Inspection on 04/01/08 for Crawshaw Hall Nursing Home

This inspection was carried out on 4th January 2008.

CSCI found this care home to be providing an Poor service.

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 24/07/07

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 4th January 2008 09:30 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.V353915.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.V353915.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.V353915.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. 24th July 2007 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 - £750 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.V353915.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. A key unannounced inspection, which included a visit to the home, was conducted at Crawshaw Hall Nursing Home on the 4th January 2008. A random unannounced inspection was carried out on 15th October 2007 to monitor compliance with the requirements issued at the last Key inspection in July 2007. One completed survey was received from a resident, two from the relatives of residents and one from a GP. At the time of this inspection 17 residents were living at the home. A tour of the premises took place and staff files and care records were inspected. A pharmacist inspector inspected all aspects of the management of medication. Members of staff on duty, residents and one visitor were spoken to. Discussions also took place with the proprietor, the manager and two nurses regarding issues raised during the inspection. What the service does well: What has improved since the last inspection? At present a major refurbishment of the home is taking place. When this is finished more bedrooms will be single occupancy and have en-suite facilities. Crawshaw Hall Nursing Home DS0000022508.V353915.R01.S.doc Version 5.2 Page 6 A new nurse call system has been installed. Members of staff have received training in dementia care and moving and handling. Recruitment procedures have improved to ensure two written references and a Criminal Records Bureau check are obtained before a new member of staff starts working at the home. What they could do better: Failure to address the requirements made about care planning at previous inspections is of very serious concern. Urgent action must be taken to ensure all care plans accurately identify and address all the care needs of each resident. It is essential that detailed records be kept about the condition of wounds and pressure sores. Risk assessments for falls, nutrition and pressure sores must be in place for each resident. It is essential that urgent action be taken to ensure medication is managed safely. Medicines must be given to residents as prescribed to help ensure their health and well being is maintained. Records of medicines received into the home and administered to residents must be accurate to help checks take place to show that medicines are being given to residents correctly. Medicines prescribed as “when required” or, as a “variable dose” should have clear written instructions for staff to follow to ensure they are given correctly. Regular recorded checks (Audits) of the medicines records and stock must be carried out to ensure residents are having their medicines correctly administered. Nursing staff should be regularly assessed as competent in handling medicines to ensure residents receive them correctly. Action must be taken to provide the support necessary for residents to have a fulfilling lifestyle. A range of suitable leisure activities must be organised regularly for residents. It is strongly recommended that sufficient supernumerary hours be allocated for the manager to enable him to effectively fulfil his managerial responsibilities. It is important that the proprietor makes an unannounced visit to the home every month and writes a report under regulation 26 for the manager. This report must include information about the conduct of the home and evidence obtained from the residents and if possible their relatives and staff. It is also good practice to send a copy of this report to the commission. Crawshaw Hall Nursing Home DS0000022508.V353915.R01.S.doc Version 5.2 Page 7 To promote the health and safety of resident’s footrests must always be in place on all wheelchairs. If a resident does not wish to use footplates, this must be subject to a risk assessment and recorded in individual care plans. 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.V353915.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.V353915.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 manager or senior member of staff visited and assessed prospective residents in hospital or their own home before admission. The care records of two residents recently admitted to the home included a pre-admission assessment. These assessments provided important information for the care plans. Crawshaw Hall Nursing Home DS0000022508.V353915.R01.S.doc Version 5.2 Page 10 Prospective residents or their relatives also 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.V353915.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 mean residents do not always receive person centred care. Medicines are not always administered to residents correctly, which could seriously affect their health and wellbeing. EVIDENCE: Crawshaw Hall Nursing Home DS0000022508.V353915.R01.S.doc Version 5.2 Page 12 The individual care plans of two residents were inspected. These plans did not identify and address all the care needs of each resident. The pre-admission assessment for one resident stated that he was blind in one eye and had hearing problems. This resident also had a behavioural chart where members of staff recorded all incidents of challenging behaviour. However, care plans, which gave clear guidance for staff to follow about how to manage these problems, were not in place. The care plan for the other residents indicated that she was not able to decide when she wanted to go to bed and had difficulty sleeping. Information about how care workers would know when she was tired and needed to go to bed and what to do to help her settle down to sleep were not included in the care plan. Care plans for this resident also gave conflicting advice. One care plan stated her speech was incoherent but another care plan stated she should inform staff if she is having any difficulty in walking. Care plans about eating and drinking, mobilising and personal cleansing and dressing were exactly the same for both these residents and not person centred. Falls risk assessments had not been carried out for these two residents and risk assessments for nutrition and pressure sores were not in place for one