Inspection on 21/03/07 for Crawfords Walk Nursing Home

This inspection was carried out on 21st March 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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

Crawfords Walk Nursing Home 04/01/06

Crawfords Walk Nursing Home 26/08/05

Crawfords Walk Nursing Home 08/02/05

Crawfords Walk Nursing Home 23/09/04

Crawfords Walk Nursing Home 16/01/04

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Sunny Bank (P.R.S.) Ltd

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

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Langrigg House

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

CARE HOMES FOR OLDER PEOPLE Crawfords Walk Nursing Home Lightfoot Street Hoole Chester Cheshire CH2 3AD Lead Inspector Anthony Cliffe Unannounced Inspection 08:00 21 and 22 March 2007 st nd 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 Crawfords Walk Nursing Home DS0000018716.V329964.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. Crawfords Walk Nursing Home DS0000018716.V329964.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Crawfords Walk Nursing Home Address Lightfoot Street Hoole Chester Cheshire CH2 3AD 01244 318567 01244 344326 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) www.bupa.com BUPA Care Homes (CFHCare) Limited Mrs Kathleen Margaret Webber Care Home 120 Category(ies) of Dementia (6), Dementia - over 65 years of age registration, with number (60), Mental disorder, excluding learning of places disability or dementia (1), Mental Disorder, excluding learning disability or dementia - over 65 years of age (30), Old age, not falling within any other category (30), Terminally ill over 65 years of age (1) Crawfords Walk Nursing Home DS0000018716.V329964.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for a maximum of 120 service users to include:* Up to 60 service users in the category of DE(E) (Dementia over the age of 65 years) * Up to 7 service users in the category of DE (Dementia under the age of 65 years) * Up to 30 service users in the category of MD(E) (Mental disorder excluding learning disability or dementia over the age of 65 years) * Up to 30 service users in the category of OP (Old age, not falling within any other category) * One service user in the category of TI(E) (Terminally ill over 65 years of age) * One service user in the category of MD (Mental disorder excluding learning disability or dementia under the age of 65) No more than 60 service users in the category DE(E) (Dementia over the age of 65 years) in receipt of nursing care may be accommodated on Watergate House and Eastgate House. Within the total number of 60 service users one named service user may be accommodated in Northgate House Within the maximum of 60 service users no more than 7 service users in the category DE (Dementia) may be accommodated. Six service users may be accommodated on either Watergate House and Eastgate House and 1 named service user on Northgate House. No more than 30 service users in the category of MD(E) (Mental disorder excluding learning disability or dementia over the age of 65 years) may be accommodated in Northgate House. Within the total number of 30 service users, one named service user may be accommodated in the category of MD (Mental disorder excluding learning disability or dementia under the age of 65). Within the total number 30 service users, one named service user in the category of MD(E) (Mental disorder excluding learning disability or dementia over the age of 65 years) may be accommodated in Watergate House No more than 30 service users in the category of OP (Old age, not falling within any other category) may be accommodated on Bridge House Within the maximum of 30 service users, one service user in the category of TI(E) (Terminal illness over 65 years of age) may be accommodated on Bridge House 2. 3. 4. 5. 6. Crawfords Walk Nursing Home DS0000018716.V329964.R01.S.doc Version 5.2 Page 5 Date of last inspection 4th January 2006 Brief Description of the Service: Crawfords Walk Nursing Home comprises five purpose-built bungalows set in landscaped gardens in the Hoole area of Chester. The home is owned and operated by BUPA Care Homes. Bridgegate House provides care for 30 frail older people; Eastgate House and Watergate House each provide care for 30 people with dementia, and Northgate House provides care for 30 people with enduring mental illness. The fifth building houses the kitchen, laundry, administration and staff facilities. The four residential units are all single storey and all residents have single bedrooms. There are no en-suite facilities. Fees range from £390 to £640 per week. Crawfords Walk Nursing Home DS0000018716.V329964.