Inspection on 26/01/06 for Cressingham House

This inspection was carried out on 26th January 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.

Other inspections for this house

Cressingham House 18/09/07

Cressingham House 31/05/06

Cressingham House 14/10/05

Cressingham House 28/10/04

Cressingham House 25/05/04

Cressingham House 24/01/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Cressingham House 19 - 25 Cressingham Road Wallasey Wirral CH45 2NS Lead Inspector Inger Moynihan Unannounced Inspection 26th January 2006 08:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Cressingham House DS0000018880.V279186.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. 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. Cressingham House DS0000018880.V279186.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Cressingham House Address 19 - 25 Cressingham Road Wallasey Wirral CH45 2NS 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) 0151 639 4626 Wallasey Free Women`s Church Council (Cressingham House) Mrs Susan Sherwen Care Home 16 Category(ies) of Old age, not falling within any other category registration, with number (16) of places Cressingham House DS0000018880.V279186.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th October 2005 Brief Description of the Service: Cressingham House was first opened as a residential home in 1966 and registered with the Metropolitan Borough of Wirral in 1986. Wallasey Free Church Womens Council set up the home, which is a registered charity (Number 21311). A voluntary management committee represented the owners and managed the registered manager and the deputy manager. At the time of the inspection, the management committee had arranged for Keychange Charity (Number 1061344) to take over the management role of the home for twelve months. During this time, Keychange Charity was expected to make regular reports regarding the operation and activities of the home, to the Trustees. At the end of the twelve months, the Trustees were to make a decision as to whether Keychange charity would assume the management of the home, on a permanent basis. Cressingham House had been converted from four mid-terraced houses. The home was set in a small courtyard garden in a quiet residential road, close to local shops and to the New Brighton promenade. Accommodation was provided on two floors, with communal areas consisting of a large and small lounge and a spacious dining room, which was located on the ground floor. There was no separate visitors room, but all rooms were single and a number were arranged as bed-sitting rooms. Five bedrooms were provided on the ground floor and a further eleven on the first floor. There was one shower/bath on the ground floor and a bath with hoist and a further shower/bath on the first floor. A two-stage stair lift serviced the first floor. Cressingham House DS0000018880.V279186.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over 2 days and was the statutory announced inspection for 2005/2006. A partial tour of the premises took place and service users records were inspected. A selection of staff, service users and relevant health care professionals were spoken to during this inspection. At the last inspection concerns were raised about the overall management of the home in relation to the safety and welfare of the service users. As a result of these concerns various other regulatory bodies were requested to carry out an inspection of this service. What the service does well: A full assessment of service users care needs has now been completed ensure staff know how to provide the appropriate level of care. to Service users health care needs are now compiled into a documented plan of care. This is in line with good practice and ensures staff know how to deliver the required care. Service users physical and mental health care needs are met through the support of relevant healthcare professionals. The activities provided are now more varied and reflect service users interests and choice. Service users are able to maintain contact with family and friends and links within the community. The routines within the home are flexible to ensure service users are able to exercise choice and control in their lives. A varied and balanced diet is provided to ensure service users good health and interest. Staff have been provided with informal training on the protection of vulnerable adults from abuse to ensure service users are protected from harm. A number of staff are involved in training to the National Vocational Qualification (NVQ) standards. A brief training plan for the forthcoming year has been established to ensure suitably qualified and competent staff are employed at the home. Cressingham House DS0000018880.V279186.R01.S.doc Version 5.1 Page 6 Service users live in a home which is run and managed by Mrs Sherwen, a person who is fit to be in charge, is of good character and runs the home for service users best interest. Service users financial interests are safeguarded from abuse. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Cressingham House DS0000018880.V279186.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cressingham House DS0000018880.V279186.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 A full assessment of service users care needs has now been completed ensure staff know how to provide the appropriate level of care. EVIDENCE: An assessment of service users care needs has now been carried out to ensure the staff to know how to provide the appropriate level of care. The assessments cover a range of appropriate information and give staff specific details about service users care needs. The registered manager acknowledged that further work needed to be carried out in this area and agreed to ensure it was completed by 10/2/06. Also two case files had still not been updated. It was agreed this work would be completed by 3/2/06. to Cressingham House DS0000018880.V279186.