Inspection on 22/01/07 for Crispins and Loadhams Nursing Homes

This inspection was carried out on 22nd January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Crispins and Loadhams Nursing... 07/11/07

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The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Crispins and Loadhams Nursing Homes 43/43a Waverley Lane Farnham Surrey GU9 8BH Lead Inspector Lesley Garrett Key Unannounced Inspection 22nd January 2007 09:30 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 Crispins and Loadhams Nursing Homes DS0000068007.V328653.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. 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. Crispins and Loadhams Nursing Homes DS0000068007.V328653.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Crispins and Loadhams Nursing Homes Address 43/43a Waverley Lane Farnham Surrey GU9 8BH 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) 01252 710574 01252 719007 www.bupa.com BUPA Care Homes (CFH Care) Limited Mrs Angela Mary Ashby Care Home 37 Category(ies) of Old age, not falling within any other category registration, with number (37) of places Crispins and Loadhams Nursing Homes DS0000068007.V328653.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 1 resident currently under age 65 Date of last inspection Brief Description of the Service: Crispins and Loadhams is a care home providing nursing care for thirty-seven service users with old age. The home has been owned by BUPA since September 2005. There are two separate buildings located in large grounds in Farnham. The service users have easy access to the grounds, which have been kept tidy and safe. The home provides accommodation over two floors, which can be accessed by a lift. Both houses provide single and double bedrooms the majority with en-suite bathroom facilities. Communal facilities including dining room, lounges and bathrooms are provided for the comfort of the service users. There is parking available for both houses. The weekly fees are between £720 - 1200 Crispins and Loadhams Nursing Homes DS0000068007.V328653.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced site visit formed part of a key inspection and took place over six and a half hours commencing at 0930 and finishing at 1600. Mrs L Garrett regulation inspector completed the visit. The registered manager assisted the inspector with the inspection process and members of staff were interviewed. A tour of the premises took place and the inspector spoke to some service users and viewed their bedrooms. A pre-inspection questionnaire has been completed by the service and the information provided will assist with this report. Feedback has also been received from comment cards completed by service users and their relatives. Records were sampled as part of the inspection process including care plans and policies and procedures. The inspector would like to thank the service users and staff for their time, assistance and hospitality during this site visit. What the service does well: What has improved since the last inspection? This is the first key inspection. Crispins and Loadhams Nursing Homes DS0000068007.V328653.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. Crispins and Loadhams Nursing Homes DS0000068007.V328653.R01.S.doc Version 5.2 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 Crispins and Loadhams Nursing Homes DS0000068007.V328653.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The pre-admission assessment that is undertaken ensures that service users can be confident that their health care needs will be met. The home has no intermediate care beds. EVIDENCE: The registered manager stated that she carries out all pre-admission assessments or another suitably qualified registered nurse prior to service users moving into the home. Three individual plans of care were sampled on the day of the site visit that demonstrated that the assessments had been completed. One service user told the inspector that the first time she met the manager was in her own home when an assessment of her needs took place. The home does not provide intermediate care beds. Crispins and Loadhams Nursing Homes DS0000068007.V328653.R01.S.doc Version 5.2 Page 9 Crispins and Loadhams Nursing Homes DS0000068007.V328653.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users have individual plans, which reflect the care, and support they require and their health care needs are fully met. Medication policies and procedures are in place that staff use that protects service users during this procedure. The privacy and dignity of the service users is respected. EVIDENCE: Three individual plans of care were sampled and were found to contain care plans, risk assessments and daily notes. The manager stated that service users and their representatives are consulted and this was evidenced in the documentation. The manager also said that the registered nurses are now responsible for transferring to the new documentation that BUPA are now using called QUEST. The inspector sampled the documentation and spoke with the individual responsible for compiling the system and found this to be Crispins and Loadhams Nursing Homes DS0000068007.V328653.R01.S.doc Version 5.2 Page 11 comprehensive. Staff had now received their training and their comments were also positive. The manager told the inspector that the home has the services of five general practitioners (G.P.) who will visit the home when called by the registered nurses. The manager also said that service users could retain their existing G.P. if they wish to do so and that the G.P.’s were in the middle of medication reviews for service users. The home also has the support of other specialist’s and the manager explained that the dietician’s