Inspection on 31/01/09 for Crosby Close (1+2)

This inspection was carried out on 31st January 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Crosby Close (1+2) 19/02/08

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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Extracts from inspection reports are licensed from CQC, this page was updated on 27/03/2009.

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 Saturday 31st January & 4th February 2009 09:55 Crosby Close (1 2) DS0000019317.V373839.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.V373839.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.V373839.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 Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Macintyre Care Manager post vacant Care Home 12 Category(ies) of Learning disability (12), Physical disability (12) registration, with number of places Crosby Close (1 2) DS0000019317.V373839.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 July 2008 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 £1574.44 (correct on 4/2/09). Crosby Close (1 2) DS0000019317.V373839.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 out of hours visit to 1 & 2 Crosby Close on Saturday 31/1/09, followed by a visit to meet with the acting manager on 4/2/09. We invited an expert by experience to take part in this inspection. An ‘expert by experience’ is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. We have also reviewed information we have received about this service since our last key inspection. This includes 3 random inspections involving a pharmacist inspector on 6/5/08, 10/6/08 & 29/7/09. The visits were needed to ensure the safety of procedures for managing medicines and included the serving of a statutory enforcement notice. The last visit confirmed that the required standards had been met. Information from notifications of incidents and events that the we are required to be told about has also been reviewed. We made surveys available to people visiting Crosby Close and received 2 replies from relatives. Crosby Close does not currently have a registered manager. For the purposes of this report the Commission is referred to as ‘we’. What the service does well: People who know and understand the complex needs of individuals moving to Crosby Close are fully involved in the assessments that need to take place to make sure that it is a suitable place for them to be. People visiting their relatives told us that the staff are supportive. One person said ‘ There is always a warm welcome when I visit. The regular staff really care and love the residents’. Another person said ‘I am grateful to staff for the loving care they provide’. People had been provided with a good level of personal care and their health needs are supported. The expert by experience said ‘the service users looked quite content in both houses; there were not any signs of anxiety’. We have not received any complaints or concerns about this service between our inspections. Crosby Close (1 2) DS0000019317.V373839.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Crosby Close (1 2) DS0000019317.V373839.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.V373839.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): 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. Individuals can be confident that people they know and are aware of their needs will be fully involved in their decision to move to Crosby Close. EVIDENCE: To look at the experience of people moving into Crosby Close we reviewed the arrangements put in place for two people who have come to live in the home since our last key inspection. Three relatives have also given us their comments. We found that detailed assessments are received from health & social care professionals who know the person concerned. People are introduced to the staff and other residents during day visits and over night stays. This gives staff the opportunity to make sure that specialist equipment and individual risk assessments are in place to care for that person safely. Information about the service provided at Crosby Close has recently been updated and provides pictorial information about the home. One person confirmed they were fully involved in supporting the move of their relative into Crosby Close. Another person told us ‘MacIntyre Care are very good at keeping us in touch and sending news sheets and annual reviews’ Crosby Close (1 2) DS0000019317.V373839.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): Standard 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 are very dependent on staff interpreting their needs and making decisions they feel are in their best interests. Improving and developing the communication skills of staff and introducing external advocacy support would enable the people living at Crosby Close to be more involved. EVIDENCE: We spent time with the people living at Crosby Close observing how they spent their time and the contact they had with staff. We spoke with staff about their understanding of people’s needs and their role as key workers. We then looked at the care plans of 2 people from each house to see if they reflected their assessed and changing needs. The people living at Crosby Close are very dependent on staff, relatives and care managers to interpret their changing needs on a daily basis and Crosby Close (1 2) DS0000019317.V373839.R01.S.doc Version 5.2 Page 10 aspirations they have for their lives. Staff are able to describe how they respond to signs, which indicate the person is well, comfortable and relaxed or uncomfortable and unhappy. The people we saw all appeared to be relaxed in their surroundings