of them. The wound care records of another resident were inspected. Although a care plan for the treatment of the wounds was in place detailed information about the condition of the wounds at each dressing change was not recorded. A written report about the care given to individual residents was completed during each shift. Care plans were reviewed monthly. Where possible the resident or their relatives were involved in care planning. Residents were registered with a GP and had access to other healthcare professionals. As part of this inspection the pharmacist inspector looked at the medicines records and the storage arrangements to ensure improvements in medicines handling had been made since the last key inspection. We checked medicines records against current stock and found some medicines did not add up correctly. Of particular concern was the number of medicines that had been allowed to run out of stock. Staff had failed to act Crawshaw Hall Nursing Home DS0000022508.V353915.R01.S.doc Version 5.2 Page 13 promptly to re order them, which had resulted in six residents going without prescribed medicines for up to twelve days. One resident had not had their strong pain relief patch replaced as it should have been three days early, we had to tell staff about this and they replaced the patch immediately. Going without prescribed medicines can seriously affect the health and well being of residents. We tried to carry out detailed checks on the medicines but this was very difficult because records of medicines receipt and administration were not always accurately made, although records of medicines disposal were now more detailed. The previous key inspection highlighted this issue but no significant improvements had been made. Handwritten records, particularly for new residents and new supplies of medicines, were still inaccurate. Important information was either left off or incorrectly written, which could lead to mistakes when administering the medicines. A previous pharmacist inspection had highlighted this but no improvements in this had been made. We looked at a medicine powder used for residents with swallowing difficulties and found the information to support its use was not sufficiently detailed, this could result in residents having further swallowing problems which could seriously affect their health and well being. We also found that all residents were sharing one ‘tub’, this is illegal as medicines prescribed to a person are for their use only. Medicines prescribed as ‘when required’ did not have detailed written care plans. In particular, three medicines used for agitation did not have enough information to support their safe use and one of these was not written on the ‘current’ list of medicines. This could result in residents getting medicines that they do not need or not getting medicines that they do need. The manager described how he had checked the medicines records and stock but this had not been carried out for sometime and did not check all aspects of medicines handling. A detailed audit is not carried out and the set up of the current system makes checking the medicines difficult. Audits are important because they check whether residents are receiving their medicines correctly and also ensure staff are competent. Personal care was carried out in the privacy of the resident’s own room or the bathroom. Care workers were observed attending to residents in a polite and friendly manner. One resident said, “They do their best.” One visitor explained her friend was well cared for and staff were very good. Crawshaw Hall Nursing Home DS0000022508.V353915.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 a lack of suitable leisure activities means residents do not have the opportunity to participate in meaningful activities of their choice. EVIDENCE: Members of staff said craft activities were occasionally organised but residents usually listened to music or watched television. Crawshaw Hall Nursing Home DS0000022508.V353915.R01.S.doc Version 5.2 Page 15 On the morning of the inspection three residents were left in the dining room for more than an hour without anything to do. One of these residents was observed to be agitated and banging on the table. One resident who completed the survey put never in answer to the question, are there activities arranged by the home that you can take part in. Visitors were welcomed into the home at anytime. One member of staff explained the daily routine was flexible and residents could choose when to get up and go to bed. Residents were encouraged to personalise their rooms with ornaments, photographs etc. A light meal of sandwiches and dessert was served at lunchtime on the day of the inspection. The manager explained that a cooked breakfast was served every morning and the main meal was in the evening. All the residents asked said the meals were good. Crawshaw Hall Nursing Home DS0000022508.V353915.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 good. 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 a good understanding of protection issues. EVIDENCE: A copy of the complaints procedure was displayed in the home. No complaints have been made to the manager or the commission since the last inspection. The relative of a resident who completed a survey wrote, ‘If there was a problem I could speak to them immediately.’ Policies and procedures for the safeguarding of vulnerable adults were in place. This issue was discussed with one care worker. She said she would report any concerns immediately. Training for members of staff in safeguarding vulnerable adults was arranged for 16 January 2008. Crawshaw Hall Nursing Home DS0000022508.V353915.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 present a major refurbishment of the home is taking place. This work is being carried out with the minimum of disruption possible to the residents and Crawshaw Hall Nursing Home DS0000022508.V353915.R01.S.doc Version 5.2 Page 18 will provide more single en-suite bedrooms. Bedrooms will have new carpets, curtains, furniture, a wall mounted television and a radio/CD player. All radiators will be covered and a new nurse call system has been installed. Despite all the work the home was clean and tidy and free from offensive odour. 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.V353915.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 good. 