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit took place on the 21st and 22nd March 2007 and lasted 15 hours. A Regulatory Inspector carried out the visit. This visit was just one part of the inspection. Other information received was also looked at. Before the visit the home manager was also asked to complete a questionnaire to provide up to date information about services provided. Questionnaires were provided for residents, families, and health and social care professionals to find out their views. During the visit various records and the premises were looked at. A number of residents and staff were also spoken with and they gave their views about the service. What the service does well: Records needed to be kept at Crawford’s Walk were completed. The quality of catering is good and a good choice and variety of food was available for residents. The buildings were well maintained providing a clean environment and the grounds were well tended. All areas were found to be clean with no unpleasant odours. Equipment is provided to assist residents and changes to facilities made to benefit their independence. Residents all have single bedrooms, which they are able to personalise with their own belongings. Crawford’s Walk has a strong management team, which provides leadership to the large staff team. A good skill mix of staff is provided. Staff training and development is progressive and over 50 of care staff had an NVQ level 2 qualification. Staff records were well maintained and demonstrated employment checks are carried out during staff recruitment. that thorough Personal money held in safekeeping for residents was handled appropriately. The health and safety of staff and residents were safeguarded. What has improved since the last inspection? Crawfords Walk Nursing Home DS0000018716.V329964.R01.S.doc Version 5.2 Page 7 The management of admissions and transfers within Crawford’s Walk had improved to ensure that residents were not admitted outside of the categories of registration. The appointment of a clinical services manager had enhanced the management team and demonstrated that the management team take appropriate action to protect residents. CSCI was informed of all events, which affect the needs of residents. The standard of record keeping had improved and a new system developed by BUPA care services was to be introduced. The recording of medicines had improved and a thorough process of quality assurance identifies errors and the action taken to reduce them. Staff continued to be supported to achieve NVQ qualification. A regular programme of supervision was in progress. 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. Crawfords Walk Nursing Home DS0000018716.V329964.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 Crawfords Walk Nursing Home DS0000018716.V329964.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): 1 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information is available for residents and their representatives so they can make a choice about where they live. Residents’ needs are assessed prior to moving in so appropriate care can be provided to them. EVIDENCE: Crawford’s Walk accommodates mainly people from the Chester area and is welcoming to anyone from outside the area or with a disability, different ethnic or cultural needs or sexual orientation. Residents or their relatives were provided with a copy of the service users’ guide and statement of purpose on request and copies of this and the most recent inspection report were available in each unit. Service user guides were not put in each bedroom. This contained Details of the facilities and services provided to residents. Information could be provided in different formats on request to head office. Survey’s returned from residents prior to the site visit confirmed that they had received information on Crawford’s Walk’s that helped them or their relative to choose to live there. Fifty per cent of surveys said Crawfords Walk Nursing Home DS0000018716.V329964.R01.S.doc Version 5.2 Page 10 residents had information sent to them prior to choosing Crawford’s Walk. A resident’s survey recorded ‘we searched a lot of information on care homes and yours turned out tops in every aspect’. Other residents’ surveys recorded that residents had been sent leaflets and visited Crawford’s Walk before making decisions. Relatives surveys returned prior to the site visit were complimentary about the choices they made on behalf of their relative. A comment card recorded ‘It is a comfort for me to know that I made the right decision in choosing this home for my mother as she is cared for so well. I cannot express my gratitude enough’. Another survey said ‘I have been made to feel welcome and enjoy friendly relationships with staff’. Four files were examined of residents who moved into Crawford’s Walk. The residents had met with the manager or registered nurse to discuss their care prior to moving in. Information was gathered and this was recorded. This included information on their physical and mental health. Copies of these documents were on residents’ files. Copies of social workers assessments and care plans were on file with information from the NHS hospital the residents were staying at. Crawfords Walk Nursing Home DS0000018716.V329964.R01.S.doc Version 5.2 Page 11 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 excellent. This judgement has been made using available evidence including a visit to this service. Detailed records of care, liaison with health and social care professionals and good medicine management ensures residents’ health and welfare needs are met. EVIDENCE: The care files of four residents were examined. Each care plan had a pre admission assessment and an assessment by the social worker or nurse assessor. From looking at care plans, observing staff working practices and talking with residents, staff, visitors and a visiting health professional the health needs