and the contact they had with staff. There are detailed care plans in place that are based on a continuous assessment and review of people’s holistic needs. However in one case we found that risk assessments for a resident who had suffered a scalding accident had not been updated. The moving and handling assessments had been updated to reflect the change of equipment following the introduction of overhead tracking hoists. This was also supported by additional staff training. Copies of each persons support plan and key information about the service being provided are available in a pictorial version. The care plans showed clear involvement of relatives and external health & social care professionals. The expert by experience said ‘the key workers get to know their service users likes and dislikes’. Since our last visit systems for recording people’s capacity to make decisions about aspects of their lives are now being recorded. This is to demonstrate people’s ability to make decisions for themselves and show that where others are making decisions, they are in the best interest of the person concerned. People living at Crosby Close do not currently have external advocacy support either as groups, to influence how their homes are being run on a day to day basis, or as individuals. The manager reports that relatives and care managers act in this capacity. We have previously recommended looking at independent advocacy to bring a fresh perspective into looking at how people are living or achieving aspirations. A theme running through this report is that the service feels as though it is organised around staff routines and people have stopped noticing the effect of the environment they have created on the people who live in each of the houses. The expert by experience said ‘we were not introduced to service users, service users should be introduced to visitors’. They found that ‘there are not meetings between staff and service users to discuss outings, holidays or menus’. Previous reports have referred to managers identifying the need to improve methods of communication with residents. The current manager reports she has recently attended a course and will be teaching staff a different sign each week. It was reported that a communication advisor is due to visit and ideas about different formats for providing residents with information about their personal experiences are being considered. Progress appears to be very slow in this area. ‘It was felt by the expert by experience that the interaction between staff and service users was poor’ and that service users needed to be encouraged to communicate more. Crosby Close (1 2) DS0000019317.V373839.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): 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. People living at Crosby Close have a planned programme of activities that takes them out and about in the community and includes time to relax but it is not always followed by staff when they are at home. People living at Crosby Close have their dietary needs assessed and monitored but staff need to look at how they interact with people at meal times and the experience they create for service users. EVIDENCE: The people who live at Crosby Close attend educational and social care day facilities during the week. At weekends staff provide people with the opportunity to relax and have a more leisurely start to the day. A visiting entertainer was due on Saturday evening to provide a musical evening for residents. Visiting therapists provide individual support. One person has regular aromatherapy. We also heard about trips to local shops and social Crosby Close (1 2) DS0000019317.V373839.R01.S.doc Version 5.2 Page 12 clubs. There was an activity folder one each house guiding staff on activities for individual residents. Not all residents had individual activities listed for the day we visited. Staff on both houses said they had not been able to provide all the activities listed, as they did not have time. Relatives are able to visit as they wish and staff support people to remain in touch with their families. One person who visits Crosby Close told us the relaxation (sensory) room, doesn’t appear to be used. The expert by experience said ‘the sensory room was painted white it looked very cold and clinical. Colours need to be added to make it warm and inviting’. The expert by experience said the ‘staff attitude towards service users at lunchtime in house two was poor. The take it or leave it attitude was very much like being in a hospital not a home’. They observed that ‘one member of staff was feeding two service users at the same time’. Another person who needed feeding ‘was not sitting in a good position. This lady was slumped in an armchair, there was too much food on the spoon, and the spoon may have been too large’. Staff did not check the mouth of another person they were feeding to make sure it was empty before offering more food. Some people had a late breakfast but everyone was served lunch at 12.30. If service users have a late breakfast then maybe it would be better to give them lunch later. Crosby Close (1 2) DS0000019317.V373839.