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Inspection on 10/05/06 for Crawshaw Hall Nursing Home

Also see our care home review for Crawshaw Hall Nursing Home for more information

This inspection was carried out on 10th May 2006.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

During the inspection members of staff were observed attending to residents in a kind and caring manner. Discussions with members of staff confirmed that promoting privacy and dignity for residents was an important part of their care. One resident said, "I like it here they give me cigarettes. I`ve a nice room and the staff are lovely." One visitor said, "The staff and nursing care is good. They identified his needs and meet them." A visiting priest said, "Everybody`s well looked after." Visitors were welcomed into the home at anytime and offered refreshments or a meal. One visitor said, "I`m staying for lunch and there`s no charge for it." All the residents asked said they had enjoyed their lunch.

What has improved since the last inspection?

There have been some improvements in care planning since the last inspection. Care plans have been put in place to address the risk of developing pressure sores. Care plans are reviewed monthly. A licensed waste carrier has been contracted to dispose of all unwanted medication from the home.

What the care home could do better:

Admission procedures must be thorough in order to ensure the needs of all residents can be met at the home. This must include a detailed pre-admission assessment and confirmation in writing that the care needs of the prospective resident can be met at the home. To promote the safety of residents a detailed risk assessment must be carried out for individual residents who need bed rails. A care plan must then be developed to explain how the risk is managedIt was of serious concern that a care plan was not in place for recently admitted resident. A care plan must be in place on the day of admission for all residents. It is essential that detailed records are kept about the condition and treatment of all pressure sores. Residents or their relatives must if possible be involved in planning care and reviewing care plans. This will ensure that the needs of each resident are identified and appropriate care given. To avoid errors in the administration of medication all hand written instructions on the medicines administrations records should be signed and witnessed. To prevent the deterioration of medication the temperature of the storage areas should be checked and recorded daily to ensure they do not exceed 25 degrees Celsius. To improve the quality of life for the residents time must be allocated for members of staff to provide recreational activities. To protect residents from abuse clear guidance must be provided for members of staff to follow if allegations of abuse are made. The policies and procedures must be amended to state the action to be taken if allegations of abuse are made. To prevent residents form falling the torn lino floor covering in one bedroom and the worn ill-fitting carpet on the first floor corridor must be repaired or replaced. It is of serious concern that staffing levels do not fully meet the needs of all residents. Urgent action must be taken to ensure recruitment procedures are thorough in order to protect residents from abuse. It is important that all members of staff receive appropriate training. Induction training should be further developed in order to meet the `Skills for Care` standard. Fifty percent of care assistants must obtain NVQ level 2 or above. Serious consideration should be given to allocating sufficient supernumerary hours to the manager to enable him to effectively fulfil his managerial responsibilities. The system for monitoring and improving the quality of care and services provided at the home must be further developed. This includes obtaining the views of residents and their relatives and compiling an annual development plan. A requirement to address this issue remains outstanding from five previous inspections. It is important that action is taken to obtain the views of residents, where possible, and their relatives and provide evidence that their views are taken seriously and acted upon. To promote the health and safety of residents and staff fire drills must be held at regular intervals. All members of staff must receive training in fire prevention. The requirement to address this issue remains outstanding from the last three inspections. Urgent action must be taken to ensure appropriate training is provided. Only approved, safe methods for the moving and handling of residents must be used. It is important that all members of staff receive up to date training in moving and handling.Crawshaw Hall Nursing HomeDS0000022508.V289116.R01.S.docVersion 5.1Page 7