of residents were met. There were good examples of care plans in place that monitored residents’ health. Care plans were individualised to each resident. The plans related to medical conditions and gave guidance to staff. A good example of this was a resident who moved in had lost weight. After moving in a review of her care was held with her family who expressed their pleasure at the high standard of care and noticed she had improved and gained weight. They said their mother had settles in well and was eating and drinking better. The residents had been brought to Crawford’s Walk with a wound to her leg. Care plans were in place Crawfords Walk Nursing Home DS0000018716.V329964.R01.S.doc Version 5.2 Page 12 to care and monitor this. Staff had taken photographs to show how the wound was healing and recorded this regularly. Advice form the tissue viability specialist was sought. On moving in the resident had been referred to the continence advisor as problems were known before she moved in. Further advice was sought after other problems occurred and aids provided to promote the resident’s dignity provided. The care plane were reviewed regularly and showed some weight loss. Staff identified that the resident’s body mass needed taking for referral to the dietician. Another resident had been admitted with severe mental health needs. The care plans of the resident contained information on how to manage his mental health and recorded an improvement in mental health. Care plans were in place to monitor eating and drinking, risk of developing pressure ulcers and assistance with personal care. Good practice in routinely monitoring residents physical health were in place and residents’ blood pressure and weight were monitored. Improvements in the physical and mental health of residents were recorded. A registered nurse said that “We could improve on recording outcomes for people with mental health problems by monitoring their moods and the negative affects that their mental health symptoms have upon them. There are tools to monitor depression and psychotic symptoms and using these would help us understand their mental health problems better”. BUPA care homes have agreed a care plan format with CSCI called QUEST. The manager for Crawford’s walk had training on how to complete this and staff training was planned for April 2007. The draft documents were available and looked comprehensive in identifying residents’ needs and guiding staff in the care of residents’ health and welfare using a ‘person centred’ approach. A unit manager said she had looked at the information on QUEST and it would “ staff will be able to record a better standard of information”. Medicines management and administration was examined. No errors were noted on medicine administration records. A monitored dosage system was used throughout the care home. Stocks of medicines were replaced weekly using the monitored dosage system making errors easier to identify. Receipts of weekly supplied medicines were recorded. Where medicines were supplied in original packages and not supplied each month the stocks of these were transferred from one month to the next so staff knew when to reorder medicines. Records were maintained for the destruction of medicines. Controlled drugs records were checked on each unit and no errors found. The deputy manager audited medicines as part of the quality assurance system. Prior to the site visit the manager informed CSCI of an incident of poor practice by a registered nurse, which had been dealt with under the disciplinary procedure. The outcome of this was the registered nurse was dismissed and referred to the Nursing and Midwifery Council. Crawfords Walk Nursing Home DS0000018716.V329964.R01.S.doc Version 5.2 Page 13 Nineteen residents’ questionnaires were returned prior to the site visit. Thirteen residents said they usually or always received the care and support they needed and two said they cared for themselves. Thirteen said staff were always available and acted upon what they said. Fifteen residents said they usually or always received the medical care they needed. Relatives/advocates questionnaires recorded ‘the choice of a resident on a dementia care unit is limited but staff do everything possible to make sure residents feel at home. They treat residents individually; they know their likes and dislikes. The home is well run and organised the staff work well as a team’. Another said, ‘ they care and respond to my mother’s needs and her family in a non judgemental way, leaving us confident she’s in the best place to fulfil her needs’. During the site visit a new method on gathering the experiences of residents was used. A small group of residents who could no longer used words or communicate their needs were watched for a period of two hours. Information on how they related to one another, staff, pets and their environment were recorded. This included staff interaction and practice. The findings of the observation were that there were positive interactions between residents, residents and staff and social interactions. One resident was sleeping for the majority of the two hours but examination of their care records recorded underlying health and mental health problems as the reason for this. Staff practice was very positive but there were occasions when staff did