will visit and speech and language specialist comes when required. The tissue viability nurse, palliative care and Parkinson’s nurse have all visited various service users when the need arises. The inspector sampled three medication administration records (MAR) and found that they contained no gaps. The medication policy is available for all registered nurses that administer the medications and the inspector saw this policy. The inspector noted that blister packs are used for the administration of tablets and the home’s local pharmacist dispenses this. It will be a recommendation at the end of the report that all hand written entries has the signature of two members of staff. The home has a privacy and dignity policy and the manager stated the subject is also discussed with new members of staff at their induction. The inspector observed staff knocking on bedroom doors prior to entering and shared rooms have curtains dividing the room. The manager explained that the service users preferred name is documented in the assessment sheet and staff made aware of it. The laundress explained the systems in place that ensured that service users wore their own clothes at all times. All service users have access to a telephone. They either have their own private line or a portable phone can be connected in their room if requested to make a call in private. Crispins and Loadhams Nursing Homes DS0000068007.V328653.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are provided with activities that match their expectations and preferences. They can maintain links with their families and friends and have access to the local community as they wish. Service users are helped to exercise choice and control in their lives and receive a wholesome balanced diet. EVIDENCE: The home has now recruited an activities coordinator and the inspector met with her. She told the inspector that she had started to compile their life plans and to talk with them to seek their opinion on activity provision. A programme is displayed and this includes group activities and one to one sessions. The activities organiser said that the home has access to a mini bus and Christmas shopping trips had been organised last year. The home also has a visiting PAT dog and the activity organiser said that these sessions are enjoyed. Crispins and Loadhams Nursing Homes DS0000068007.V328653.R01.S.doc Version 5.2 Page 13 The manager stated that some service users were able to visit the local church for the Christmas service and once a month there is a communion service for those that wish to participate and the Roman Catholic priest visits regularly. The manager told the inspector that religion is discussed with the service users on admission and the appropriate religious minister contacted if that is their wish. Family and friends are welcomed to the home and the manager said there are no restrictions to the visiting time. It was also stated that all visitors to the home could see their relative or friend in private if requested. The manager stated that service users are able to make choices in their daily lives. Service users stated that they are given a choice of meal and may choose the time they get up in the morning or go to bed. Observation of service users’ bedroom confirmed that personal possessions are permitted in the home. The inspector met with the Head Chef who has been at the home for three months. He has another part time chef and kitchen assistant. An example of good practice noticed by the inspector was a poster on the wall in the kitchen informing the night staff of the food that is available should a service user request during the night shift. The chef explained the various checks that must be made on the food and storage and where this is documented. The service users that the inspector spoke with were complimentary about the food. One service user said ‘the food is very good’ and another said ‘the food is good and the chef is very nice’. Crispins and Loadhams Nursing Homes DS0000068007.V328653.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users and their relatives can be sure that any complaint will be taken seriously and acted upon. Service users are protected from abuse as staff had clear knowledge of the procedures for safeguarding their welfare. EVIDENCE: During this site visit the inspector saw, clearly displayed, the home’s complaint policy and this contained clear timescales for action. Comment cards received by the Commission prior to the site visit indicated that most of the respondents knew about the policy. The manager keeps a complaints log and all complaints received last year were resolved within the timescales and there are no on going issues. The home has a safeguarding adults policy and the manager stated that home also uses the local authority policy. There was one referral made under the local authority procedures, last year, which has been satisfactorily resolved. The staff receives training in this area and the inspector looked at the training plan to confirm this. Crispins and Loadhams Nursing Homes DS0000068007.V328653.