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): Standard 18, 19 & 20 - 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. People receive the help they need to maintain their personal care and health needs but staff need to make sure that the records of clinical care meet current standards and personal equipment used by residents is kept clean. People are supported to take the medicines they are prescribed and systems to monitor staff are following the correct procedures are in place. However the information we have indicates this is still an area that needs to be kept under close review. EVIDENCE: A relative told us that ‘great concern is shown’ for their relatives well being ‘both physically and in trying to find ways to maximise their quality of life’ by providing stimulation. The people living at Crosby Close had received good attention to their personal care and hygiene. Equipment is in place to prevent people from developing pressure sores. It was reported no residents have pressure sores. The care plans we reviewed provided good information about people’s contact with other Crosby Close (1 2) DS0000019317.V373839.R01.S.doc Version 5.2 Page 14 health & social care professionals needed to maintain their health and wellbeing. Our review of resident care identified one person who had been scalded because of an accident with a hot drink. The injury had needed medical attention and the community nurses rather than the nurses employed in the home were providing on-going treatment. This incident had not been reported to us as required. The expert by experience observed over lunch time that ‘There was a very hot drink on the table this could be a hazard if a service user had got hold of it. Steam could be seen coming from the cup’. Following on from earlier visits, that led to the issuing of a statutory enforcement notice, auditing procedures have been reviewed to make sure staff can account for all the medicines stored in the home and administered. From our review at this inspection we could see that there is still close monitoring of the medication systems to make sure people get the medicines they need. However we have still had 3 notifications of incidents involving medication procedures since the compliance carried out by a pharmacist inspector. These were investigated by the organisation and did not involve problems for service users at that time. Following our last inspection we recommended that procedures were put in place for checking suction equipment to make sure it was in working order when needed. This has been carried out and records of the checks are maintained. We also recommended that the registered nurses record the assessments they carry out on care staff who are involved in clinical procedures. We spoke to a new member of staff who is involved in setting up liquid feeds (PEG). They described the training they had received but details of this had not been recorded. Where the registered nurses are delegating clinical tasks clear records need to be maintained and the continued competence of staff kept under review. The procedure for the care of the PEG tube did not include details of the actions required to prevent infection. The manager reported that none of the MacIntyre Care audits she is aware of covers infection control. We discussed current training being provided by the Herts & Beds Health Protection Agency. It is advised that the Department of Health Essential Steps audit is introduced and kept under review. We observed that personal equipment used by residents needed cleaning. Each person’s medication is now kept in a locked cupboard in their bedroom. Records of storage temperatures are not currently being kept. We advice that a risk based approach is taken to reviewing the frequency with which the storage temperatures need to be recorded to demonstrate medicines are being kept at the correct temperature. Crosby Close (1 2) DS0000019317.V373839.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): 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. There are policies and procedures in place to protect people living at Crosby Close and provide staff with the training they need. EVIDENCE: We have not been made aware of any concerns or safeguarding issues between our inspections that would alert us to concerns about the care of people living in the home. MacIntyre Care work with other statutory agencies where issues arise. Following an earlier moving and handling accident Hertfordshire Adult Care services, who fund the placements of the current residents, continued to review and hold meetings with representatives of MacIntyre Care. MacIntyre Care were prosecuted by the Health & Safety Executive following their investigation. The Health & Safety Executive made a further follow up visit to Crosby Close on 15/1/09. At the time of this visit it was reported that no further feedback had been received. To improve procedures overhead tracking hoists have been installed and staff have received training in the use of this new equipment. Two staff in the home are also being trained as moving and handling assessors. The moving and handling assessments we saw in each person’s care plan reflected the use of the new equipment where this applied. Relatives told us they are listened to and feel supported by staff. Crosby Close (1 2) DS0000019317.V373839.R01.S.doc Version 5.2 Page 16 Staff receive training in protecting people from harm and those we spoke to say they would be able to speak out if they needed to report bad practice. Issues related to the safe use of equipment, which has the potential to restrain service users is recorded as part of each person’s care plan. Crosby Close (1 2) DS0000019317.V373839.R01.S.doc Version 5.2 Page 17 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 adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at Crosby Close need to be provided with homely, comfortable, safe clean environment to live in. EVIDENCE: The expert by experience said ‘both homes did not feel “homely”. They were functional but not like a real home’. They observed that ‘the approach to home 1 is spoilt by an old Christmas tree and cardboard in a large bag by the front gate. The