Inspection on 26/08/05 for Crawfords Walk Nursing Home

This inspection was carried out on 26th August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Crawfords Walk Nursing Home 21/03/07

Crawfords Walk Nursing Home 04/01/06

Crawfords Walk Nursing Home 08/02/05

Crawfords Walk Nursing Home 23/09/04

Crawfords Walk Nursing Home 16/01/04

Similar services:

Sunny Bank (P.R.S.) Ltd

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Ashwood Court Unit 1

Langrigg House

Parkside

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 CH2 3AD Lead Inspector Wendy Smith Anthony Cliffe Unannounced Inspection 26th August 2005 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 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 F51 F01 S18716 Crawfords Walk V245288 260805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Crawfords Walk Nursing Home Address Lightfoot Street Hoole Chester CH2 3AD 01244 318567 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) BUPA Care Homes Limited Mrs Kathleen Margaret Webber Care Home 120 Category(ies) of DE(E) Dementia over 65 (60) registration, with number MD(E) Mental Disorder over 65 (30) of places OP - Old Age (30) DE - Dementia (6) TI(E) Terminally Ill (1) Crawfords Walk Nursing Home F51 F01 S18716 Crawfords Walk V245288 260805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1 The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 2 3 The total number of service users must not exceed 120 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 maximum of 60 service users no more than 6 service users in the category DE (Dementia) may be accommodated on Watergate House and Eastgate 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 No more than 30 service users in the category of OP (Old age, not falling within any other category) may be accommodated on Bridgegate House 4 5 6 7 Within the maximum of 30 service users 1 service user in the category of TI(E) (Terminal illness over 65 years of age) may be accommodated on Bridgegate House Date of last inspection 8th February 2005 Crawfords Walk Nursing Home F51 F01 S18716 Crawfords Walk V245288 260805 Stage 4.doc Version 1.40 Page 5 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. The majority of places in the home are contracted to the local Health Authority. The four units providing nursing care are Bridgegate House, providing care for 30 frail older people, Eastgate House and Watergate House, each providing care for 30 people with dementia, and Northgate House, providing 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. Crawfords Walk Nursing Home F51 F01 S18716 Crawfords Walk V245288 260805 Stage 4.doc Version 1.40 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection visit took place on 26th August 2005 over a period of seven hours. Three inspectors conducted it as part of the Commission for Social Care Inspection’s statutory inspection programme. The inspection was carried out using a process of cross referencing the documentation of identified service users following discussion with them, and following the delivery of care and support to them. A tour of the buildings, including all communal areas and a number of bedrooms, was completed. Residents, relatives and members of staff were spoken with on each of the houses, and time was spent in discussion with the service manager. What the service does well: What has improved since the last inspection? What they could do better: Care plans on Northgate House and Watergate House could be improved. Crawfords Walk Nursing Home F51 F01 S18716 Crawfords Walk V245288 260805 Stage 4.doc Version 1.40 Page 7 Any incident of a resident assaulting another resident needs to be considered for referral or discussion under the local authority adult protection procedures. 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. Crawfords Walk Nursing Home F51 F01 S18716 Crawfords Walk V245288 260805 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Crawfords Walk Nursing Home F51 F01 S18716 Crawfords Walk V245288 260805 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3. Standard 6 is not applicable. All residents are assessed before admission to the home to ensure that their needs can be met. EVIDENCE: The 90 mental health places at the home are all contracted to health services. Of these, 40 places are solely for health funded residents, and five are used to provide respite care (three in Eastgate House and two in Watergate House). The home manager acts as ‘gatekeeper’ for these places and told the inspectors ‘no-one comes through the door unless I say so’, however it was evident that there are tensions involved in this process, in particular with regard to respite service users. Whilst the respite care service provides a valuable resource for carers, and is most often a positive experience, a number of respite service users are very disorientated by their new environment and present significant challenges to the smooth running of the unit. The admission of residents is complicated as the home accepts the assessment from the continuing care services and this does not necessarily inform the home of the complex needs of residents Crawfords Walk Nursing Home F51 F01 S18716 Crawfords Walk V245288 260805 Stage 4.doc Version 1.40 Page 10 admitted to respite beds. Sometimes when service users are admitted for a short stay it transpires that they are unable to return home after their stay, and the home is asked to continue the placement. For long stay residents, there was evidence of a full needs assessment being carried out prior to admission being agreed, and the assessment documents were contained in their care plans. Crawfords