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Crawshaw Hall Nursing Home Burnley Road Crawshaw Booth Rossendale BB4 8LZ Lead Inspector Mrs Susan Hargreaves Unannounced Inspection 10:00 10 & 12th May 2006 th X10029.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 Crawshaw Hall Nursing Home DS0000022508.V289116.R01.S.doc Version 5.1 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 and Care Homes for Adults 18 – 65*. 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. Crawshaw Hall Nursing Home DS0000022508.V289116.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Crawshaw Hall Nursing Home Address Burnley Road Crawshaw Booth Rossendale BB4 8LZ 01706 228694 01706 215670 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) Mrs Eileen Karoo Mr Jainarain Buluck Care Home 23 Category(ies) of Dementia (6), Dementia - over 65 years of age registration, with number (23), Mental disorder, excluding learning of places disability or dementia (6), Mental Disorder, excluding learning disability or dementia - over 65 years of age (23) Crawshaw Hall Nursing Home DS0000022508.V289116.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Under Annex 2, a max of 6 service users aged 50 years and above requiring nursing care who fall into the category of MD or DE Staffing will be accordance with the Notice issued dated 7 August 2001 The registered provider shall, at all times, employ a suitably qualified and experienced person who is registered with the National Care Standards Commission as manager of Crawshaw Hall Nursing Home. 1st November 2005 Date of last inspection Brief Description of the Service: Crawshaw Hall Nursing Home provides 24-hour care for people who suffer from a mental disorder or dementia. Although the majority of people are over 65 years the home can admit up to 6 people who are under the age of 65 years old. The home is a large detached grade 2 listed building with extensive grounds. There is a secure garden area, which is easily accessible to residents when the weather permits. A parking area for use by visitors and staff is available at the front of the building. The home is situated on the outskirts of the village of Crawshawbooth and near to the local amenities provided in the village. Rawtenstall is approximately 2 miles away. Accommodation is provided in single and twin-bedded rooms. There are no en-suite rooms but bathroom and toilet facilities are easily accessible. Communal lounges and dining rooms are located on the ground floor. All the rooms are spacious and airy and there are many unique decorative features in keeping with the age of the building. The current fees charged at Crawshaw Hall Nursing Home are £452-700 per week. Additional charges are payable for hairdressing, chiropody, toiletries, magazines, newspapers and outings. A copy of the statement of purpose and service user guide is available to prospective service users on request. Crawshaw Hall Nursing Home DS0000022508.V289116.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over two days. No additional visits have been made since the last unannounced inspection. At the time of this inspection 18 residents were living at the home. A tour of the premises took place and staff files and care records were inspected. Members of staff on duty, residents and visitors were spoken to. Discussions also took place with the manager and proprietor regarding issues raised during the inspection. What the service does well: What has improved since the last inspection? What they could do better: Admission procedures must be thorough in order to ensure the needs of all residents can be met at the home. This must include a detailed pre-admission assessment and confirmation in writing that the care needs of the prospective resident can be met at the home. To promote the safety of residents a detailed risk assessment must be carried out for individual residents who need bed rails. A care plan must then be developed to explain how the risk is managed. Crawshaw Hall Nursing Home DS0000022508.V289116.R01.S.doc Version 5.1 Page 6 It was of serious concern that a care plan was not in place for recently admitted resident. A care plan must be in place on the day of admission for all residents. It is essential that detailed records are kept about the condition and treatment of all pressure sores. Residents or their relatives must if possible be involved in planning care and reviewing care plans. This will ensure that the needs of each resident are identified and appropriate care given. To avoid errors in the administration of medication all hand written instructions on the medicines administrations records should be signed and witnessed. To prevent the deterioration of medication the temperature of the storage areas should be checked and recorded daily to ensure they do not exceed 25 degrees Celsius. To improve the quality of life for the residents time must be allocated for members of staff to provide recreational activities. To protect residents from abuse clear guidance must be provided for members of staff to follow if allegations of abuse are made. The policies and procedures must be amended to state the action to be taken if allegations of abuse are made. To prevent residents form falling the torn lino floor covering in one bedroom and the worn ill-fitting carpet on the first floor corridor must be repaired or replaced. It is of serious concern that staffing levels do not fully meet the needs of all residents. Urgent action must be taken to ensure recruitment procedures are thorough in order to protect residents from abuse. It is important that all members of staff receive appropriate training. Induction training should be further developed in order to meet the ‘Skills for Care’ standard. Fifty percent of care assistants must obtain NVQ level 2 or above. Serious consideration should be given to allocating sufficient supernumerary hours to the manager to enable him to effectively fulfil his managerial responsibilities. The system for monitoring and improving the quality of care and services provided at the home must be further developed. This includes obtaining the views of residents and their relatives and compiling an annual development plan. A requirement to address this issue remains outstanding from five previous inspections. It is important that action is taken to obtain the views of residents, where possible, and their relatives and provide evidence that their views are taken seriously and acted upon. To promote the health and safety of residents and staff fire drills must be held at regular intervals. All members of staff must receive training in fire prevention. The requirement to address this issue remains outstanding from the last three inspections. Urgent action must be taken to ensure appropriate training is provided. Only approved, safe methods for the moving and handling of residents must be used. It is important that all members of staff receive up to date training in moving and handling. Crawshaw Hall Nursing Home DS0000022508.V289116.R01.S.doc Version 5.1 Page 7 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. Crawshaw Hall Nursing Home DS0000022508.V289116.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Crawshaw Hall Nursing Home DS0000022508.V289116.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Admission procedures were not thorough. The care needs of all residents were not thoroughly assessed prior to admission. Some prospective residents did not receive confirmation in writing that their needs could be met at the home. EVIDENCE: The individual records of three residents were inspected. Although it was evident that a senior member of staff had visited the residents prior to admission detailed assessments had been completed for only two of them. Two of these residents had not received confirmation in writing that their needs could be met at the home. Crawshaw Hall Nursing Home DS0000022508.V289116.R01.S.doc Version 5.1 Page 10 Information about the admission procedure was included in the statement of purpose and service user guide. Crawshaw Hall Nursing Home does not offer intermediate care. Crawshaw Hall Nursing Home DS0000022508.V289116.R01.S.doc Version 5.1 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care was given in a manner, which promoted the privacy and dignity of all residents. A care plan was not in place for each resident. Care plans were reviewed monthly but residents or their relatives were not involved in this process. Medication was administered correctly promoting good health. Crawshaw Hall Nursing Home DS0000022508.V289116.R01.S.doc Version 5.1 Page 12 EVIDENCE: The individual care plans of four residents were inspected. Three of these plans contained information about the care needs of each resident and explained how these needs were to be met. However, a care plan, which addressed all the identified needs for a recently admitted resident, was not available. Another care plan provided insufficient information about the care and condition of a pressure sore. Appropriate risk assessments relating to falls, pressure sores and nutrition had been carried out. Where a risk had been identified for example, developing pressure sores, a care plan was in place describing the action necessary to reduce the risk. A detailed risk assessment for the use of bed rails for one resident was not in place. A report about the care and condition of each resident was completed daily. Care plans were reviewed monthly but there was no evidence to suggest that the resident or their relatives were involved in this process. One relative said a nurse had discussed some aspects of care with her but she had not seen the care plan. Residents were registered with a GP and had access to other healthcare professionals. At the time of the inspection none of the residents were self-medicating. Registered nurses were responsible for administering all medication. Records of the receipt, administration and the disposal of unwanted medication were seen. A licensed waste carrier was responsible for removing all unwanted medication. Several hand written medicines administration records were not signed or witnessed. Although medication was stored correctly the manager was advised to check and record the temperature of the storage areas daily to ensure medication did not deteriorate if the temperature exceeded 25 degrees Celsius. A small quantity of unwanted medication was being stored in the home. Personal care was carried out in private. Members of staff were observed attending to residents in caring and professional manner. One member of staff explained in detail how she promoted privacy and dignity for all residents. One resident said, “The staff are lovely.” A visitor commented on how polite the staff were. Crawshaw Hall Nursing Home DS0000022508.V289116.R01.S.doc Version 5.1 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the 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 adequate. This judgement has been made using available