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 and 9 A documented plan of the care provided to each service user is now in place. This is in line with good practice and ensure staff are clear on how to deliver the required care. Service users physical and mental health care needs are met through the support of relevant healthcare professionals. Although systems are in place for the safe handling, storage and administration of service users medication. However some improvements still need to be made to the record keeping to ensure service users medical welfare. EVIDENCE: A documented plan of the support provided to each service user is in place to ensure staff are provided with the necessary guidance on how to look after the service users in accordance with their required needs. Additional work still needs to be carried out to this documentation to ensure it is an accurate reflection of service users current care needs. Also two case files have yet to be updated. It was agreed this work would be completed by 10/2/06. A part of the care planning process includes staff keeping a record of service users Cressingham House DS0000018880.V279186.R01.S.doc Version 5.1 Page 10 welfare on a regular basis. It was noticed however that in one instance no record had been made for a period of six days. To ensure staff are up to date on all aspects of the service users care requirements, a record of their general welfare must be carried out more frequently. In another instance there was no documented evidence that staff had followed the instructions given by a service users GP. This issue was discussed with the registered manager and it was highlighted that such record keeping is vitally important as it formulates the basis of any future decision-making. The registered manager agreed to address this issue on the day of the inspection. Documentation is in place to demonstrate that service users have access to a range of relevant health care professionals to support them with their physical and mental welfare. A selection of healthcare professionals were contacted during this inspection in order to seek out their views on the standards of care provided at Cressingham House. All of these healthcare professionals spoke highly of the standard of care provided at Cressingham House. Their comments included Cressingham House is a very good home, the staff are always on the ball with the patients care needs and I find them very receptive and open to my guidance and instructions. Other comments included the staff are aware of the service users care needs and are very open and flexible in their style of care. I have never seen any signs of neglect or abuse and the service users only praise the staff for their hard work and caring nature. This is a very positive aspect of the home and reflects well upon me registered manager and staff team. The service user spoken to during inspection confirmed they always had access to relevant health care professionals such as heard GP and district nurse when necessary. One service user spoken to during inspection said she was extremely happy with the care she received. Her comments included the staff are so kind and I feel my needs are fully met. I really cant speak highly enough of the staff team. At the last inspection concerns were raised about the way in which service users medication was being managed. As a result of these concerns the pharmacy inspector from the CSCI was asked to carry out an inspection of the service. This inspection resulted in 4 requirements and 3 recommendations. Since this time the registered manager has demonstrated a commitment to ensuring improvements in this aspect of care provision. However the following issues did arise which the registered person is required to address to ensure service users welfare and safety: • The medication administration record sheets indicated that changes had been made to service users medication, however this information was not recorded in the service users care plan in order to explain why this change had occurred. DS0000018880.V279186.R01.S.doc Version 5.1 Page 11 Cressingham House • • Staff had not signed the medication administration record sheets to indicate that any creams had been administered. Not all staff have completed training in relation to the safe handling of service users medication. To ensure service users are receiving the required medical care, the registered person must ensure all medication administration record sheets are kept up to date. Cressingham House DS0000018880.V279186.