Walk Nursing Home F51 F01 S18716 Crawfords Walk V245288 260805 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10. Care plans were very well completed on Bridgegate and Eastgate House, but could be improved on Northgate House and Watergate House to demonstrate the needs of residents can be met. The health needs of residents are met on Bridgegate, Eastgate and Northgate but not on Watergate House. The procedures for managing medication ensure that residents’ receive their prescribed medication. The privacy and dignity of residents is respected. EVIDENCE: Northgate House A sample of four residents’ care records was seen during this inspection. The plans were completed in line with each residents needs. Each contained basic information covering all areas of personal care, risk assessments for falls and moving and handling. They also included records of activities, visiting professionals and a copy of the daily report sheets. A resident had signed one Crawfords Walk Nursing Home F51 F01 S18716 Crawfords Walk V245288 260805 Stage 4.doc Version 1.40 Page 12 of the four care plans, a staff member had signed one and the other two had not been signed. Care plans were kept in ring binders, which were in poor condition. Daily record sheets showed the day-to-day activities of each resident. Details such as “allowed…(resident) to eat in her own room” and “no management problems encountered” were used throughout the records. This type of language could be construed as patronising and should not be used. Two of the four residents care plans contained information regarding bathing and weights. Information on the visiting professional sheets showed that GP’s had visited each resident. Details of visits from the opticians were seen, however other professional visits had not been recorded. During the inspection staff showed respect for the residents by the way they spoke to them. Staff acted in a friendly and warm manner towards residents. Bridgegate House Samples of five care plans, relating to residents spoken with during the inspection, were viewed. All of these care plans had been completed to a very good standard and fully documented the needs that had been identified by the inspector and explained the action that was being taken to meet the identified needs. They were written in a sensitive manner and demonstrated that the staff were aware of each person’s individual holistic needs. Charts were in place to record food and fluid intake, and re-positioning for the more frail residents. Two people were being care for in bed. The inspector was informed that no residents had a pressure ulcer. Care plans, and conversations with residents, provided evidence that their health and personal care needs were met by the home’s staff and by visiting professionals. Watergate House There was a wide use of bed rails. Risk assessments in the care plans identified that residents were at risk of falling out of bed, but it was unclear why staff thought that all of these residents would fall out of bed. A sample of care plans was inspected. Not all care plans were completed in full, for example a risk assessment for one resident was only partly completed and was still awaiting a signature from relatives after one year. A care plan had identified a risk of choking, but all of the evaluations related only to the person’s nutritional intake rather than the risk of choking. A resident had been Crawfords Walk Nursing Home F51 F01 S18716 Crawfords Walk V245288 260805 Stage 4.doc Version 1.40 Page 13 admitted into a respite bed. A copy of the continuing care assessment was on file. The assessment identified that the resident presented with agitated behaviour and required ‘skilled intervention’. No care plan or risk assessment had been completed for this resident. The resident was observed to be in an agitated state and invading the personal space of other residents, who were telling the resident to ‘go away’. Daily records and accident records referred to incidents when the resident had assaulted other residents and caused a resident to fall. Staff acted appropriately and requested a reassessment of the resident’s mental health and medication, which was not changed due to ‘family wishes’. The resident continued to present with aggressive and challenging behaviour. The resident’s care was discussed with staff, who described the resident as ‘very challenging and agitated’. Staff described the management of the resident as ‘trying to divert her and asking her to stop’ and could not determine what the ‘skilled intervention’ referred to in the continuing care assessment from the Primary Care Trust (PCT) meant. Daily records described that when the resident was agitated, staff had attempted to keep her in her room on one occasion. Staff said they did not use physical interventions to manage the resident’s physically aggressive behaviour yet described that they held her by the wrists but told ‘not to hold her by her fingers’. The registered manager stated the resident would not be accommodated in the home again without ‘a formal mental health assessment’. See requirement 1. Eastgate House Samples of two resident’s care plans were examined and two residents talked about their care. One of the residents had recently moved into the home and the unit manager had completed a pre admission assessment. The information about the resident was detailed and identified the resident as independent of need in many areas of personal care, with staff providing guidance. The care plans for the resident promoted the maintenance of her independence and promotion of her skills. The resident was identified as requiring supervision with medication and