Inspection on 29/05/07 for Crosby Close (1+2)

This inspection was carried out on 29th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 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) 19/02/08

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

Similar services:

Claremont House

Coopers Mill Ltd

Sun Court Nursing Home

Bramley Avenue (73)

Paradise Lodge

Grangewood

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 Alison Jessop Unannounced Inspection 29th May 2007 10:00 Crosby Close (1 2) DS0000019317.V342160.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.V342160.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.V342160.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.V342160.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. 24th August 2006 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 are £1339.96 (correct as of 29/5/07). Crosby Close (1 2) DS0000019317.V342160.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One Regulatory Inspector carried this unannounced inspection out over one day. Time was spent in each bungalow gaining feedback from the people who live there. Most of the residents are unable to communicate verbally, therefore the inspector observed their non-verbal communication, observed care practice and gained feedback from staff. Two requirements made in the last inspection report remain outstanding. What the service does well: What has improved since the last inspection? A lot of work has been done to review care plans and risk assessments, particularly in relation to moving and handling. All staff have been given more moving and handling training. A new conservatory in bungalow one has been installed and offers a light, spacious area in which residents can look out into the garden. Crosby Close (1 2) DS0000019317.V342160.R01.S.doc Version 5.2 Page 6 Some new staff have been recruited however three more staff are due to start. This should ease the staffing shortages and ensure service users needs are met with a consistent approach. 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. Crosby Close (1 2) DS0000019317.V342160.R01.S.doc Version 5.2 Page 7 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.V342160.R01.S.doc Version 5.2 Page 8 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): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Admissions are not made to the home until a full needs assessment has been undertaken, ensuring that so far as possible service users needs can be met. EVIDENCE: No new residents have been admitted since the previous inspection. The admission procedure will be followed and a comprehensive assessment is carried out which involves other professionals to ensure that the placement is suitable. Crosby Close (1 2) DS0000019317.V342160.R01.S.doc Version 5.2 Page 9 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): 6, 7 & 9 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People who live at the home are not in control of their own life and do not always have the opportunity to make their own choices and decisions. Risk assessments are not always followed due to low staffing levels, leaving both service users and staff at risk. EVIDENCE: Care plans provide detailed information about resident’s social and health care needs. Although the majority of the people who live there are unable to express their wishes in a verbal capacity, staff are aware of preferences by monitoring reactions and by using a process of elimination. Staff appeared to have a good understanding of how residents are feeling and about their likes and dislikes. Care plans and risk assessments are stored in several files. A lot of information that is no longer relevant to the residents current care needs is stored in the Crosby Close (1 2) DS0000019317.V342160.R01.S.doc Version 5.2 Page 10 files making it very difficult to find out which is current information. This could prove problematic if new staff were looking at files to see what care was required or if information was required in an emergency. One resident living in the home has a preference to stay up late at night and new procedures on moving and handling had to be introduced so that the resident was able to choose when they went to bed. The resident’s choice has now been restricted due to insufficient staffing levels at night and the need to for two staff to carry out hoisting procedures. Following an accident in the home where a resident fell out of a hoist sling, new risk management procedures have been introduced. Risk assessments offer comprehensive information on how to move people safely. Two of the risk assessments on moving and handling residents state that two staff are required to carry out a task. This is not being followed by staff at night as there is currently only one member of staff in each house. The manager stated that the Hertfordshire County Council contract is being reviewed and staffing levels at night will increase when this has been agreed. The contracts team confirmed this. Crosby Close (1 2) DS0000019317.V342160.R01.S.doc Version 5.2 Page 11 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): 12, 13, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Generally staff are aware of the need to support residents to take part in a variety of activities both within the home and in the community and to make choices about their lifestyle, however this may be limited due to the number of staff available. EVIDENCE: 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 stated that residents enjoy going out for walks in the park, to the shops and on day trips. During the inspection some of the residents were relaxing at home, listening to music and sitting with staff in the kitchen. One member of staff was observed doing a puzzle and reading a book with a resident who was later taken into the conservatory which over looks the garden. The service has the use of a mini bus. Staff said ‘we do arrange day trips to the seaside and Crosby Close (1 2) DS0000019317.V342160.R01.S.doc Version 5.2 Page 12 every year we go on a canal trip however this has to be planned well in advance and the number of outings are restricted due to the current staffing levels.’ Another said ‘we try our best to take residents out but it’s not always possible when you only have two staff on a shift in each house.’ As well as providing nursing and social care, staff also cook meals, carry out domestic tasks, deal with laundry and organise activities. 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 meals are balanced and nutritional and cater for the varying cultural and dietary needs of the people who live there. Care staff are sensitive to the needs of those residents who find it difficult to eat and give assistance with feeding at an appropriate pace. Crosby Close (1 2) DS0000019317.V342160.R01.S.doc Version 5.2 Page 13 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): 18, 19, 20 & 21 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Personal healthcare needs including specialist health, nursing and dietary requirements are clearly recorded in each resident’s plan; they give a comprehensive overview of their health needs and act as an indicator of change in health requirements. Risk management for moving and handling is inadequate and does not protect the residents and staff from harm. This is due to insufficient staffing levels at night. Regulatory requirements made at the last inspection in relation to the administration of medication have not been met which may put people at risk. EVIDENCE: Care practice observed was carried out in a sensitive, caring manner. The residents looked relaxed and appeared to be well cared for. Staff have a very good understanding of the needs of the people who live there. The general healthcare needs of the people who live in the home are met. Individual person centred healthcare plans reflect the needs of the residents in detail. Residents no longer receive specialist healthcare support such as Crosby Close (1 2) DS0000019317.V342160.R01.S.doc Version 5.2 Page 14 physiotherapy and hydrotherapy unless a referral is made by the GP. Staff are also responsible for ensuring that residents do exercises, which are prescribed by the physiotherapist. The people who live at the service have technical aids and equipment they need for maximum independence. Hoisting equipment cannot be used at night due to insufficient staffing levels and risk assessments state that in some cases two staff are required to move people whilst in bed. Therefore personal healthcare needs are not fully met at night. Previous requirements in relation to the storage and administration of medication have not been met. Hand written instructions on the Medication Administration Records had not been signed and a system for carrying forward medication has not been implemented. Crosby Close (1 2) DS0000019317.V342160.R01.S.doc Version 5.2 Page 15 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): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is clear when an incident needs to be referred to the Local Authority as part of the local Safeguarding procedures in place. It is open and transparent when discussing incidents with external bodies. EVIDENCE: The service has not received any complaints since the previous inspection. The service often receives compliments. Each resident has a named nurse and key worker. The views and reactions of residents are monitored on a day-to-day basis. The police who are taking no further action have investigated one incident, which occurred. This is in relation to the incident where the service user fell out of the sling. Macintyre Care have carried out a full investigation and the outcome has yet to be submitted to CSCI. The manager has reviewed procedures for the safe keeping of service users money and new bank accounts have been opened. Crosby Close (1 2) DS0000019317.V342160.R01.S.doc Version 5.2 Page 16 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): 24 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The living environment is appropriate for the particular lifestyle and needs of the residents and is homely, clean, comfortable and well maintained. However, the continued practice of the use of door wedges leaves people who live and work in the service at risk. EVIDENCE: Each house offers a comfortable, homely atmosphere to service users. Bedrooms are individually decorated to reflect resident’s personality and taste. House one has recently had a new conservatory installed, which offers a bright area overlooking the garden. The lounge in house one is also due to be redecorated with new carpet being fitted. Both houses are very clean, odour free and good infection control procedures were observed. Crosby Close (1 2) DS0000019317.V342160.R01.S.doc Version 5.2 Page 17 Door wedges were observed at the last inspection to be used around the