525 per week. Crabwall Hall DS0000065424.V310653.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced visit took place on the 20 October 2006 and lasted 7 hours. Paul Ramsden, Inspector, undertook the visit. All of the key standards for older people were looked at. A meeting with the home manager to feedback on the findings of the visit took place on the 26 October 2006. This visit was just one part of the inspection. Before the visit the home manager was also asked to complete a questionnaire to provide up to date information about services in the home. Questionnaires were also made available for residents and families to find out their views. Other information received since the last key inspection was also reviewed. Eleven resident and three relative forms have been returned. During the visit various records and the premises were looked at. A number of residents, two visiting relatives and the staff members on duty were spoken with and they gave their views about the home and the service provided. A new 12-bedded extension is currently being built, due to its location and access arrangements from the current building two of the existing bedrooms will be lost when the work is completed. All of the new rooms will have their own bathroom and storage space. Additional lounge space is also being built within the extension. What the service does well: What has improved since the last inspection? Crabwall Hall DS0000065424.V310653.R01.S.doc Version 5.2 Page 6 A new company care planning system has been implemented; this is an improvement on the previous system, the plans seen during the visit provided staff members with the necessary information for them to look after a person’s needs. The new manager and administrator have and are continuing to do so improving the administrative systems within the home. The manager has undertaken a staff-training audit; any identified needs are in the process of being addressed. This will help to ensure that residents are safe from harm and that they are protected by robust procedures. 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. Crabwall Hall DS0000065424.V310653.R01.S.doc Version 5.2 Page 7 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 Crabwall Hall DS0000065424.V310653.R01.S.doc Version 5.2 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 The quality rating for this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information and opportunities to visit before moving in are available and residents are assessed before moving in to ensure that their needs can be met at the home. EVIDENCE: The home provides a range of information to residents; these include the statement of purpose, the service user guide and the procedures to be followed in the event of a complaint. As part of the inspection process the care files of three people living at the home were looked at. Pre-admission assessments demonstrating that a resident’s individual needs were being assessed in an accurate and consistent way had been carried out. The home manager or senior staff members carry out the assessments in order to assess specific individual needs before a service is provided. Where applicable copies of information provided by the placing authority were also seen on the files. Residents, relatives and other healthcare professionals are involved with the pre-admission assessment. Evidence of this participation was seen during the visit. The visiting relatives Crabwall Hall DS0000065424.V310653.R01.S.doc Version 5.2 Page 9 also confirmed this. Since the previous inspection visit new Avery Healthcare assessment documentation has been introduced Intermediate care is not provided at Crabwall Hall. Crabwall Hall DS0000065424.V310653.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 The quality rating for this outcome area is good. This judgement has been made using available evidence including a visit to this service. The clients care plans seen provided sufficient information for staff members to be able to take appropriate action to meet an individuals needs. EVIDENCE: Since the previous inspection visit a considerable amount of work has been undertaken on the client files and the new Avery Healthcare care-planning system has been fully implemented. The care plans seen as part of the case tracking process provided staff members with the necessary information for them to look after a person’s needs. The health and well being of residents was being monitored and an appropriate record of development and actions taken was being kept. Care plans were being reviewed and where necessary re-written on a regular basis. Residents or their families/advocates are involved in the care planning process. Risk assessments, including falls are undertaken; those seen as part of the case tracking process had been completed appropriately. Crabwall Hall DS0000065424.V310653.R01.S.doc Version 5.2 Page 11 Staff members spoken to have a good understanding of the people they were supporting and were able to meet their diverse needs. The changing needs of individuals are discussed as and when required; the inspector was able to see this in practice during the visit. The staff members at the care home continually monitor the residents’ health needs and there was evidence to show that they were receiving appropriate support from health care professionals. This included GPs, community nurses, optician, dentist and chiropodist. All personal care is carried out in the privacy of a resident’s bedroom or one of the bathrooms. Residents spoken with confirmed that they had been able to express their opinions and wishes about their daily routines and that staff were flexible. Staff members were observed interacting with residents in an appropriate, dignified and respectful way; they were seen to address residents appropriately according to their recorded wishes. Residents had use of a telephone in private and personal mail was delivered unopened. Avery Healthcare has a written policy on the receipt, administration [including self-administration] safekeeping, handling, recording and disposal of medication within its homes. Medication was appropriately stored and since the previous inspection a new controlled drugs cabinet has been fitted to the office wall. No obvious issues concerning the medication system were seen during the visit. Crabwall Hall DS0000065424.V310653.