front garden could do with a tidy up there are dead flowers in hanging baskets and the garden itself has dead flowers’. Our visit over the weekend demonstrated a lack of care and consideration to providing a clean environment that promoted the dignity of residents. We saw that the soft furnishings, including specialist seating for residents, had stains on them. The kitchens on both houses were dirty and the surfaces in the kitchen cupboards are worn and blistered. When we visited the following week the houses were much cleaner. The acting manager reported that cleaning Crosby Close (1 2) DS0000019317.V373839.R01.S.doc Version 5.2 Page 18 issues had been identified and a cleaning schedule was being put in place. The nursing and care staff are expected to do the cleaning as no additional staff are provided. The acting manager reported she had identified the need to deep clean carpets in December but this was something she did not have the authority to arrange and was waiting for this to be authorised. The overall impression was one of shabbiness. There were areas of paint damage and scuffed walls. A hand written sign above one person’s bed gave staff instructions on use of bed rails. Information for staff should be discrete. There are several wooden gates beside the bedroom doors in house 1. These are kept locked open but were originally put in place to stop a resident who no longer lives in the home going into other people’s rooms. These were referred to in our report 19/2/08 when we were told they would be removed when the corridors were decorated so as not to so that unsightly areas are not left. The name signs on bedroom doors had been removed leaving unsightly marks. Information in the home indicated this had been picked up and action was to be taken to replace them. On the Saturday we visited the bathrooms were very cluttered and in some areas dirty. Fire extinquishers on both houses had been removed from the wall fixings and may be hazardous to staff and residents unless they are safely secured. Crosby Close (1 2) DS0000019317.V373839.R01.S.doc Version 5.2 Page 19 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, 33, 34 & 35 - 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 who have contact with people living at Crosby Close tells us they are happy with the care provided but we have found there are times when staff are not fulfilling the roles expected of them by their employer. EVIDENCE: The information in this report raises concerns about the organisation and motivation of staff to deliver a consistent service across all the areas that is currently expected of them. As well as providing nursing and social care, staff also cook meals, carry out domestic tasks, deal with laundry and organise activities. One person who visits the service told us their experience at weekends was there are bank staff on duty ‘who don’t really know the residents and often are unable to answer questions put to them’. Another person said that ‘sometimes they seem a bit short of staff’. We found that the use of bank staff had recently decreased following staff recruitment and where possible regular staff are used so they know the people living at Crosby Close. There is currently a shortage of registered nurses with only 2 permanent staff available. The home is Crosby Close (1 2) DS0000019317.V373839.R01.S.doc Version 5.2 Page 20 dependent on regular bank and agency staff to make sure a registered nurse is available on each shift. The observations we made during our first visit indicates that the organisation and management of shifts need to be reviewed so that sufficient staff are available to support the planned programme of activities, support people individually at meal times, supervise residents, keep the houses clean and maintain health & safety standards. In both houses we observed times when residents using therapeutic equipment were left without supervision as staff attended to other tasks. We looked at the personnel records for 4 staff. MacIntyre Care provide a list of the checks carried out by their personnel departments for inspectors to look at. Not all the information was complete but after contact with the personnel department we were able to confirm that the required checks had been carried out. This includes taking up of 2 references a satisfactory criminal records check and confirmation of a current registration with the Nursing & Midwifery Council for the registered nurses. Details of the training and checks carried out on an agency member of staff were not available. The manager was advised to request a summary of this information from the agencies when agency staff are booked. The manager told us that staff supervision is now happening on a more regular basis. There is a training plan in place and National Vocational Qualifications (NVQ) training is available for the care staff. It was reported that NVQ training for new staff will now relate to the care of people with learning disabilities (LDQ). New personal development portfolios have been introduced to enable people to plan and evidence their training and development from induction onwards. Crosby Close (1 2) DS0000019317.V373839.R01.S.doc Version 5.2 Page 21 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 living at Crosby Close cannot be currently sure that they will be provided with a consistent service that reflects current practice. EVIDENCE: Crosby Close does not currently have a registered manager. The deputy manager, Stephanie Hawes, is in charge while recruitment takes place. The area manager Sue Martindale provides additional supervision and support. We have been advised that 2 senior support worker posts are to be