evidence including a visit to this service. Leisure activities were not routinely organised. Visitors were welcomed into the home at anytime. The daily routine was flexible in order to meet the needs and preferences of residents. Meals were wholesome and appetising. EVIDENCE: Resident’s interests and hobbies were recorded in their individual care plans. Leisure activities were not advertised in the home and on the day of the inspection none were organised. A number of residents spent most of the day sitting in the lounge with the TV on and showing little interest in the Crawshaw Hall Nursing Home DS0000022508.V289116.R01.S.doc Version 5.1 Page 14 programmes. One member of staff explained that with the increase in the number of residents and their higher dependency levels staff did not have time to organise leisure activities. Visitors were welcomed into the home at anytime and offered refreshments or a meal. A priest regularly visited a resident at the home. Residents were encouraged to as much as possible to make decisions about their lifestyle. Residents had personalised their rooms with photographs, ornaments etc. The daily routine was flexible in order to meet the needs and preferences of the residents. The meal served at lunchtime on the first day of the inspection was wholesome and appetising. Members of staff were observed assisting residents in a sensitive and caring manner. Lunchtime was unhurried allowing time for residents to eat at their own pace and enjoy the meal. Menus were varied and offered choice. Crawshaw Hall Nursing Home DS0000022508.V289116.R01.S.doc Version 5.1 Page 15 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Complaints were taken seriously and investigated. The procedure to follow if allegations of abuse were made did not give clear guidance about the action to take. EVIDENCE: A complaints procedure was available. The registered manager was currently investigating a complaint made to CSCI. Policies and procedures relating to the protection of vulnerable adults were available. However, the policy and procedure needed reviewing and amending to clearly state the action to be taken if allegations of abuse are made. This issue was discussed with two members of staff. They both said they would report concerns to a senior member of staff. However, they were unsure of the procedure to follow if allegations of abuse were reported to them. Crawshaw Hall Nursing Home DS0000022508.V289116.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) 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, 25 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was clean and comfortable and provided a homely environment for the residents. Laundry facilities were appropriate for the size of the home. EVIDENCE: At the time of the inspection the home was clean, tidy and free from offensive odour. However, the lino floor covering next to the bed in one room was torn Crawshaw Hall Nursing Home DS0000022508.V289116.R01.S.doc Version 5.1 Page 17 and the carpet on the first floor corridor was worn and ill fitting. These could increase the risk of falling for some residents. There are plans for major improvements to the home including an increase in the number of single rooms and extensive refurbishment and redecoration of the home. The proprietor explained that this work was to take place over the summer. The grounds and gardens were well kept and accessible to residents. The front door bell remains broken causing inconvenience for visitors. Although some radiators had been fitted with covers the schedule for completing this work had been suspended. Low surface temperature radiators were to be fitted as part of the planned improvements to the premises. Laundry facilities were appropriate for the size of the home. An infection control policy was available. Crawshaw Hall Nursing Home DS0000022508.V289116.R01.S.doc Version 5.1 Page 18 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the 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 poor. This judgement has been made using available evidence including a visit to this service. Staffing levels were insufficient to fully meet the needs of all residents. Recruitment procedures were not thorough potentially putting residents at risk. Induction training needed further development to ensure consistency in the delivery of care. Less than 50 of care assistants had NVQ level 2 EVIDENCE: Although staffing levels remained unchanged since the last inspection there had been an increase in the number and the needs of residents. It was evident from discussion with staff and observation that they were experiencing some difficulty in fully meeting the needs of residents. Several residents were nursed in bed or remained in their own rooms. These residents required the assistance of two members of staff for all personal care. Members of staff did not have time to do activities with the residents. At the time of the inspection the residents were left unsupervised in the lounge for quite long periods of time. Crawshaw Hall Nursing Home DS0000022508.V289116.R01.S.doc Version 5.1 Page 19 The files of four recently appointed members of staff were inspected. Three of these files contained all the required pre-employment checks to ensure protection of the