Inspection on 19/02/08 for Crosby Close (1+2)

This inspection was carried out on 19th February 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Crosby Close (1+2) 31/01/09

Crosby Close (1+2) 29/05/07

Crosby Close (1+2) 24/08/06

Crosby Close (1+2) 05/01/06

Crosby Close (1+2) 22/06/05

Crosby Close (1+2) 28/01/05

Crosby Close (1+2) 05/10/04

Crosby Close (1+2) 23/03/04

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Claremont House

Coopers Mill Ltd

Sun Court Nursing Home

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Paradise Lodge

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Upaya Ananda

15 Bramble Close

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

CARE HOME ADULTS 18-65 Crosby Close (1 2) 1 2 Crosby Close Off Hill End Lane St. Albans Hertfordshire AL4 0AT Lead Inspector Sheila Knopp Unannounced Inspection 19th February 2008 10:25 Crosby Close (1 2) DS0000019317.V360089.R01.S.doc Version 5.2 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 Crosby Close (1 2) DS0000019317.V360089.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 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. Crosby Close (1 2) DS0000019317.V360089.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Crosby Close (1 2) Address 1 2 Crosby Close Off Hill End Lane St. Albans Hertfordshire AL4 0AT 01727 834139/833142 01727 838130 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) Macintyre Care (Jacqueline Huck) Carol Halcrow Care Home 12 Category(ies) of Learning disability (12), Physical disability (12) registration, with number of places Crosby Close (1 2) DS0000019317.V360089.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. This home may accommodate 12 people who have learning disability (associated with physical disability) who require nursing care. Records kept in relation to every person containing such details as may be prescribed. First level nurse (RNMH) on duty throughout the 24 hour day supported by additional staff as required by Registering Authority. The additional category of `E` applies to one named service user only. This category will cease if the named service user leaves the home on a permanent basis. 29th May 2007 Date of last inspection Brief Description of the Service: 1 and 2 Crosby Close is a care home providing nursing care and accommodation for 12 adults with learning and physical disabilities. It is owned and managed by Macintyre Care and is a short distance away from St Albans City Centre and the local amenities. The home was opened in 1996 and consists of two detached bungalows, each accommodating 6 service users, in a close of similar buildings. All the home’s bedrooms are single and 10 of the bedrooms have en-suite facilities. Each bungalow has a well-maintained garden, which is easily accessible. The Statement of Purpose is available in each bungalow and is in a pictorial form. A copy of the Service User Guide has been given to each service user and discussed with them. A copy of the most recent inspection report can be obtained from the manager. The current weekly fees for this service are £1336.37 (correct on 29/2/08) Crosby Close (1 2) DS0000019317.V360089.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 1 star. This means the people who use this service experience adequate quality outcomes. The information in this report is based on an unannounced visit to the home by two regulation inspectors carrying out the work of the Commission. For the purposes of this report the Commission will be referred to as ‘we’. We have also reviewed the information we have received about this service between inspections and included information from our last inspection on 29 May 2007 where we feel standards have not changed. This is our second key inspection to Crosby Close within a year. We have carried out a further visit to check on the actions taken by MacIntrye Care following a moving and handling accident that is currently the subject of an investigation by the Health & Safety Executive. The Health & Safety Executive are the enforcing authority for health & safety issues in care homes providing nursing care. What the service does well: The people living at 1 & 2 Crosby Close are supported to achieve a high standard of personal care that reflects their individual needs and maintains their dignity. Their health care need are kept under review and they have access to community specialists to provide additional support. Each person has the aids they need to support their daily lives and promote independence and comfort Each person living at Crosby Close has their own room, which they have made their own by adding personal possessions, and items that provide a focus for relaxation and interest. The modern layout of the home provides light airy spaces with wide corridors and doorways for ease of movement. Relatives are encouraged to be involved in the lives of each individual and the home. Crosby Close (1 2) DS0000019317.V360089.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: MacIntrye Care need to ensure that the monthly visits they are required to do to check on the quality of the service includes an unannounced visit. To demonstrate that decisions are being made in the best interest of each person the manager needs to make sure that the service’s assessment and care planning records for each individual are consistent with the requirements of the Mental Capacity Act. To promote the interests of individual residents, who have no one to support them other than staff in the home, a review of the availability of independent advocacy services should be carried out. To protect residents MacIntyre Care need to review why issues to do with the quality of recording on medicine charts have been allowed to continue across three inspections and ensure the registered nurses are working within current Crosby Close (1 2) DS0000019317.V360089.R01.S.doc Version 5.2 Page 7 professional practice. Enforcement action will be taken if compliance within the required timescales is not demonstrated. To ensure staff are trained to meet the stated aims of the home MacIntrye Care need to ensure the quality of nursing care is kept under review and reflects current professional practice. Opportunities for care staff to attend nationally accredited Learning Disability Qualifications (LDQs) from induction onwards need to be provided To protect residents the manager needs to review the storage arrangements for irritant substances such as dishwasher tablets. 