not uphold the dignity of residents. The incidents were discussed with the unit manager and registered manager. The registered manager said she would speak to the manager of the unit and staff concerned given the level of staff training provided on the care of residents. The registered manager demonstrated through induction and training records that staff had completed BUPA care homes ‘Personal Best’ training, which asked staff to think about how they cared for residents and provide examples of evidence of how they provided positive, care to them. The registered manager said this would be addressed. Crawfords Walk Nursing Home DS0000018716.V329964.R01.S.doc Version 5.2 Page 14 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 good. This judgement has been made using available evidence including a visit to this service. Residents are supported in making choices about their lifestyle but the provision of facilities to support their independence could improve so they have more control over their lives. EVIDENCE: Crawford’s Walk employs two activities coordinators one of which was on sick leave. The registered manager provided information that an activities organiser’s post had been advertised in the Chester Chronicle. It had dedicated facilities for the provision of activities and activities took place within the individual units. Details of the activities available were displayed on the units. Residents said there were a variety of planned activities available to them. Social activity care plans were in place and life histories completed for residents by their families. Residents talked about their daily lives and choices they made. Activities taking place during the site visit included an exercise group, quiz, mobile library, trips out shopping, lunch and hairdressing. Some activities were available on request. There were details of a regular church service and residents were offered the choice of communion during the site visit. Crawfords Walk Nursing Home DS0000018716.V329964.R01.S.doc Version 5.2 Page 15 The activities coordinator confirmed that he had increased his hours to seven and a half hours a day with the other activities coordinator being long term sick. He was working in the four units and getting to know the other residents. He talked about the individual activities that he did with residents. He said he regularly took a resident swimming and another to play putting a golf ball. There were details of forthcoming events with a spring fair and Grand National sweepstake. Nineteen residents’ surveys were returned prior to the site visit. Two of these said activities were always arranged and eight said they were usually arranged. Eight said activities were sometimes arranged and two said they were never arranged. Daily living routines, activities and choice were discussed with residents. A resident said, “I have a lot of responsibility, I help clean up and look after some of the other residents by arranging the menu. I collect residents’ choices for meals and write the daily menu on the board. If I don’t like what’s on the menu they will listen. You can order a hot supper now, which we couldn’t before. The kitchen sends up plenty of food so the residents that change their mind can do so. I go out every day to get my newspaper and look around the shops. I have my own routine. I look after my own bedroom and clean it. I would like to do my own cooking and laundry but we don’t have the facilities. I get my own money when I want and go out to the pub on occasion”. Another resident said, “I moved in here two months ago. I have my own bedroom and own furniture. The food is too fussy sometimes, too much choice, I’m a meat and two vegetables man. I can have an English breakfast if I want and hot supper but haven’t troubled staff to order one. I’m younger than most people in here so feel out of place. I would like a canteen or occupational room where you can meet other people. Otherwise I spend most of the day in the smoke room. I would like to do more things with my hands. The staff are great and leave me be but ask me to join in things. I can go out when I want”. Relatives and advocates questionnaires received prior to the site visit said visitors were always welcomed and that staff were very good at communicating with them about their relative or friend. Breakfast and lunch were seen being served. Residents had the choice of a cooked breakfast or lighter option. Residents were able to choose their meals. Menus were on display to inform residents of the alternative choice. Fifteen out of nineteen residents surveys returned prior to the site visit said residents always or usually enjoyed the food provided at Crawford’s Walk. Crawfords Walk Nursing Home DS0000018716.V329964.R01.S.doc Version 5.2 Page 16 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 excellent. This judgement has been made using available evidence including a visit to this service. Complaints and concerns are acted on to demonstrate they are taken seriously. An informed staff group and manager protect residents from abuse. EVIDENCE: There was one recorded complaint since the last site visit. The complainant contacted the CSCI prior to the site visit regarding a complaint made. The complainant was advised to discuss further the complaint that had been made. The complainant contacted