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 needed to provide effective care for the residents. Recruitment procedures were thorough. EVIDENCE: Examination of the duty rota confirmed that staffing levels were appropriate to meet the assessed needs of the residents. Discussion with the proprietor, manager and a care worker confirmed that training opportunities were available for all members of staff. This included, induction training for new employees, dementia care, health and safety, basic food hygiene, first aid, infection control and moving and handling. Crawshaw Hall Nursing Home DS0000022508.V353915.R01.S.doc Version 5.2 Page 20 Three care workers had NVQ level 2 in health and social care and another two were working towards this qualification. One member of staff had been appointed since the last inspection. Examination of the file of this employee confirmed that all the required preemployment checks had been carried out before she had started working at the home. Crawshaw Hall Nursing Home DS0000022508.V353915.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): 31,33,35,37 and 38 (older people) and 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. Management arrangements do not ensure all residents receive person centred care nor do they ensure the national minimum standards are met. Crawshaw Hall Nursing Home DS0000022508.V353915.R01.S.doc Version 5.2 Page 22 EVIDENCE: The registered manager is an experienced nurse and keeps up to date with current practice by reading a variety of care journals and attending relevant training courses. The manager explained that it was difficult for him to complete all the management responsibilities when he was also on duty as the nurse in charge. It is strongly recommended that for one or two shifts every week another nurse is on duty with the manager to allow him to fully meet the requirements of his role as registered manager. This would also ensure the manager had time for checking medication was managed correctly and care plans were person centred. The home has achieved the nationally accredited Investors in People award. Satisfaction questionnaires were ready to be given out to residents and their relatives later in January. 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. Although the proprietor regularly visited the home he did not demonstrate his supervision and support of the manager by completing a written report for the manager every month. Policies and procedures for safe working practices were in place. However, care workers were observed using a wheelchair without the footrests in place. This is dangerous and can result in injury to the resident. If a resident does not wish to use footplates, this must be subject to a risk assessment and recorded in individual care plans. Fire alarms and emergency lighting were tested regularly. Fire drills also took place regularly and a staff attendance record was kept. Records of the routine servicing of equipment were available. These included up to date gas safety and electrical installation certificates. Crawshaw Hall Nursing Home DS0000022508.V353915.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 1 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 ENVIRONMENT Standard No Score 19 3 20 X 21 X 22 X 23 X 24 X 25 X 26 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 2 32 X 33 2 34 X 35 3 36 X 37 2 38 2 Crawshaw Hall Nursing Home DS0000022508.V353915.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. Standard OP7 Regulation 15(1) Requirement To ensure the care needs of all residents are met. Care plans must accurately identify and address the care needs of each resident. Timescale of 02/02/07, 31/08/07 and 29/11/07 not met. In order to identify those residents who are at risk of falling a falls risk assessment must be carried out for all residents. Timescale for action 15/02/08 2 OP7 13(4)(c) 25/01/08 3 OP8 12(1)(a)(b) 4 OP8 To ensure the healthcare 25/01/08 needs of all residents are identified risk assessments relating to nutrition and the development of pressure sores must be carried out. 17(1)(a)Schedule To ensure residents receive 25/01/08 3(n) effective wound care detailed records must be kept of the condition of the wound at each dressing change. Timescale of DS0000022508.V353915.R01.S.doc Version 5.2 Page 25 Crawshaw Hall Nursing Home 5 OP9 13(2) 10/05/06, 02/02/07, 14/08/07 and 16/11/07 not met. Medicines must be given to 25/01/08 residents as prescribed and at the right time in relation to food intake. Receiving medicines at the wrong dose, wrong time or not all can seriously affect the health and well being of residents. Timescale of 18/11/07 not met. Systems must be put in place that ensure the quality of medicines handling is maintained. Robust recorded audits will ensure residents receive their medicines as prescribed and ensure staff are competent. Timescale of 18/11/07 not met. Nursing staff should be assessed as competent in handling medicines to ensure residents receive them correctly. Timescale of 18/11/07 not met. An accurate record must be made of all medicines administered to residents to help prevent mistakes. Timescale of 18/11/07 not met. 22/02/08 6 OP9 24(1) 7 OP9 18(1)(a) 22/02/08 8 OP9 Schedule 3 17(1)(a) 3(i) 25/01/08 9 OP9 13(2) To ensure medication is 25/01/08 managed safely a record of all medication received into the home must be kept. Medication must not be DS0000022508.V353915.R01.S.doc Version 5.2 Page 26 Crawshaw Hall Nursing Home 10 OP12 16(2)(n) 11 OP37 17(2) Schedule 4 (5) used communally each resident must have their own supply. Timescale of 31/08/07 and 18/11/07 To enable residents to 29/02/08 have a fulfilling lifestyle a range of leisure suitable activities must be organised. To ensure the manager 22/02/08 receives proper support and supervision the registered person must make an unannounced visit to the home every month and provide a report for the manager under regulation 26. A copy of this report should be supplied to the commission. To prevent injury to residents wheelchairs with footrests in place must always be used unless a risk assessment states otherwise. 25/01/08 12 OP38 13(5) 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 2 3 Refer to Standard OP7 OP9 OP9 Good Practice Recommendations Care plans should be person centred and not exact copies of each other. All handwritten instructions on the medicines administration records should be signed and witnessed. Medicines prescribed as “when required” or, as a “variable dose” should have clear written instructions for staff to follow to ensure they are given correctly. DS0000022508.V353915.R01.S.doc Version 5.2 Page 27 Crawshaw Hall Nursing Home 4 OP31 5 OP33 It is strongly recommended that the manager is allocated supernumerary time in order to effectively fulfil all managerial responsibilities. 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.V353915.R01.S.doc Version 5.2 Page 28 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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