residents. It was apparent from the other file that this member of staff had started working at the home before a POVA/CRB check had been obtained. The work permit for an adaptation student did not state Crawshaw Hall as the intended place of work. It was evident from discussions with members of staff and the manager that training opportunities were available. This included first aid, mental health problems, Huntington’s disease and NVQ’s. However, only 25 of care assistants had achieved NVQ qualifications. Induction training for new employees took place but this did not meet the ‘Skills for Care’ standard. Crawshaw Hall Nursing Home DS0000022508.V289116.R01.S.doc Version 5.1 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. An effective quality monitoring system was not in place. Members of staff had not received training in fire safety and moving and handling. Crawshaw Hall Nursing Home DS0000022508.V289116.R01.S.doc Version 5.1 Page 21 EVIDENCE: The registered manager was an experienced nurse with NVQ level 4 in management. However, he explained that it was becoming increasingly difficult to effectively combine nursing and managerial duties without supernumerary hours. The home had achieved the nationally accredited Investors in People award. However, a formal system of obtaining the views of residents and their relatives about the care and services provided at the home was not in place. An annual development plan to help monitor the quality of the service and improve outcomes for residents was not available. Transactions involving resident’s money were seen to be well maintained and up to date. Fire alarms and emergency lighting were tested regularly. A fire risk assessment was in place. Although the members of staff asked were aware of fire procedures fire drills were held infrequently and members of staff had not received up to date training in fire safety. Records of the routine servicing of equipment were seen. Three members of staff said they had not received moving and handling training. During the inspection two members of staff explained how they used an inappropriate moving and handling technique. Records of the routine servicing of equipment were seen. Records maintained by the cook included fridge and freezer temperatures. The cook was unable to check food temperatures because the probe was broken. Crawshaw Hall Nursing Home DS0000022508.V289116.R01.S.doc Version 5.1 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 X 3 2 4 X 5 X 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 ENVIRONMENT Standard No Score 19 2 20 X 21 X 22 X 23 X 24 X 25 2 26 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No Score 31 2 32 X 33 2 34 X 35 3 36 X 37 X 38 2 Crawshaw Hall Nursing Home DS0000022508.V289116.R01.S.doc Version 5.1 Page 23 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 OP3 Regulation 14(1)(d) Timescale for action The registered person shall not 10/05/06 provide accommodation to a service user at the care home unless, so far as it shall have been practicable to do so - (d) the registered person has confirmed in writing to the service user having regard to the assessment the care home is suitable for the purpose of meeting the service user’s needs in respect of his health and welfare. Timescale of 29/07/05 and 01/11/05 not met. The registered person shall not 10/05/06 provide accommodation to a service user at the care home unless, so far as it shall have been practicable to do so – (a) needs of the service user have been assessed by a suitably qualified or suitably trained person; (b) the registered person has obtained a copy of the assessment; (c) there has been appropriate consultation regarding the assessment with the service user or a representative of the service DS0000022508.V289116.R01.S.doc Version 5.1 Page 24 Requirement 2. OP3 14(1)(a) (b)(c) Crawshaw Hall Nursing Home 3. OP7 15(1) 4. OP7 13(4) 5. OP7 15(2)(b)(c) (d) 6. OP8 17(1)(a) Schedule 3 user. A detailed pre-admission assessment must be completed for all prospective residents. Unless it is impracticable to carry out such consultation, the registered person shall, after consultation with the service user or a representative of his, prepare a written plan as to how the service user’s needs in respect of his health and welfare are to be met. All residents must have a care plan. The registered person shall ensure that – unnecessary risks to the health and safety of service users are so far as possible eliminated. A detailed risk assessment must be carried out for all residents requiring bed rails. A care plan must also be developed explaining the strategies in place to minimise the risks. The registered person shall (b) keep the service user’s plan under review. (c) where appropriate and, unless it is impracticable to carry out such consultation, after consultation with the service user or a representative of his, revise the service user’s plan. (d) notify the service user of any such revision. The registered person (a) maintain in respect of each service user a record which included the information, documents and other records specified in schedule 3 relating to the service user. (n) a DS0000022508.V289116.R01.S.doc 10/05/06 16/06/06 28/07/06 10/05/06 Crawshaw Hall Nursing Home Version 5.1 Page 25 7. OP12 