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Although there are some issues regarding the quality of the food currently being supplied to the home the residents were positive about the home and the support they received. EVIDENCE: Residents were able to move around freely within the home and a choice of sitting areas was available. They confirmed that routines within the home were flexible and that they were able to make choices in many areas of daily living; for example times of rising and retiring, participation in planned activities and where to spend time and with whom. Staff members were seen to knock on doors and to await permission before entering residents’ bedrooms. The residents made a number of positive comments during the visit; these included, “staff are very good”. A monthly programme of activities is provided and all of the residents are given their own personal copy. The one seen during the inspection listed on a daily basis what events or activities had been arranged for the month. Residents confirmed that various religious denominations conduct services in the home and they are free to attend if they wish to do so. A beauty and massage therapist visits the home on a regular basis, and residents are able to purchase various treatments. There is also a visiting hairdresser. Newspapers Crabwall Hall DS0000065424.V310653.R01.S.doc Version 5.2 Page 13 and magazines are delivered daily to order. Links with the local community are maintained and people are able to come and go from the building. During the inspection visit a number of the residents spoken with said that they thought the quality of the meals, including the meat, provided to them had deteriorated. This view was also expressed strongly in the majority of the survey forms received. One of the residents said, “If the food is not of a good enough quality to cook why is it sent out”. The manager said that she was fully aware that some food had not been up to the previous high standards and was trying to address the problem. Residents and staff members said that the company was now using a central supplier for some of the food provided, this was the cause of the problem and although the supplier had met the residents the issues remained. The manager explained that if necessary she was prepared to revert back to the previous suppliers in order to address the problem. The residents have been kept fully informed about the action she is taking. As this issue is in hand a requirement regarding the food provided at the home has not been made. Meals can be taken in the dining room or in the privacy of residents’ own rooms. Although there is an issue with the quality of food supplied the menus seen had the flexibility to meet individual needs and choices. Residents are asked what they would like to eat. There was a choice of two main courses at lunchtime with a sweet, and soup with a selection of sandwiches or a hot snack at teatime. Residents had access to a small kitchen and were able to prepare their own drinks or snacks if they wished. Special diets can be prepared where necessary. Crabwall Hall DS0000065424.V310653.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 The quality rating for this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to complain and action is taken to respond to their concerns. Adult protection training for staff is available to ensure the continued safety of residents. EVIDENCE: There is a written complaints procedure for the home. This is also included in the Statement of Purpose and Service User Guide. Residents were aware of their right to complain if they were unhappy with any aspect of the service they received at Crabwall Hall and said that they would inform the home manager or another senior employee of any concerns or complaints. The pre-inspection questionnaire states that two complaints have been received by the home in the previous 12 months. These were all dealt with in the agreed timescale. The home has an Adult Protection procedure (including Whistle Blowing), which complies with the Public Disclosure Act 1998 and the Department of Health Guidance ‘No Secrets’. The manager was able to demonstrate that she is fully aware of the appropriate procedures to follow should an incident arise. Some of the staff members have received training in this area; more are to attend in the immediate future. Staff members spoken with confirmed that they had a good understanding of the potential indicators of abuse and what to do if they became aware of any allegations. Crabwall Hall DS0000065424.V310653.R01.S.doc Version 5.2 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 23, 24 and 26 The quality rating for this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The accommodation has extremely good facilities so that residents live in a safe, clean and comfortable home. Standards of hygiene and cleanliness are very high. EVIDENCE: A tour of the premises was undertaken; this included communal areas and a number of bedrooms. The home both externally and internally is maintained to a very good standard and standards of décor, furnishings and fittings were commendably high throughout the home, as were standards of hygiene and cleanliness. All bedrooms had en suite facilities. There were seven additional toilets, four