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is maintained, decorated and furnished to a good standard and the facilities are safe and clean. EVIDENCE: Both of the buildings within the grounds are well maintained and decorated to a good standard. The manager stated that just before Christmas both lounges were decorated and new curtains bought. The manager told the inspector that she has regular discussions with her line manager about replacing some of the curtains, carpets and furniture. The home has a new full time maintenance person who was away training on the day of the site visit. The manager stated that he is responsible for all the Crispins and Loadhams Nursing Homes DS0000068007.V328653.R01.S.doc Version 5.2 Page 16 routine checks for example water temperatures and fire alarms. The grounds were observed to be tidy, safe and accessible for service users. During the tour of the building the inspector observed the home to be clean, hygienic and free from offensive odours. The laundry person spoke with the inspector and explained the systems in place for doing the laundry for both homes to ensure that service users receive their own clothes. She has a sewing machine and is able to repair items of clothing if required and to sew on nametapes. The laundry was clean and tidy with enough space to ensure dirty and clean laundry are not mixed. Crispins and Loadhams Nursing Homes DS0000068007.V328653.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The number of staff and the skill mix was adequate to meet service users assessed needs and training (including national vocational training) takes place to ensure service users are in safe hands at all times and that staff are competent to do their jobs. Service users are protected by the home’s recruitment policy and procedures. EVIDENCE: There were adequate numbers of staff on duty for the number and needs of service users, with a good skill mix. The inspector looked at the rotas and the staff rota sent with the pre-inspection questionnaire and found numbers were consistent. The manager stated that the home has the capacity to increase staff numbers if dependency levels increased. The deputy manager positions for both buildings were vacant. The manager stated that she has sufficient staff to cover these vacancies pending recruitment of new staff and that the posts have been advertised. National Vocational Qualification (NVQ) training takes place regularly and over 50 of staff has this certificate. The training co-ordinator works with new staff Crispins and Loadhams Nursing Homes DS0000068007.V328653.R01.S.doc Version 5.2 Page 18 on the induction programme, which is linked with the ‘skills for care’ induction standards. The inspector sampled two recruitment folders. The home had all the necessary documentation required including two references, application form and gaps in employment history had been explored on a separate sheet. All applicants have had a criminal record bureau check. The inspector spoke with the training co-ordinator who explained that all mandatory training takes place and this includes fire awareness, protection of vulnerable adults and manual handling. A record was sampled of all training that has taken place and that which is planned. Crispins and Loadhams Nursing Homes DS0000068007.V328653.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is run by a manager that is fit to be in charge and is run in the best interests of the service users. Service user’s financial interests are safeguarded. The health, safety and welfare of service users are promoted and protected. EVIDENCE: The inspector spoke with the manager who has enjoyed her extended role to include both of the homes. She is supported by her operations manager and has clear lines of accountability which she said enables her to do her job well. She stated that she has now nearly completed her registered managers award. Crispins and Loadhams Nursing Homes DS0000068007.V328653.R01.S.doc Version 5.2 Page 20 The manager advised that she has always operated an open door policy and service users and relatives or representatives can speak to her at anytime. She holds service user meetings every three months and relatives are also invited with minutes kept of the meetings. The manager has completed service user surveys but it is recommended that the home seek the views of other stakeholders also. The inspector had the opportunity to speak with the home’s administrator. She said that a personal allowance account is kept for the service users if they wish. All transactions are documented with receipts kept. The administrator said that service users are supported to manage their own finances if they are able and wish to do so. The inspector had the pre-admission questionnaire to check that certain health and safety checks and certificates were in place and these included the electrical certificate. The gas certificate and the lift have been checked as was evidenced by certificates that were also made available on the day of the site visit. The manager stated that fire alarms are tested weekly and that the home has had a full health and safety audit. Crispins and Loadhams Nursing Homes DS0000068007.V328653.R01.S.doc Version 5.2 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 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 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 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Crispins and Loadhams Nursing Homes DS0000068007.V328653.R01.S.doc Version 5.2 Page 22 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. Standard Regulation Requirement Timescale for action 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 1 Refer to Standard OP9 OP33 Good Practice Recommendations It is recommended that for all hand written entries on the medication administration record there are the signatures of two registered nurses. It is recommended that the manager seek the views of stakeholders in the community as part of their quality assurance system for example G.P.’s, chiropodist and any voluntary organisations. Crispins and Loadhams Nursing Homes DS0000068007.V328653.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Surrey Area Office The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN 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 Crispins and Loadhams Nursing Homes DS0000068007.V328653.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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