the CSCI to confirm satisfaction with how the complaint was being dealt with and had been taken seriously and improvements noted. Nineteen residents’ surveys were returned prior to the site visit and eighteen recorded that residents knew how to make a complaint or who to talk to if they had concerns. The manager had made two referrals to the local council under the protection of vulnerable adults. Crawford’s Walk cooperated with the local council and suspended staff. The local council asked the registered manager to investigate the concerns raised. The local council were satisfied that the registered manager had completed a full investigation and no further action was taken. A staff member was supervised for a period of three months following an investigation. A staff member was dismissed and referred to the Nursing and Midwifery Council for not following the policy and procedure on medicine administration. Another staff member was dismissed and five disciplined for not following procedures in wound management. Crawfords Walk Nursing Home DS0000018716.V329964.R01.S.doc Version 5.2 Page 17 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 excellent. This judgement has been made using available evidence including a visit to this service. Residents live in a safe, comfortable and well maintained environment, which is equipped to meet their needs. EVIDENCE: The home is set in its own grounds and each of the residential units has its own enclosed garden. There is a sensory garden, which was awarded a gold award by BUPA care services. The grounds were very well maintained and pleasant areas had been provided for residents to sit and walk in. Eastgate House was clean and tidy. All areas were appropriately decorated and furnished and were maintained in good condition. A shower room had been provided from a former bathroom. This had disabled access and equipment. A new carpet and wood effect flooring had been provided in the dining area, and smoking room created. Crawfords Walk Nursing Home DS0000018716.V329964.R01.S.doc Version 5.2 Page 18 Bridgegate House the replacement of bedrooms flooring had commenced with wood affect no slip flooring provided. The building was nicely decorated and well maintained. A Patio decked area had been created off the main lounge and enclosed garden area made with a new fence. Large earthenware potted plants and patio furniture had been added. Building was to commence on extensions to Northgate House to provide an additional ten bedrooms with en-suite facilities and Eastgate House seven bedrooms with en-suite facilities. Local residents, residents and their families had been consulted about this and a meeting to discuss how the arrangements for any disruption to residents accommodated and to discuss health and safety arrangements was planned for 23rd March. The home has a maintenance manager and two part time members of staff who assist him and who maintain the gardens. Crawfords Walk Nursing Home DS0000018716.V329964.R01.S.doc Version 5.2 Page 19 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 good. This judgement has been made using available evidence including a visit to this service. The numbers and skill mix of staff are adequate to meet residents’ needs. Staff recruitment ensures that residents are protected. The induction and training programme provides a skilled workforce that protects residents’ welfare. EVIDENCE: Staffing levels were appropriate and the manager confirmed that staffing numbers were determined by the dependency of residents and could change. Each unit had an appropriate mix of qualified and unqualified staff. The unit manager on each unit was experienced in the care of the residents for that unit. The pre inspection questionnaire returned prior to the site visit recorded that twenty-one of the forty-one care staff employed had an NVQ level 2 qualification. Four staff had commenced employment and had been supervised through an induction programme, which included training on the protection of vulnerable adults. The records of these staff were examined. All contained appropriate identification documentation and completed POVA First and Criminal Record Bureau disclosures. All files had two written references. Files contained copies of the induction programme. The personal identification numbers of registered nurses were checked with the Nursing and Midwifery Council. Staff completed Crawfords Walk Nursing Home DS0000018716.V329964.R01.S.doc Version 5.2 Page 20 the induction programme supervised by the manager, deputy or a registered nurse dependent upon the grade of staff. Induction programmes ran each month and included familiarisation with policies and procedures. Staff received a handbook which contained the companies adult abuse policy and the General Social Care Council code of practice during induction. Staff had a post induction supervision session or appraisal. Staff files contained evidence that staff had undertaken statutory training. Training had been completed in Personal Best, the BUPA customer care training. This was completed by a supervisor and contained examples of staff thinking about how they did their job and giving examples of working with residents to demonstrate good practice. Recently registered nurses employed had been assigned a supervisor to monitor post registration