when presenting agitated behaviour. There were clear interventions recorded in the care plan to manage her challenging behaviour, which advocated the use of distraction and diversion techniques, taking the resident to a quiet area and using photographs of her family to calm her. Evaluation of the care plan recorded success in using these interventions. Staff had the resident’s mental health reviewed as they identified a pattern of agitated behaviour and a medication prescribed on an as required basis to manage this. The care plan for another resident described the circumstances and approach to be used by staff to manage the resident’s aggressive and agitated behaviour. The unit manager had identified the best practice approach of the use of a quiet environment when staff recognised the signs the resident was becoming agitated. There was a clear rational and action plan for the use of as Crawfords Walk Nursing Home F51 F01 S18716 Crawfords Walk V245288 260805 Stage 4.doc Version 1.40 Page 14 required medication to minimise the resident’s agitated behaviour. This identified that medication should be used only once as this was effective. Two residents on Eastgate house talked about the standard of care. One resident said ‘I am comfortable and I am looked after’. Another resident said ‘I enjoy crocheting, I like to keep myself busy. Staff check on us regularly and I am looked after, especially by her’, referring to the unit manager who was present. The representatives form the local Catholic Church was visiting the home. This is a regular planned visit. They led the singing of hymns and residents were offered the opportunity to join in if they wished. Medication administration and management was examined on Eastgate and Watergate House. No errors were found. The management of as required medication used in the management of residents who present with agitated and challenging behaviour has improved with clear guidance and a rational for its use. Care plans contained the reason why as required medication was used, when it should be used and the amount of times it should be used. Crawfords Walk Nursing Home F51 F01 S18716 Crawfords Walk V245288 260805 Stage 4.doc Version 1.40 Page 15 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 standard(s) 12, 13 and 15. Social stimulation is provided for residents and they are able to exercise choices in daily living routines. Residents enjoy a good diet. EVIDENCE: Northgate House The interests and daily preferences of residents are recorded in their care plans. The residents’ religious preferences were noted in the care plan and it was said that residents could see the minister of their choice. On the day of the inspection, church representatives were visiting the home and they said that they “liked visiting the residents” and “were welcomed by the staff and assisted by them as needed”. Residents said that they “liked living in the home”; they “liked their bedroom” also that “the food was good”. Staff said that residents could see visitors in private or in the shared areas. Residents spoken to confirmed this. There were no restrictions on visiting. Bridgegate House Crawfords Walk Nursing Home F51 F01 S18716 Crawfords Walk V245288 260805 Stage 4.doc Version 1.40 Page 16 Social activities are provided for residents on Monday and Wednesday mornings, and Tuesday and Thursday afternoons. At 10am most residents were in the dining room having breakfast. Two residents were spoken with in the lounge. One of these people told the inspector how happy she was at the home and that she was very well cared for. Her relative was spoken with later that morning and confirmed that she was also very satisfied with the care being provided for her mother. The other resident expressed a number of negative feelings about the home. His comments were made openly and were discussed with the nurses on duty. They were well aware of his low mood and said that he had found it difficult to accept his loss of independence and settle in his new environment. They were sympathetic to his feelings. Both of these residents said that the food provided was very good. There was evidence of social interaction between the residents sitting in the lounge. Two residents were spoken with in their bedrooms. One of these people was feeling very unhappy and had lost her appetite. She felt very unsettled at Crawfords Walk and was considering moving to another home. She was unable to identify any specific complaints about the home. Her care plan showed that this had been fully explored with her doctor and her family over several months. The other resident had only lived at Crawfords Walk for a short while and his wife was currently a resident on one of the other units. He was able to visit her and spend time with her daily, however due to their differing needs they could not be accommodated on the same unit. He expressed his satisfaction with the care he received. His family had arranged for Sky television to be installed in his bedroom and a garden area with seats to be developed outside the patio window of his room. Staff confirmed that they receive an excellent service from the catering staff, and said that any requests from residents can usually be provided for. Watergate House Staff had bought plants and garden furniture from fund-raising money. Crawfords Walk Nursing Home F51 F01 S18716 Crawfords Walk V245288 260805 Stage 4.doc Version 1.40 Page 17 Eastgate House Two residents on Eastgate house talked about the standard of care. One resident said ‘I am comfortable and I am looked after’. Another resident said ‘I enjoy crocheting, I like to keep myself busy. Staff check on us regularly and