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. Crosby Close (1 2) DS0000019317.V360089.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Crosby Close (1 2) DS0000019317.V360089.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 2 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People using the service can be confident that an assessment will be completed to ensure that the home can meet people’s individual needs. EVIDENCE: No new residents have been admitted since our inspection in August 2006. There are admission procedures in place to ensure a detailed assessment involving other health & social care professionals is carried out to make sure the placement is suitable. Crosby Close (1 2) DS0000019317.V360089.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7 & 9 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The people who live at Crosby Close need wider opportunities made available to them so they can exercise more choice over their lives. EVIDENCE: To review how people are involved in making decisions and organising their day-to-day lives we observed the interaction between residents and staff, had discussions with staff and reviewed 6 care plans. Each person has a care plan that provides detailed information about his or her social and health care needs. Although the majority of the people who live at Crosby Close are unable to express their wishes in a verbal capacity, staff are aware of preferences by monitoring reactions and signs of well being. Staff appeared to have a good understanding of how residents are feeling and about their likes and dislikes. Everyone we met appeared to be relaxed and comfortable. Crosby Close (1 2) DS0000019317.V360089.R01.S.doc Version 5.2 Page 11 The care planning system is currently being reviewed and we saw two examples of the new format, which is designed to provide clearer information on each person’s goals and aspirations and links to the risk assessments in place. The care plans are person centred and regularly reviewed. Overall the information we saw was up to date but there is a tendency for staff to make general statements such as ‘ate most of lunch’ rather than recording more precise measurable information. A moving and handling assessment did not record that the person had epilepsy, which may be significant to remind staff of the risks that may be present when moving them. Recording the precise details of food texture and size, when being cut up, for people at risk of choking will mean there is consistency between staff and accidents may be prevented. The care plans are very large complex documents, which may make it difficult for people who are not familiar with the individual to deliver personalised care. The managers response to discussions about this are that the residents would always have someone who knows them present when their care needs are being attended to. Despite an increase in staffing levels residents who require three people to transfer them safely may have their choice of time to go to bed reduced because only two staff would be available late in the evening. Each person has a named nurse and key worker to support their interests. Independent advocacy services are not currently available to support individual residents or promote the interests of the group through residents meetings and consultations. Crosby Close (1 2) DS0000019317.V360089.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 15, 16 & 17 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The people who live at Crosby Close need to know that staff will respond appropriately to the choices and decisions they make in their every day lives and include them in the running of their home. Residents are provided with freshly cooked nutritionally balanced meals which support their health needs and what they like. EVIDENCE: To review how people were spending their time and being supported to lead fulfilling lives we observed the activities that were taking place in each house, reviewed the information included in care plans and had discussions with staff. Most of the people who live in the home have access to educational day care facilities. Those that spend time at home are taken out into the community. Staff spoke of residents enjoy going out for walks in the park, to the shops and Crosby Close (1 2) DS0000019317.V360089.R01.S.doc Version 5.2 Page 13 on day trips. Residents didn’t have holidays last year due to staffing issues at that time but it is hoped this will be reviewed for the coming year. On the day we visited some residents were going out to a show later in the afternoon. Residents have wheelchair accessible transport, which enables them to go out and about in the community. The manager is aware that more work is required to plan individual programmes for each resident and link them into a daily activity plan for each house so that people can follow their interest and goals. We observed that that the service provided to residents on the day we visited was task led rather than person centred. A resident asked several times if they could go out to the park and was told ‘later, you can go out this afternoon’. There were sufficient staff available to respond to the request but they carried on with their