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 The activities provided are now more varied to reflect service users interests and care needs. Service users are able to maintain contact with family and friends and links within the community. The routines in the home are flexible which means service users can exercise choice and control in their lives. A varied and balanced diet is provided to ensure service users good health and interest. EVIDENCE: Staff continue to provide a range of activities and work is being undertaken by the registered manager to develop this aspect of care provision. One of the health care professionals spoken to during the inspection praised the staff team for addressing this aspect of care provision. A Chaplin visits the home on a regular basis to offer service users communion and support when required. The Chaplin spoke highly of the staff team and the standard of care provided. He stated he had been visiting the home for about 30 years and had always Cressingham House DS0000018880.V279186.R01.S.doc Version 5.1 Page 13 found the staff to be professional and courteous. He confirmed he had no complaints to make. The service users confirmed the routines in the home are flexible and they can come and go as they wish. Service users relatives are welcome to visit the home at any time. The registered manager stated that since last inspection improvements have been made to the menu planning and a more varied menu is now in place to ensure service users interest and good health. Nutritional assessments have also been carried out. A Community Nurse for older people was also carrying out an assessment of service users general health care needs and has given the staff advice and guidance around nutritional healthcare. Service users confirmed they enjoyed their meals and a choice was always available. Cressingham House DS0000018880.V279186.R01.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Staff have been provided with informal training on the protection of vulnerable adults from abuse to ensure service users are protected from harm. Some improvements need to be made to the complaints procedure to ensure service users and all relevant stakeholders are aware of who they can contact in the event of them wishing to make a complaint. EVIDENCE: The registered manager is in the process of arranging training on the protection of vulnerable adults from abuse. It is anticipated this will be completed by April 2006. In the interim the registered manager has provided staff with an informal training session in this aspect of care provision. For service users further protection, the registered manager has provided the telephone number of the organisation Action on Elder Abuse where staff and service users can report any incidents of abuse anonymously. A documented is complaint procedure is in place. Further details do need to be included in this document to ensure service users and relevant stakeholders are aware of who they can contact in the event of them wishing to make a complaint and the procedure they should follow. Cressingham House DS0000018880.V279186.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 The standard of the decor is mixed with some parts of the home being maintained to a good standard and other parts being in need of further decoration and refurbishment. The home does not therefore present as a homely and comfortable environment throughout. EVIDENCE: Since the last inspection no further improvements have been made to the home although it is acknowledged that working is being undertaken to address this issue. While the ground floor accommodation is comfortable and homely, improvement still need to be made to the bathrooms and toilets and first floor accommodation, as at present it does not meet the National Minimum Standards For Older People. The following issues were raised during inspection: • • • Light shades had not always been provided in bathrooms and toilets tile grouting is blacked the paint on the water pipes was flaking and had become blackened DS0000018880.V279186.R01.S.doc Version 5.1 Page 16 Cressingham House • • strip lights were used in the top floor corridor which are deemed more suitable to kitchen and laundry areas the general paintwork was discoloured and scratched. All of these points contributed to providing an unwelcoming and somewhat institutional environment. Through discussion with the registered manager it is clear the registered provider, through Keychange Charity, has made a commitment to ensuring the standards of the facilities are improved. Some building work has already been carried out to provide en suite facilities in a number of vacant bedrooms, although this work has currently been put on hold. The representatives from the Keychange Charity continue to keep the CSCI up to date on the developments of this work. All parts of the home are clean and tidy and comfortably warm. Cressingham House DS0000018880.V279186.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29 and 30 Staff files do not hold all of the required information in order to demonstrate that thorough recruitment procedures have been carried out. A number of staff are involved in training to the NVQ standards and a brief training plan for the forthcoming year has been established to ensure suitably qualified and competent staff are employed at the home. EVIDENCE: Prior to any member of staff being employed at the home, a Criminal Records Bureau check is taken up along with two staff references. However, staff records examined did not hold all the other required information to demonstrate that thorough recruitment procedures have been followed. In the light of this the registered person is required to ensure all staff records hold the required information as stipulated in Schedule 2 of the Care Homes Regulations 2001. A number of care staff are attending NVQ training and the registered manager has identified future training for the staff team. While it was acknowledged that this training audit was appropriate, it does need to be developed to ensure all service users care needs are included. The registered manager stated that plans were being made for a more detailed training audit to be carried out in Cressingham House DS0000018880.V279186.R01.S.doc Version 5.1 Page 18 the near future with a representative of the Keychange Charity. In the light of this, the registered person is required to write to the CSCI and inform the inspector of how this issue will be addressed. Cressingham