I am looked after, especially by her’, referring to the unit manager who was present. The representatives form the local Catholic Church was visiting the home. This is a regular planned visit. They led the singing of hymns and residents were offered the opportunity to join in if they wished. The housekeeper served breakfast in the dining room from a hot trolley. Staff made fresh toast and hot drinks in the small kitchen. There was a choice of a cooked breakfast of bacon and tomatoes and hot porridge. There was hot and cold milk available for cereals. There were a variety of cereals available. Residents sat at the dining table or had a small table at the armchair they were sat in. Staff were available to assist residents and supervise them as necessary. Crawfords Walk Nursing Home F51 F01 S18716 Crawfords Walk V245288 260805 Stage 4.doc Version 1.40 Page 18 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 standard(s) 18 Policies, procedures and staff training are in place to protect service users from abuse, but staff need to be clear on what level of physical intervention is acceptable when managing residents aggressive behaviour. Managers at the home need to monitor and report the incidents of physical confrontation between service users and report these under the adult protection procedures when necessary to improve the protection of service users. EVIDENCE: A resident had been admitted into a respite bed. A copy of the continuing care assessment was on file. The assessment identified that the resident presented with agitated behaviour and required ‘skilled intervention’. No care plan or risk assessment had been completed for this resident. The resident was observed to be in an agitated state and invading the personal space of other residents, who were telling the resident to ‘go away’. Daily records and accident records referred to incidents when the resident had assaulted other residents and caused a resident to fall. Staff acted appropriately and requested a reassessment of the resident’s mental health and medication, which was not changed due to ‘family wishes’. The resident continued to present with aggressive and challenging behaviour. The resident’s care was discussed with staff, who described the resident as ‘very challenging and agitated’. Staff described the management of the resident as ‘trying to divert her and asking her to stop’ and could not determine what the ‘skilled intervention’ referred to in the continuing care assessment from the Primary Care Trust (PCT) meant. Daily records described that when the resident was agitated, staff had attempted to keep her in her Crawfords Walk Nursing Home F51 F01 S18716 Crawfords Walk V245288 260805 Stage 4.doc Version 1.40 Page 19 room on one occasion. Staff said they did not use physical interventions to manage the resident’s physically aggressive behaviour yet described that they held her by the wrists but told ‘not to hold her by her fingers’. These incidents were discussed with the staff and registered manager. Staff were not aware the matters were required to be notified to the Commission for Social Care Inspection under Regulation 37 of the Care Homes Regulations 2001. The manager was advised to consider that physical abuse between residents must be discussed under the local authority adult protection procedures. See Requirement 2 and recommendation 1. Crawfords Walk Nursing Home F51 F01 S18716 Crawfords Walk V245288 260805 Stage 4.doc Version 1.40 Page 20 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 standard(s) 19, and 26. The home is well maintained. Some bathrooms are in need of refurbishment. All areas were cleaned to a good standard and the laundry provides a good service for residents. EVIDENCE: The grounds and gardens are tidy and well maintained. Safe and pleasant outdoor sitting areas are provided for residents of each unit. A maintenance person is employed 40 hours per week, and an additional 40 hours per week are allocated for grounds maintenance. Northgate House The house is furnished in a domestic style with additional equipment such as grab rails, raised toilet seats and hoists provided as necessary to meet the residents’ needs. A good standard of décor was evident. During discussions Crawfords Walk Nursing Home F51 F01 S18716 Crawfords Walk V245288 260805 Stage 4.doc Version 1.40 Page 21 with the maintenance manager, a refurbishment and redecoration programme was seen to be in place. The lounge/dining area has a variety of seating affording choice of style of seating for residents. A tour of the unit was undertaken. All the shared areas and a selection of bedrooms were seen. Bedrooms were entered with the consent of the residents. All bedrooms are single and were personalised with residents’ own furniture and mementoes. The heating and lighting was sufficient throughout the unit. A previous requirement with regard to the bath being replaced had not been met, however the manager provided evidence that this was in hand and should be completed in the near future. See requirement. The house was clean, tidy and free from any unpleasant smells. Bridgegate House Bedrooms are not carpeted, which detracts somewhat from a domestic appearance. The standard of furnishings is good. Adjustable height beds are provided for all residents and pressure relieving mattresses were in place on a number of beds. Where bedrails were in use, protective covers were provided. Many bedrooms were personalised with residents’ belongings, plants and flowers. One bedroom had been made very pleasant but was spoiled with the storage of several boxes containing liquid feed. There was a storeroom opposite to this bedroom, which