bathrooms and two shower rooms. Three of the bathrooms were assisted and both showers had wheelchair access. All bedrooms were equipped with a call system, remote controlled television, BT external telephone socket and also an internal telephone for talking to staff. There were also grab rails and other aids provided as necessary. Bedrooms seen Crabwall Hall DS0000065424.V310653.R01.S.doc Version 5.2 Page 16 during the inspection were personalised, comfortable, well-furnished and contained items of furniture belonging to residents’. A new 12-bedded extension is currently being built, due to its location and access arrangements from the current building two of the existing bedrooms will be lost when the work is complete. All of the new rooms will have their own bathroom and storage space. Additional lounge space is also being built within the extension. Some of the residents spoken with during the visit said that the work was causing some disruption. A resident has written on a survey form, “will be very glad when the building work is completed”. The laundry is appropriately equipped and good systems are in place for the care of peoples’ clothes. Crabwall Hall DS0000065424.V310653.R01.S.doc Version 5.2 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff members work positively with residents, families and visiting professionals to improve the quality of life of people living in the home. A robust staff recruitment process is in place in order to protect residents from possible harm. EVIDENCE: Staff on duty and rotas seen demonstrated that staffing levels and the skill mix of staff was adequate to meet the needs of the residents within the home. Staff members were cheerful, friendly and were seen to be a close and supportive team. The residents spoken with during the visit were complimentary about their attitude and competence. One resident said, “staff are very good, you cannot fault them”. According to the information provided in the pre-inspection questionnaire 65 of senior and care staff members have either achieved an NVQ qualification or are undertaking one. . The files for two recently appointed members of staff seen contained all of the required information and a robust recruitment procedure was in place for the protection of residents. Prospective staff members are checked against the POVA list before employment commences and CRB disclosures are obtained. All applications are subject to equal opportunities monitoring. Crabwall Hall DS0000065424.V310653.R01.S.doc Version 5.2 Page 18 Copies of induction records were seen on the day of the visit. Staff members also confirmed that this had happened and that they had worked as a supernumerary staff member when they had commenced employment. Avery Healthcare provides a range of training courses; these include, safer manual handling, first aid, adult protection and health and safety. The home manager has undertaken an audit of staff training; any identified needs are in the process of being addressed. Staff meetings are being held on a regular basis. Crabwall Hall DS0000065424.V310653.R01.S.doc Version 5.2 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 The quality rating for this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are appropriate procedures in place to make sure that residents are safe from possible harm. EVIDENCE: The home has an experienced and competent manager who is undergoing registration with the Commission for Social Care Inspection. She has attended courses/training in order to fulfil her management responsibilities and was able to demonstrate an awareness of the diverse needs of the resident group and how to manage the staff team. The residents and staff members that commented said that she was approachable and supportive. Crabwall Hall DS0000065424.V310653.R01.S.doc Version 5.2 Page 20 Attempts are being made to seek the opinions of residents about the quality of service provided by the home. Quality assurance surveys to ascertain whether residents and families are happy with the standards of care being provided is undertaken. Copies of the results will be made available. This is an on-going process. Most residents managed their own financial affairs, but the home held cash for some of the residents who had requested this service. Each resident’s money was kept in a separate compartment of a box, which was locked away. These monies were inspected; those checked had correct balances and were being well managed. The systems for the recording of any monies or valuables held were good. All staff members are supervised on a continuous basis; this helps to ensure that the high quality of care provided to residents is maintained. The maintenance records demonstrated that the appropriate service contracts were in place. These included the passenger lifts, hoists and fire alarm system. The fire safety record was seen during the visit. This showed that the fire alarm and emergency lighting systems were being tested at the intervals recommended by Cheshire Fire Service. Fire drills and staff training were ongoing. These systems ensure that residents are protected form possible harm. Monthly visits to comply with regulation 26 of the Care Homes Regulations are being carried out. Crabwall Hall DS0000065424.V310653.R01.S.doc Version 5.2 Page 21 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 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 4 3 X 3 4 X 3 STAFFING Standard No Score 27 3 28 3 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 Crabwall Hall DS0000065424.V310653.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Crabwall Hall DS0000065424.V310653.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT National Enquiry Line: 0845 015 0120 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. 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