created to enable this service to develop. The current quality assurance systems in place involve a variety of audits including monthly visits by a representative of the organisation & health & safety audits. MacIntyre Housing, who are responsible for the building had just Crosby Close (1 2) DS0000019317.V373839.R01.S.doc Version 5.2 Page 22 visited to review the environment. We have been advised that MacIntyre Care are currently reviewing their quality assurance systems to look at a framework which covers all aspects of the service and plan to introduce new monitoring systems at Crosby Close over the next year. Questionnaires are also sent to people in contact with the service to get their views. Following our visit last February we asked for details of the outcomes of the surveys carried out for that year by the organisation but did not receive a response. There are systems in place to enable residents to have access to money for their day to day expenditure and check that it is kept securely. The staff meeting minutes of 26/1/09 indicated staff needed to be reminded to do this. Records of how decisions are made regarding items purchased for residents are recorded. Staff receive training in first aid, infection control, fire safety and health & safety procedures. However we noted inconsistencies in the staff approach to health and safety practice that could place people at risk. Our visit at the weekend found that the drug refrigerator in house 2 was left unlocked. The office door and gate used as a further deterrent to residents gaining access to this area were open. The shredding machine had been left in operational mode. The laundry door was unlocked and cupboards containing hazardous cleaning products were also unlocked. One of the residents is mobile and at times left unsupervised while staff attended to the needs of other residents. These issues were pointed out to the nurse in charge who took immediate steps to make these areas safe. Our report 19/2/08 also raised concerns about cleaning products being left in unlocked areas. We were told that the firs aid training includes details on what to do in the event of a choking incident. Recent national guidance has been issued on this. The external clinical waste bin, which, people can view form the kitchen in house 1 has a damaged lid which means the bin is not sealed. This could prevent a hazard from flies or vermin. Clinical waste bins should be kept locked. This needs to be taken up with the clinical waste carrier and a new bin provided. MacIntyre Care may wish to consider providing a screened area to house waste bins and improve the environment. Crosby Close (1 2) DS0000019317.V373839.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 2 25 x 26 x 27 x 28 x 29 x 30 2 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 3 3 2 2 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 2 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 x 2 x 2 x x 2 x Crosby Close (1 2) DS0000019317.V373839.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? NO 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 YA19 YA41 Regulation 37 Requirement Notifications of untoward incidents and events affecting service users need to be reported in accordance with this regulation and guidance issued by the Commission. To make sure people who live at Crosby Close are living in a safe clean environment that supports their dignity MacIntyre Care are required to provide an action plan with timescales for: 1. Cleaning and removal of stains from carpets 2. Redecoration of communal areas, bedrooms & corridors on both houses. 3. Upgrading of kitchens 4. Removal of obsolete door gates (house 1). 5. Introduction of a cleaning schedule so the premises and equipment used by residents is kept clean. 6. Providing an external clinical waste bin that can be locked. Consider providing a locked compound or suitable screening for the storage DS0000019317.V373839.R01.S.doc Timescale for action 04/02/09 2. YA24 23(2) 30/04/09 Crosby Close (1 2) Version 5.2 Page 25 3. YA32 18(1) 4. YA33 18(1) 5. YA42 13(4) area. 7. Securing of fire extinguishers. To make sure people are getting the care they need according to current nursing practice a review systems for training, assessing and recording the competency of staff carrying out tasks delegated to them by the registered nurses should be carried out, i.e. involvement with PEG feeds and where individuals have complex needs such as choking & feeding problems). To make sure people living at Crosby Close are supported by an effective staff team, who can maintain all aspects of the service consistently, a review of the current staffing levels and roles and responsibilities of the nursing and care staff should be carried out. To protect people living in the home hazardous substances must be kept locked and equipment made safe. 30/04/09 30/04/09 31/01/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. YA28 YA18 YA18 YA20 Refer to Standard Good Practice Recommendations Introduce an infection control audit so that procedures are kept under review to reduce the risk of infection. Review clinical procedures for the care of PEG tubes to include references to the action required to prevent infection. Risk assess how frequently the temperature of the medication storage areas in residents rooms needs to be recorded to show medicines are being kept at the required DS0000019317.V373839.R01.S.doc Version 5.2 Page 26 Crosby Close (1 2) temperature. Crosby Close (1 2) DS0000019317.V373839.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.V373839.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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