could perhaps have been used for these boxes. Over-rideable locks are fitted to toilets and bathrooms. All bedrooms were light and airy and all have pleasant outlooks onto a garden or grounds. The sluices were locked but the cleaner’s store was not. Bathroom 38 was being used for storage. All areas were clean and there were no unpleasant smells. Watergate House The environment was found to be clean and well maintained. East gate House The environment was found to be clean and well maintained. Crawfords Walk Nursing Home F51 F01 S18716 Crawfords Walk V245288 260805 Stage 4.doc Version 1.40 Page 22 The home had a large laundry, which was found to be clean, tidy and well organised. The laundry is well equipped to meet the needs of residents. The laundry supervisor was spoken with. She has her own team of five staff and is responsible for their rota. Three staff are on duty each day, and their hours can be flexible depending on the workload. It was evident that the staff took a pride in their work and staff spoken with on the residential units said that they receive a good service from the laundry. Crawfords Walk Nursing Home F51 F01 S18716 Crawfords Walk V245288 260805 Stage 4.doc Version 1.40 Page 23 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27. The number and skill mix of staff is appropriate to meet the needs of residents. EVIDENCE: Northgate House Agreed staffing levels were maintained with two nurses and three care staff on each shift. The duty rota showed three staff were on duty at night. The person in charge said that five care staff working on this unit had obtained NVQ level II or III in care. Staff had completed mandatory training in fire awareness, moving and handling and food hygiene. Other courses available included health and safety, abuse and medication. Each staff member had a training record which showed mandatory training had been undertaken. Bridgegate House Two nurses, an adaptation student, and two care assistants were on duty. The duty rota showed that there are always five staff are on duty during the day and this includes at least two registered nurses. At night there is one nurse and two care assistants. In addition to this, nursing students have work experience places working alongside the nurses. There was some use of agency staff to cover for sickness and holidays, and some of the regular staff had worked additional hours, up to 60 hours in a week. Crawfords Walk Nursing Home F51 F01 S18716 Crawfords Walk V245288 260805 Stage 4.doc Version 1.40 Page 24 Watergate House Staff were provided to comply with the existing staffing agreement. The unit manager is a first level registered mental nurse. The duty rota showed that there are always five staff are on duty during the day and this includes at least two registered nurses. At night there is one nurse and two care assistants. The inspector noted that two members of staff were working six nights (72 hours) per week. This was discussed with the home manager, who said that she was aware of this practice and was keeping it under review. She said that the staff concerned were working these hours by choice. Staff have received training to help them caring for residents who have challenging behaviour. Eastgate House Staff were provided to comply with the existing staffing agreement. The unit manager is a first level registered mental nurse. The duty rota showed that there are always five staff are on duty during the day and this includes at least two registered nurses. At night there is one nurse and two care assistants. In addition there is a house keeper on the unit who served residents with breakfast and provided assistance. Crawfords Walk Nursing Home F51 F01 S18716 Crawfords Walk V245288 260805 Stage 4.doc Version 1.40 Page 25 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37 Records are kept securely in the home and residents have access to information kept about them. EVIDENCE: Northgate House All records, policies and procedures seen were up to date and accurate. These were kept secure within the home. During discussions some residents confirmed that they had access to information kept about them Crawfords Walk Nursing Home F51 F01 S18716 Crawfords Walk V245288 260805 Stage 4.doc Version 1.40 Page 26 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 2 x x x x x x 3 x Crawfords Walk Nursing Home F51 F01 S18716 Crawfords Walk V245288 260805 Stage 4.doc Version 1.40 Page 27 yes Are there any outstanding requirements from the last inspection? 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 14 and 15 Requirement Timescale for action 1.11.05 2. OP37 37 The registered person must ensure that records that identify residents needs and staff responsibilities in meeting their health and welfare are in place and kept under review. Including appropriate risk assessments, risk management strategies and where necessary treatment and advice from health care professionals. The registered person must 1.10.05 inform the Commission for Social Care Inspection of any event in the care home which adversely affects the well being or safety of any resident. 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 18 Good Practice Recommendations Incidents of residents physically assualting other residents should be considered for referral or discussion under the local authority adult protection proceedures. F51 F01 S18716 Crawfords Walk V245288 260805 Stage 4.doc Version 1.40 Page 28 Crawfords Walk Nursing Home Commission for Social Care Inspection Unit D, off Rudheath Way Gadbrook Park Northwich Cheshire, 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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