own administrative tasks. We observed that staff generally spoke about residents over their heads. Staff didn’t appear to include residents in the day-to-day running of the house for example, opening the door to visitors and making introductions, talking about the domestic tasks and food preparation as it was carried out. Staff did take the opportunity to spend one to one time with people doing hand massages and manicures. Resident’s families and friends can visit the home at any time and are encouraged to take residents out. Families are in contact by telephone and messages are passed on to residents by staff. The people who live at Crosby Close are provided with a varied and nutritious date. People with dietary or swallowing problems receive active support from dieticians and speech and language therapists. The staff observed providing people with support at meal times and to take fluids during the day were patient and used their skills well to support people with complex needs. Crosby Close (1 2) DS0000019317.V360089.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards -18, 19 & 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people living at Crosby Close are supported to maintain their health and achieve a high standard of personal care that reflects their individual needs and maintains their dignity. However they can not be confident that medication records are always maintained to a satisfactory level to ensure people are protected at all times. EVIDENCE: We observed sensitive interaction between residents and staff. Daily baths or showers maintain personal hygiene to a high standard and staff had provided residents with the mouth they need to maintain good oral hygiene. We reviewed the care plans of three residents in each of the houses, including two in a new format which develops the person centred approach further by focussing more on the outcomes for each resident. They also establish clearer links between the plan of care for each area and risk assessments in place to maintain safety. Staff sign to say they have read the risk assessments in place for each individual but there were no records of how staff competencies are assessed to feed people who are at risk of choking or have food & fluids via a Crosby Close (1 2) DS0000019317.V360089.R01.S.doc Version 5.2 Page 15 tube. The care staff were able to tell us how they carried out these procedures and confirmed they were instructed by the nursing staff. We were able to see that residents have good access to their General Practitioner and specialist community nurses and health care professionals to maintain their health. The manager reported that none of the residents has pressure sores. Residents are provided with the necessary equipment on their beds and chairs to prevent people with limited mobility getting sores. The high level of attention to maintaining their nutritional needs and daily skin care is also a positive factor in maintaining well being in this area. However, one of the care plans we looked at only had very basic information about the assessment and action required by staff to prevent pressure sores. We advised the manager to review the Prevention of Pressure Sore standards issued by the National Institute of Clinical Excellence (NICE) so staff demonstrate clear links between the assessments they have in place and current professional practice. We checked the medicine procedures and again found that we were not able to check the amount of medication given out against the records of stock received. A hand written entry made by a registered nurse on the administration record did not provide enough information for staff to administer the item safely. The registered nurses are individually accountable for making sure correct practices are followed and we have advised they are all issued with a copy of the revised Nursing and Midwifery Council - Standards for Medicines Management (updated Feb 08). An immediate requirement letter has been served and further enforcement action will be taken if the required action is not taken. Crosby Close (1 2) DS0000019317.V360089.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 & 23 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The people who live at Crosby Close can be confident that there are systems in place to respond to problems reported by staff or outside agencies but would benefit from having the support of people outside the home who are aware of the issues very dependent people face in getting their experiences and views across. EVIDENCE: The manager reported that there had been no complaints about the service since our last inspection. Information about how to make a complaint is displayed in each house. However the residents are largely unable to express their views verbally and rely on staff, who know them, to monitor their reactions and responses, on a day to day basis, so they can identify any changes, which may indicate positive and negative feelings. A member of staff observed that the training they receive is not always geared to supporting and enabling staff to promote independence and participation with very dependent people. The views of relatives are also considered as part of their regular contact, care reviews and questionnaires about the service. However the manager reported that residents who do not have anyone other than staff in the home to promote do not currently have access to advocacy services. The manager reported steps are being taken to train staff and review the implications of the Mental Capacity Act in relation to the people who live at Crosby Close (1 2) DS0000019317.V360089.R01.S.doc Version 5.2 Page 17 Crosby Close. This is to demonstrate that all decisions are being taken in their best interests. She anticipates this being included as part of the annual care reviews with social services that are due to take place