Inspection on 24/07/07 for Crawshaw Hall Nursing Home

This inspection was carried out on 24th July 2007.

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

Crawshaw Hall Nursing Home 04/01/08

Crawshaw Hall Nursing Home 10/05/06

Crawshaw Hall Nursing Home 01/11/05

Crawshaw Hall Nursing Home 31/05/05

Crawshaw Hall Nursing Home 14/12/04

Crawshaw Hall Nursing Home 06/07/04

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

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 24th July 2007 10:30 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.V342565.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 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.V342565.R01.S.doc Version 5.2 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.V342565.R01.S.doc Version 5.2 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. 10th May 2006 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 ensuite 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 £375 - £580 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 at the home. Crawshaw Hall Nursing Home DS0000022508.V342565.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A key unannounced inspection, which included a visit to the home, was conducted at Crawshaw Hall Nursing Home on the 24th July 2007. A random unannounced inspection was carried out on 3rd January 2007 to monitor compliance with the requirements issued at the last Key inspection in May 2006. The relatives of two residents completed surveys about the home. In answer to the question: ‘Do you receive the care and support you need?’ One relative responded always and the other usually. One relative wrote ‘They seem to genuinely care about my father’. At the time of this inspection 15 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 and residents were spoken to. Discussions also took place with the nurse in charge and proprietor regarding issues raised during the inspection. What the service does well: What has improved since the last inspection? To ensure action is taken to prevent residents from developing pressure sores a risk assessment is in place for each resident. Crawshaw Hall Nursing Home DS0000022508.V342565.R01.S.doc Version 5.2 Page 6 The procedure to follow if allegations of abuse are made has been amended and clearly states what action to take. When all the care workers who are working towards NVQ qualifications have completed their training more than 50 of care workers will have an NVQ qualification at level 2 or above. Fire drills are held regularly and a training DVD in fire safety is available for all staff to watch. What they could do better: Urgent action must be taken to improve care planning in order to provide person centred care for all residents. Care plans must clearly identify and address the individual needs of each resident. This includes medical conditions and challenging behaviour. Wound care records must contain detailed information about the dressings to be used and condition of the wound. Dressings must be changed as frequently as stated in the care plan. It is of very serious concern that medication was not managed safely. Urgent action must be taken to ensure a record of all medication received into the home is kept. It is essential that the resident’s doctor be asked to review their medication when their needs change. Medication must be given to the resident for whom it has been prescribed and must not be used communally. To ensure residents do not run out of their prescribed medication a system for re-ordering must be in place. The medicine trolley must be thoroughly cleaned. It is important to provide the support necessary for residents to have a fulfilling lifestyle. A range of suitable leisure activities must be organised for the residents. Urgent action must be taken to ensure residents are protected from abuse. All members of staff must be given training in safeguarding vulnerable adults. To ensure appropriate action is taken is taken when the behaviour of a resident becomes challenging care workers must receive training in dealing with challenging behaviour. To promote the wellbeing of residents the odour problem in one bedroom must be addressed. To prevent residents from falling the worn carpet on the first floor must be repaired or replaced. It is of concern that care workers responsible for looking after residents with dementia and mental health problems have not received appropriate for that role. It is strongly recommended that all care workers be given training in dementia care and mental health problems. Crawshaw Hall Nursing Home DS0000022508.V342565.R01.S.doc Version 5.2 Page 7 Failure to address the requirement made at three previous inspections about recruitment practices is of serious concern. Two written references and a POVA/CRB must be obtained before any new employees start working at the home. Urgent action must be taken to ensure care workers use approved, safe methods for moving and handling residents. All members of staff must receive training in moving and handling. 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. Crawshaw Hall Nursing Home DS0000022508.V342565.R01.S.doc Version 5.2 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.V342565.