practice. Supervision of staff was ongoing and records of this kept on their personnel files. A recently appointed registered nurse said of the standard of support “ The manager is very supportive and training ongoing. Training is mostly distance learning workbooks with a reflective element. You complete one for every training set. I’m responsible for making sure care staff have training materials”. Training calendars were on each unit and recorded planned and completed training for health and safety, food hygiene, fire training, dementia care, moving and handling and infection control. Crawfords Walk Nursing Home DS0000018716.V329964.R01.S.doc Version 5.2 Page 21 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 and 38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Robust quality assurance systems, financial procedures and maintenance of the building and equipment safeguards residents and ensure they are safe. EVIDENCE: The home manager has been in post for eight years. She is a registered mental nurse and has the registered manager award. A deputy manager or clinical services manager supported her and they form a strong management team supported by a full time administrator. An area manager carries out visits required by regulation 26 of the Care Homes Regulations. Crawfords Walk Nursing Home DS0000018716.V329964.R01.S.doc Version 5.2 Page 22 The clinical services manager is responsible for audits that compliment the quality assurance system. Each month she completed an audit of 25 care plans and 28 medicine administration records of individual residents randomly across the site. Copies of these were on residents’ files. The audits identify errors in the writing and recording of both care plans and medicine administration records. This sets out timescales for errors to be rectified and clearly identifies who is responsible for ensuring errors were rectified. The clinical services manager clarified that if timescales were not met then a decision if disciplinary action should be taken would be considered. A part of the quality assurance system there were audits of accidents, pressure ulcers, equipment, water temperatures each time residents were bathed, maintenance and fire system each month. The regional manager then audits the care home each month using the original data gathered by the manager. Staff had completed a ‘personal best’ initiative, to improve the quality of the service provided. The residential units hold their own staff meetings. Heads of department meetings were held monthly and include catering and housekeeping. A resident customer satisfaction survey for Crawford’s Walk was completed in 2006 and results released. Crawford’s Walk scored well, particularly in questions about care, activities provision and choice, variety and choice of menu and personal choices. Overall Crawford’s Walk reached an excellent/very good score rate and increased its rating by 14 on 2005. The home has a full time administrator and a part time receptionist. The administrator is a corporate appointee for 14 residents, mainly living on Northgate House, under long standing arrangements. Some of the other residents have personal spending money in safekeeping. Residents’ money is not kept on the premises but paid into a bank account. All monies are held in one bank account in which each person has a separate account that yields its own interest. The administrator draws out personal spending money weekly. Records, both written and electronic, were kept and were examined. Crawford’s walk was involved in the research of ‘Pictures to Share’ a registered charity which developed a set of books around specific themes. The subjects included childhood in pictures and women’s work in pictures and the countryside. The activities organiser showed residents a range of pictures around the themes mentioned and noted their response to them. This was feedback to the research team and the most popular pictures chosen. Each unit had copies of the books and staff were seen to use them to promote residents memory or to start a conversation. Information provided by the provider in a pre inspection questionnaire and records held on site were examined. All the required maintenance and health and safety checks of the building and equipment had been completed. Crawfords Walk Nursing Home DS0000018716.V329964.R01.S.doc Version 5.2 Page 23 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 4 9 3 10 4 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 4 17 X 18 3 3 X X X X X X 4 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 4 X 4 X 3 X X 3 Crawfords Walk Nursing Home DS0000018716.V329964.R01.S.doc Version 5.2 Page 24 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. 1. Refer to Standard OP8 Good Practice Recommendations Psychosocial interventions that monitor the impact of residents’ mental health problems upon them should be introduced to assist residents and staff to understand individual residents’ mental health problems 2. OP12 Crawfords Walk Nursing Home DS0000018716.V329964.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT 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 Crawfords Walk Nursing Home DS0000018716.V329964.R01.S.doc Version 5.2 Page 26 - 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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