home. A requirement was made that doors must only be held open by methods approved by the local fire safety officer. This requirement remains unmet, as the laundry door and the door to the relaxation room were wedged open. This leaves the people who live and work in the service at risk. Crosby Close (1 2) DS0000019317.V342160.R01.S.doc Version 5.2 Page 18 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): 32, 33, 34 & 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The level of staffing severely restricts the ability of the service to deliver person centred support and compromises the safety of staff and residents. EVIDENCE: Evidence was gained throughout the inspection that there are insufficient staffing levels working in the home at night. There is one nurse and one care worker to cover both houses. The people who use the service cannot be hoisted therefore choices are restricted. Also staff may be carrying out unsafe moving and handling techniques. The contract for the home is currently being reviewed and extra night staff will be employed once this has been agreed. Both houses benefit from a range of qualified and well trained care staff. All staff have received an update on moving and handling recently. The manager stated that a lot of training has been organised in the next couple of months and staff are encouraged to develop by completing NVQ awards. Crosby Close (1 2) DS0000019317.V342160.R01.S.doc Version 5.2 Page 19 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. Crosby Close (1 2) DS0000019317.V342160.R01.S.doc Version 5.2 Page 20 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): 37, 39 & 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Manager has the required qualifications and experience and is competent to run the home. She works to continuously improve services and provide an increased quality of life for residents. EVIDENCE: The manager has done a lot work to review the policies and procedures in the home, particularly in relation to moving and handling procedures. Financial restraints have meant that staffing levels have not been adequate at night, however Adult Care Services are in the process of reviewing the homes contract to ensure that adequate staffing is provided. The manager has also ensured that continuity is provided by the use of regular agency staff. Crosby Close (1 2) DS0000019317.V342160.R01.S.doc Version 5.2 Page 21 The service has a quality assurance system that incorporates the views if the families of the residents living in the home. Procedures relating to health & safety in the home are generally satisfactory however; the laundry door and relaxation room doors were wedged open using unsafe methods, which may leave people at risk. Gates are fitted to the bedroom doors in house one and are no longer used; it is recommended that these are removed completely. Crosby Close (1 2) DS0000019317.V342160.R01.S.doc Version 5.2 Page 22 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 3 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 1 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 2 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 1 X 1 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 x 3 X 3 X X 1 X Crosby Close (1 2) DS0000019317.V342160.R01.S.doc Version 5.2 Page 23 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA7 Regulation 12(2) Requirement Timescale for action 29/08/07 2. YA9 3. YA12 4. 5. YA19 YA20 6. YA33 Service users choices must not be restricted. Service users must so far as possible be able to choose when to go to bed. 12(1)(a)& Instructions on moving and (13)(4)(a) handling risk assessments must & (c) & be followed. Where risk 13(5) assessments state that two staff are required to move a person, this must be adhered to. 16 (2)(m) Staffing levels must be & (n) adequately managed in order to be able to provide regular activities to the service users. 12(1)(a) Service users care needs must be met at all times of the day and night. 13(2) Accurate medication records must be kept - Administration Record (MAR) Sheetshandwritten instructions must be signed; amounts must reconcile. Amounts of medication must be carried forward. Carried forward from inspection report 24/08/06 – a new timescale has been provided for compliance. 18(1)(a) The registered person must ensure that adequate numbers DS0000019317.V342160.R01.S.doc 29/06/07 29/08/07 29/08/07 29/06/07 29/08/07 Crosby Close (1 2) Version 5.2 Page 24 7. YA42 23(4) & 13(4) of staffing are available 24hours a day. Door wedges must not be used and a safe and suitable alternative option as recommended by the fire safety officer must be employed. Carried forward from inspection report dated 24/08/06. A Statutory Requirement Notice has been served. 29/06/07 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 YA6 Good Practice Recommendations It is recommended that information no longer relevant to service users current care needs are removed from the current care plan file in order for staff to be able to gain access to current information quickly. An activities co-ordinator should be employed to facilitate ‘day care’ for those service users who remain at home. 2 YA12 Crosby Close (1 2) DS0000019317.V342160.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Hertfordshire Area 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.V342160.R01.S.doc Version 5.2 Page 26 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!