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (older people) and 2 (adults 18-65) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A thorough admissions procedure ensured sufficient information was obtained in order to identify the needs of each resident. EVIDENCE: The individual records of two residents were inspected. Each contained a detailed pre-admission assessment. The manager or a senior member of staff visited prospective residents in hospital or their own home prior to admission. These assessments provided important information for the care plans. Crawshaw Hall Nursing Home DS0000022508.V342565.R01.S.doc Version 5.2 Page 10 Prospective residents or their relatives received confirmation in writing that their needs could be met at the home. Standard 6 is not applicable to this service. Crawshaw Hall Nursing Home DS0000022508.V342565.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 (older people) 66,9,16,18,19 and 20 (adults 18-65). Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Deficiencies in care planning and medication procedures mean residents do not always receive safe and person centred care. EVIDENCE: The individual care plans of two residents were inspected. These plans did not identify and address all the care needs of each resident. Crawshaw Hall Nursing Home DS0000022508.V342565.R01.S.doc Version 5.2 Page 12 One resident had challenging behaviour and a history of asthma and used inhalers. However, care plans to address these problems and provide clear guidance for staff to follow if this resident became aggressive were not in place. The wound care records of a resident suffering from a pressure sore were inspected. The care plan did not state which dressing to use and was not up dated when a different dressing was used. The care plan also stated the dressing was to be changed every 5 days. However, the record of dressing changes indicated this was being done every six or seven days. Detailed records of the condition of the wound were not kept. Appropriate risk assessments had been carried out for falls, nutrition, pressure sores and if necessary the use of bed rails. A written report about the care given to individual residents was completed during each shift. There was no evidence to suggest that the residents or their relatives were involved in care planning. Residents were registered with a GP and had access to other healthcare professionals. Medication was stored correctly in a locked trolley, which was secured to the wall when not in use and a locked storeroom on the first floor. The temperature of these areas was checked and recorded daily. The medicine trolley was very dirty and in urgent of cleaning. Records relating to the management of medication were in place. However, a record of most of the medication received into the home was not kept. Hand written instructions on medication administration records were not signed or witnessed. On one medication administration record the handwritten dose stated 25mg but the label on bottle stated 0.25mls three times a day. Although this was the same dose it could be misleading and the cause of a medication error. The nurse in charge explained that tablets for one resident had not been ordered because he no longer needed them. This had not been agreed with the GP and the nurse was advised to request a review of this resident’s medication. Medication prescribed for pain for one resident was out of stock. This medication had been prescribed four times a day but a handwritten instruction on the medication administration record indicated this should be given when Crawshaw Hall Nursing Home DS0000022508.V342565.R01.S.doc Version 5.2 Page 13 required. However, there was no evidence to suggest this change had been agreed with the GP. There were two boxes of medication in the trolley without a label from the chemist stating who they had been presribed for. A resident who had been prescrided this medication did not have a stock for his own use. However, the medication administration record chart for this resident indicated he had been given this medication every evening. This suggests this medication was being used communally. The manager was also advised to write the amount of medication remaining from the previous prescription on the current medication administration record. This will enable proper control of stock and ensure residents do not run out of their prescribed medication. Personal care was carried out in the privacy of the resident’s own room or the bathroom. Two care workers explained how they promoted privacy and dignity for all residents. One resident said, “They look after me.” Crawshaw Hall Nursing Home DS0000022508.V342565.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 (older people) 12,13,15, and 17 (adults 18-65). Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Resident’s decisions were respected but they were not supported by care workers to have a fulfilling lifestyle. EVIDENCE: Resident’s interests and hobbies were recorded in their individual care plans. A limited range of activities was advertised in the home. These included movie, music, pub lunch, shopping trip and complementary therapy. However, Crawshaw Hall Nursing Home DS0000022508.V342565.R01.S.doc Version 5.2 Page 15 discussion with members of staff confirmed that activities were not usually organised and residents usually watched the television. One care worker said, “I love talking to residents they have really interesting backgrounds.” This care worker explained that one resident liked reading and another resident watched videos in their own room. An outside entertainer visited the home approximately every two months. Visitors were welcomed into the home at anytime and offered refreshments. Residents were encouraged to make decisions about their lifestyle and daily routine. The daily routine was flexible and residents could choose when to get up and go to bed. Residents had personalised their rooms with photographs, ornaments etc. The meal served at lunchtime looked wholesome and appetising. Care workers were observed assisting residents in a caring and sensitive manner. Lunchtime was unhurried allowing time for residents to enjoy their meal. All the residents asked said they had enjoyed their lunch. One resident said there was always a choice. Crawshaw Hall Nursing Home DS0000022508.V342565.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 (older people) 22 and 23 (adults 18-65). Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents and their relatives felt able to express their concerns. Staff had not been given the training necessary to ensure that residents were protected from abuse. EVIDENCE: A copy of the complaints procedure was in displayed in the home. No complaints have been made to the manager or the commission since the last inspection. The relative of one resident wrote on the survey ‘we have had a few issues and they been discussed and sorted out’. Policies and procedures for the safeguarding of vulnerable adults were in place. This issue was discussed with two care workers. They said they would report any concerns immediately. However, one of these care workers said she had not received any training in safeguarding vulnerable adults. The other care worker had only worked at the home for a days. It was evident from the care records that a number of residents had challenging behaviour. The nurse in charge said care workers had not been trained in dealing with challenging behaviour. Crawshaw Hall Nursing Home DS0000022508.V342565.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 (older people) 24 and 30 (adults 18-65). Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The premises provided a comfortable and ‘homely’ environment for the residents. EVIDENCE: At the time of the inspection the home was clean and tidy. However, there was a strong smell of urine. Communal rooms are spacious and suitable for a Crawshaw Hall Nursing Home DS0000022508.V342565.R01.S.doc Version 5.2 Page 18 variety of activities. The carpet on the first floor is worn and could increase the risk of falling for some residents. The nurse in charge explained this carpet would be replaced when the home was refurbished. The proprietor said the plans for major improvements to the home have been approved. Some radiators had been fitted with guards and the nurse in charge was advised that risk assessments should be carried out to prioritise this work. The grounds and gardens were well kept and accessible to all residents. Laundry facilities were appropriate for the size of the home. An infection control policy was in place. Crawshaw Hall Nursing Home DS0000022508.V342565.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 (older people) 32,34 and 35 (adults 18-65). Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Members of staff were encouraged to acquire the skills and knowledge necessary in order to meet the needs of the residents. Recruitment practices put residents at risk. EVIDENCE: Examination of the duty rota confirmed that staffing levels were appropriate to meet the assessed needs of the residents. It was evident from discussion with members of staff that some training opportunities were available. This included induction training for new employees and fire safety. Two care workers had NVQ level 2 and 3 in care. In addition to this two care workers were working towards NVQ level 2 and 1 Crawshaw Hall Nursing Home DS0000022508.V342565.R01.S.doc Version 5.2 Page 20 towards NVQ level 4. However, care workers had not received training in dementia care or mental health problems. The files of six members of staff appointed since the last inspection were examined. Four of these files indicated that all the required pre-employment checks to ensure protection of the residents had been completed prior to appointment. However, one employee was allowed to start working at the home before two written references had been obtained. Another employee had been allowed to start induction training at the home before a POVA/CRB check had been received. Crawshaw Hall Nursing Home DS0000022508.V342565.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 (older people) 37,39 and 42 (adults 18-65). Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home was effectively managed but a lack of training for care workers in some areas of health and safety could put residents at risk. Crawshaw Hall Nursing Home DS0000022508.V342565.R01.S.doc Version 5.2 Page 22 EVIDENCE: The registered manager is an experienced nurse and has an NVQ level 4 in management. One care worker said the manager and senior nurse were really helpful and approachable. The home has achieved the nationally accredited Investors in People award. Satisfaction questionnaires were given out to the relatives of residents in May 2007. Completed questionnaires were analysed to help identify areas for improvement. An annual development plan to help monitor the quality of the service and further improve outcomes for residents was not available. Records of transactions involving resident’s money were seen to up to date. Policies and procedures for safe working practices were in place. However, one care worker explained that she had been shown moving and handling procedures by the manager. During the inspection care workers were observed using the underarm lift. This is dangerous and can cause injury to the resident and staff. Fire alarms were tested weekly and emergency lighting annually by a service engineer. Fire drills also took place regularly and a staff attendance record was kept. A fire training DVD was available for staff to watch. Records of the routine servicing of equipment were seen including an electrical installation certificate dated 29/11/05 and gas safety certificate dated 29/03/07. The testing of small electrical appliances was carried out in May 2007. Records maintained in the kitchen included fridge, freezer and food temperatures. Crawshaw Hall Nursing Home DS0000022508.V342565.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 X 2 X 3 3 4 X 5 X 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 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 2 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 X 33 2 34 X 35 3 36 X 37 X 38 2 Crawshaw Hall Nursing Home DS0000022508.V342565.R01.S.doc Version 5.2 Page 24 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 OP7 Standard Regulation 15(1) Timescale for action To ensure the care needs of all 31/08/07 residents are met. Care plans must accurately identify and address the care needs of each resident. This includes challenging behaviour & medical conditions. Timescale of 02/02/07. To ensure residents receive 14/08/07 effective wound care detailed records must be kept of the wound, the dressings to be used and the condition of the wound. Dressings must be changed as frequently as stated in the care plan. Timescale of 10/05/06 and 02/02/07 not met. To ensure medication is 31/08/07 managed safely a record of all medication received into the home must be kept, when the needs of a resident change the GP must be asked to review their medication, all medication changes must be agreed with the resident’s GP, medication must not be used communally each resident must have their own supply. DS0000022508.V342565.R01.S.doc Version 5.2 Page 25 Requirement 2 OP8 17(1)(a) Schedule 3(n) 3 OP9 13(2) Crawshaw Hall Nursing Home 4 OP12 5 OP18 16(2)(m)(n) 13(6) 6 OP19 13(4)(a) 7 OP26 16(2)(k) 8 OP29 19(1)(b) Schedule 2 9 OP38 13(5) To ensure residents do not run out of their prescribed medication a system for reordering must be in place. The medicine trolley must be thoroughly cleaned. To enable residents to have a fulfilling lifestyle a range of leisure suitable activities must be organised. To ensure all residents are protected from abuse All members of staff must have training in safeguarding vulnerable adults and dealing with challenging behaviour. To prevent residents from falling the carpet on the first floor corridor must be repaired or replaced. Timescale of 16/06/06 and 30/03/07 not met. To promote the wellbeing of residents and provide a homely atmosphere the odour problem in one bedroom must be addressed. In order to safeguard residents from abuse two written references and a POVA/CRB check must be obtained before new employees start working at the home. Timescale of 01/11/05, 10/05/06 and 03/01/07 not met. To prevent injury to residents and staff safe moving and handling techniques must always be used. All members of staff must have appropriate training in moving and handling. Timescale of 9/12/05, 28/07/06 and 23/02/07 not met. 26/10/07 30/11/07 30/11/07 31/08/07 10/08/07 31/08/07 Crawshaw Hall Nursing Home DS0000022508.V342565.R01.S.doc Version 5.2 Page 26 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 OP7 2 OP9 3 OP9 4 OP25 5 OP30 6 OP33 Refer to Standard Good Practice Recommendations Residents or their relatives should be involved in planning care. All handwritten instructions on the medicines administration records should be signed and witnessed. The amount of medication remaining from a previous prescription should be ‘carried forward’ onto the next medication administration record. All radiators should be fitted with covers. Risk assessments should be carried to prioritise this work. To ensure care workers have the skills and knowledge in order to meet the needs of the residents it is strongly recommended that they are given appropriate training in dementia care and mental health problems. An annual development plan to help monitor the quality of the service and further improve outcomes for residents should be developed. Crawshaw Hall Nursing Home DS0000022508.V342565.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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. 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