16(2)(n) 8. OP18 12(1) 9. OP19 13(4)(a) 10 OP27 18(1)(a) record of the incidence of pressure sores and of treatment provided to the service user. The registered person shall having regard to the size of the care home and the number and needs of service users – (n) consult service users about the programme of activities arranged by or on behalf of the care home, and provide facilities for recreation including, having regard to the needs of the service users activities in relation to recreation, fitness and training. The registered person shall ensure that the care home is conducted so as (a) to promote and make proper provision for the health and welfare of service users. The procedure to follow if allegations of abuse are made must be amended to clearly state what action must be taken. The registered person shall ensure that – (a) all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety. The torn lino in one and the carpet on the first floor corridor must be repaired or replaced. The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users – (a) ensure that at all times suitably qualified, competent and experienced persons are DS0000022508.V289116.R01.S.doc 28/07/06 16/06/06 16/06/06 16/06/06 Crawshaw Hall Nursing Home Version 5.1 Page 26 11. OP29 12. OP28 13. OP33 working at the care home in such numbers as are appropriate for the health and welfare of service users. 19(1)(b) The registered person shall not 10/05/06 Schedule 2 employ a person to work at the care home unless (b) he has obtained in respect of that person the information and documents specified in (i) paragraphs 1 to 7 of schedule 2 A satisfactory POVA/CRB check must be obtained before a person starts work. Timescale of 01/11/05 not met 18(1)(c)(i)(ii) The registered person having 29/09/06 regard to the size of the care home, the statement of purpose and the number and needs of service users – (c) ensure that the persons employed by the registered person to work at the care home receive – (i) training appropriate to the work they are to perform; and (ii) suitable assistance, including time off, for the purpose of obtaining further qualifications appropriate to such work. 50 of all care assistants must have or be working towards NVQ level 2 or above by the date given. 24(1)(2)(3) (1) The registered person shall 28/07/06 establish and maintain a system for (a) reviewing at appropriate intervals, and (b) improving at the care home, including the quality of nursing where nursing is provided at the care home. (2) The registered person shall supply to the Commission a report in respect of any review conducted by him for the DS0000022508.V289116.R01.S.doc Version 5.1 Page 27 Crawshaw Hall Nursing Home 14. OP38 23(4)(d) 15. OP38 23(4)(e) 16. OP38 13(5) purpose of paragraph (1), and make a copy of the report available to service users. (3) the system referred to in paragraph (1) shall provide consultation with service users and their representatives. (Timescale of 28 May, 26 Nov 2004, 25 March, 2 Sept 2005 and 31 March 2006 not met.) The registered person shall after consultation with the fire authority (d) make arrangements for persons working at the care home to receive suitable training in fire prevention. Timescale (25 March, 2 Sept and 30 Dec 2005 not met.) The registered person shall after consultation with the fire authority (e) ensure, by means of fire drills and practice at suitable intervals, that the persons working at the care home and, so far as practicable, service users, are aware of the procedure to be followed in case of fire, including the procedure for saving life. All members of staff must regularly attend fire drills. The registerd person shall make arrangements to provide a safe system for moving and handling service users. All members of staff must receive training. (Timescale of 9 Dec 2005 not met.) 28/07/06 16/06/06 28/07/06 Crawshaw Hall Nursing Home DS0000022508.V289116.R01.S.doc Version 5.1 Page 28 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. 3. 4. 5. 6. 7. 8. 9. Refer to Standard OP9 OP9 OP19 OP25 OP27 OP30 OP31 OP38 Good Practice Recommendations All handwritten instructions on the medicines administration records should be signed and witnessed. The temperature of the area where medication is stored should be checked and recorded daily. The front door bell should be repaired. All radiators should be fitted with covers. Work permits for overseas staff should accurately state the place of employment. Induction training should meet the ‘Skills for Care’ standards. It is strongly recommended that the manager is allocated supernumerary time in order to effectively fulfil all managerial responsibilities. A new probe for checking food temperatures should be obtained as soon as possible. Crawshaw Hall Nursing Home DS0000022508.V289116.R01.S.doc Version 5.1 Page 29 Commission for Social Care Inspection East Lancashire Area Office 1st Floor, Unit 4 Petre Road Clayton Business Park Accrington BB5 5JB 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. Extracts may not be used or reproduced without the express permission of CSCI. Crawshaw Hall Nursing Home DS0000022508.V289116.R01.S.doc Version 5.1 Page 30 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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