House DS0000018880.V279186.R01.S.doc Version 5.1 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 35 and 38 Service users live in a home which is run and managed by a person, who is fit to be in charge, is of good character and runs the home for service users best interest. Service users financial interests are safeguarded from abuse. The health, safety welfare of the service users and staff is promoted throughout the home. However, some improvements still need to be made in this area of care to ensure staff and service users safety. EVIDENCE: Mrs Susan Sherwen is now the registered manager of Cressingham House and during discussion she demonstrated a commitment to ensuring the service continues to be run for service users best interest. Mrs Sherwen has clearly worked very hard to address all of the requirements and recommendations made following the last inspection and subsequent inspections carried out by Cressingham House DS0000018880.V279186.R01.S.doc Version 5.1 Page 20 other regulatory bodies. Mrs Sherwen has implemented new management systems for the smooth running of the home and the improved service provision. In 2004 arrangements were made for a charity, Keychange Charity, to take over the management of the home. While Keychange Charity is not yet registered with the CSCI for this service, they have taken on an advisory role with regard to the management and development of the home. The registered manager takes responsibility for the finances of one service user. The records inspected were in good order. Overall the systems in place to ensure service users health and safety are now much improved. Increased monitoring now takes place with appropriate records being maintained. At the last inspection a number of concerns were raised in relation to the maintenance of the equipment within the home. As a result of this the Department of Environmental Health was asked to carry out an inspection of the home. This inspection resulted in one issue being raised in relation to be servicing of the bath hoist. The registered manager is in the process of addressing this issue. The storeroom under the stairs which held equipment that may present as a danger to service users was not fitted with a lock. The registered manager agreed to remove any items of potential danger immediately and ensure a lock was fitted by the end of the week. At the last inspection, a number of concerns were raised in relation to the Fire safety in the building. As a result of these concerns the Fire Department was asked to carry out an inspection of the home. The registered manager stated she has now addressed all of the outstanding issues although it was noted that doors were still being wedged open. Wedging doors open is not acceptable and could place both service users and staff at risk of harm in the event of a fire. In the light of this, the registered person is required to ensure correct door opening devices are fitted. Cressingham House DS0000018880.V279186.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 2 x x x x x x 3 STAFFING Standard No Score 27 x 28 x 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x x x 3 x x 2 Cressingham House DS0000018880.V279186.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? yes 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 2 3 Standard OP3 OP7 OP7 Regulation 14 15 15 Requirement The registered person is required to ensure all assessments are fully updated. The registered person is required to ensure all care plans are fully updated. The Registered person is required to ensure all records relating to service users welfare are kept up to date at all times The registered person is required to ensure a record is kept of the reasons why any changes are made to service users medication. The registered person is required to ensure the medication administration record sheets are signed to indicate any prescribed creams are administered. The provider is required to ensure that all carers handling medication have complete assessed and certificated training. The registered person is required to ensure the complaint procedure is developed to ensure service users and stakeholders DS0000018880.V279186.R01.S.doc Timescale for action 10/02/06 10/02/06 10/02/06 4 OP9 18 10/02/06 5 OP9 18 10/02/06 6 OP9 18 31/03/06 7 OP16 22 02/03/06 Cressingham House Version 5.1 Page 23 8 9 OP19 OP29 23 19 10 OP30 18 11 OP38 13 12 OP38 13 are aware of the homes procedure. The registered person is required to ensure the standard of the decor is improved. The registered person is required to ensure all records relating the employment of staff are in place and available for inspection. The registered person is required to ensure suitably qualified and competent staff are employed in the home. In this instance that training audit is carried out with the staff team. The registered person is required to ensure the health, safety and welfare of the service users. In this instance that doors are not wedged open and proper door opening devices are fitted. The registered person is required to ensure the health, safety and welfare of the service users In this instance that a lock is fitted to the storeroom door if potentially dangerous equipment is being stored there. 01/08/06 02/03/06 01/04/06 16/03/06 10/02/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. . . Refer to Standard Good Practice Recommendations There are no recommendations resulting from this inspection. Cressingham House DS0000018880.V279186.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Liverpool Local Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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