over the next few months. Our last report referred to an accident in the home being investigated under the multi-agency Hertfordshire Safeguarding Adult procedure following an accident in which a resident fell out of a hoist sling. The police did not take any action following their investigation but we are aware that an investigation by the Health & Safety Executive is on going. New risk management procedures have been introduced and continue to be updated following advice from a moving and handling expert. MacIntrye Care has demonstrated an open and transparent response when discussing incidents with external agencies. Staff receive training in the how to protect vulnerable. The staff we spoke to were confident they would be able to raise any concerns. New staff are issued with a copy of the General Social Care Council Code of Conduct so they are aware of their responsibilities to protect people and conduct themselves appropriately. Our last report confirmed that the manager had reviewed procedures for the safe keeping of service users money and new bank accounts had been opened. At this visit we checked the systems for enabling residents to have access to money for their day to day use and found that appropriate records were being kept to ensure their was a clear audit of how any money had been spent and who had access to the funds. Crosby Close (1 2) DS0000019317.V360089.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24 & 30 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The people at 1 & 2 Crosby Close live in a modern, domestic style environment, which is well maintained, provides specialist equipment and adaptations to meet their needs and allows each person to have their own personal space, which reflects their individual personality. EVIDENCE: Each house offers a comfortable, homely atmosphere to service users. Bedrooms are individually decorated to reflect resident’s personality and taste. A conservatory has been added to house one to provide more space and options for seating and activities that take place. The corridors are wide allowing easy access for people using wheelchairs and mobility aids. Some of the rooms have en-suite facilities and specialist bathing and shower equipment is available in spacious bathrooms. A stained and unsightly chair should be removed from the bathroom on House 2 to make sure a dignified environment is maintained. Crosby Close (1 2) DS0000019317.V360089.R01.S.doc Version 5.2 Page 19 Wooden door gates across the threshold of some of the rooms in House 1 are no longer in use. The manager reported that these will be removed when the corridors are next decorated so that unsightly areas are not left. We found that both houses were clean and fresh. Staff have access to liquid soap and paper towels to promote good hand hygiene. The manager has a copy of the new Department of Health – ‘ Essential Steps to Safe, Clean Care’ self assessment tool which now needs to be carried out as a further check on the systems in place to prevent infection. Crosby Close (1 2) DS0000019317.V360089.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 35 & 35 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The people living at 1 & 2 Crosby Close have benefited from an increase in the number of staff available to support them but may still experience limits being placed on the choices they make. EVIDENCE: We reviewed the staff support residents receive by observing staff practise, during the day, interviewing staff and reviewing rotas and staff recruitment and training records. The staffing levels between the two houses have been increased to provide better cover and support. This includes an additional member of staff at night so there is a member of staff on each house and one person who floats between the two. Three of the residents need three people to help them into bed with the aid of moving and handling equipment. This means if someone chooses to go to bed later in the evening their choice is limited. This was raised in the previous inspection report. During the day staff are able to provide additional cover between the two houses if required. Crosby Close (1 2) DS0000019317.V360089.R01.S.doc Version 5.2 Page 21 A training matrix is in place to ensure staff receive the training updates they need and to make up for the shortfall that occurred in the previous year due to staffing problems. The care staff are carrying out tasks delegated to them by the registered nurses in relation to residents who receive their food and fluids via a tube (PEG) but there were no records to show how their competency had been assessed and was kept under review. This was discussed with the manager at the time of the inspection so the relevant records and assessments could be developed to demonstrate good practice in this area. The manager reported that nursing staff are supported to identify training to support their continued professional development. The care staff are following induction programmes before moving on the general National Vocational Qualifications (NVQ) in Health & Social Care. It does not appear from the information we obtained that staff are provided with training based on the new Skills for Care Learning Disability Qualifications (LDQs) programme or that the manager has information about planned developments in this area. LDQs are specifically designed to demonstrate achievement in a learning disability context. Recruitment records are held at Macintyre’s regional headquarters and are checked periodically by a CSCI Provider Relationship Manager. No concerns have been bought to the attention of the link inspector. The list of checks kept on the staff files of recently recruited staff indicated the required checks on integrity and experience are carried out before people are employed. Crosby Close (1 2) DS0000019317.V360089.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 39 & 42 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The people who live at Crosby Close cannot be confident that robust action will be taken at all times to protect them. EVIDENCE: The manager has been assessed as having the required qualifications and experience to carry out her role. We are concerned that this is the third inspection that has identified problems with the way the medication systems are managed that have not been dealt with under the organisations own management and monitoring systems without the need for further enforcement action. Crosby Close (1 2) DS0000019317.V360089.R01.S.doc Version 5.2 Page 23 Staffing levels have been reviewed and increased following a review of the contract with Hertfordshire County Council adult care services. However there is concern that the need to increase staffing to meet moving and handling requirements was not identified through the organisations own risk assessment process until an incident had occurred. The staffing section of this report also identifies where staffing levels at night may reduce choice for individual residents. We were able to see that the action being taken to ensure safe moving and handling practices continue to be followed and risk assessments, training and monitoring processes are kept up to date is continuing. To ensure there are robust systems in place to monitor the quality of the service provided the monthly visits the company are required to do should be unannounced. The recent reports indicate that these have been announced and staff know when they are taking place. The January report was not yet available to the manager. We have asked that the manager provide us with the outcome of the recent questionnaires sent out to relatives and key people in contact with the service as part of their quality review process. We have found a number of issues related to nursing practice and would like to see the organisation reviewing the quality of the nursing care provided and how access to up to date professional guidance is used to update policies and procedures. We found staff were leaving gaps in the daily progress notes they keep on each person. This is contrary to good practice as the information should be complete at the time of entry and not allow for additions between entries. Staff receive training in safe working practices, risk assessments are in place and checks on safety equipment are maintained. Generally there is a high degree of awareness in relation to safety issues. A risk assessment was recorded for a visiting contractor hanging curtains while we were there. However staff need to review how they store dishwasher tablets as these are irritant and were in an unlocked cupboard in the kitchen in the kitchen of House 1. One person has a suction machine, which can be used by the nursing staff in the case of an emergency. There was no record of this being regularly checked to make sure it is in working order when needed. There were no details in the care plan to remind staff where it must be kept so they can find it quickly in an emergency. To protect residents these areas were brought to the attention of the manager at the time of the inspection for further action. Crosby Close (1 2) DS0000019317.V360089.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 2 33 2 34 3 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 x 2 x LIFESTYLES Standard No Score 11 x 12 2 13 3 14 x 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 1 x 2 x 2 2 x 2 x Crosby Close (1 2) DS0000019317.V360089.R01.S.doc Version 5.2 Page 25 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. Standard YA20 Regulation 13(2) 17 (1)(a) Schedule 3(3)(i) Requirement To protect residents accurate medication records must be kept The medication records must enable staff to reconcile the amount of medication brought into the home with the amount administered to residents. Any hand written entries on the medication administration chart (MAR) must be checked for accuracy, include the full details of the drug, dosage, strength, timing, frequency, route of administration and conform to NMC Standards for Medicines Management. Brought forward from inspection on 24/08/06 & 29/5/07 – Enforcement action has been considered and an immediate requirement letter issued. Timescale for action 14/03/08 Crosby Close (1 2) DS0000019317.V360089.R01.S.doc Version 5.2 Page 26 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA9 Good Practice Recommendations Make sure people are able to choose when to go to bed and their choice is not limited by the number of staff available to support them. Any limitations on how they choose to organise their lives needs to be recorded. The registered nurses should be provided with a copy of the NMC Standards for Medicines Management (updated February 2008) to ensure they are aware of their professional responsibilities to practice safely and protect residents. Review systems for training, assessing and recording the competency of staff carrying out tasks delegated to them by the registered nurses i.e. involvement with PEG feeds and where individuals have complex needs such as choking & feeding problems). To protect residents the arrangements for storing dishwasher tablets should be risk assessed, reviewed and secure storage provided where necessary. Record regular checks on infrequently used equipment, such as suction machines, to ensure they are in working order when needed. Record in the care plan where this equipment is kept so staff know where to find it in an emergency. 2 YA20 3 YA32 4 5 YA42 YA42 Crosby Close (1 2) DS0000019317.V360089.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Crosby Close (1 2) DS0000019317.V360089.R01.S.doc Version 5.2 Page 28 - 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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