Inspection on 05/01/06 for Crosby Close (1+2)

This inspection was carried out on 5th January 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 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) 29/05/07

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

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 OAT Lead Inspector Bijayraj Ramkhelawon Unannounced Inspection 5th January 2006 14:45 Crosby Close (1 2) DS0000019317.V276001.R01.S.doc Version 5.1 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.V276001.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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.V276001.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Crosby Close (1 2) Address 1 2 Crosby Close Off Hill End Lane St. Albans Hertfordshire AL4 OAT 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.V276001.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 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. 22nd June 2005 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 the home 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. Crosby Close (1 2) DS0000019317.V276001.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a positive unannounced inspection, the feedback received mostly from staff was excellent and the standard of support and practices observed was good. Service users who were able to communicate said that they were well looked after and they had a good rapport with the staff. There was a pleasant and relaxed atmosphere in the home. Staff were very organised and were busy with the routine of the day in supporting the service users. The staff should be commended for their dedication and professionalism in meeting the needs of the service users. Each service user had a structured plan of activities for the day. Care plans were well documented and updated to reflect the changing needs of service users. However, staff confirmed that there have been difficulties in accessing service users’ money on their behalf and this issue must be dealt as soon as possible. Staff should have training in protection of vulnerable adults and fire drills must be carried out on a regular basis. What the service does well: What has improved since the last inspection? What they could do better: Regular audits of medicines must be carried out to prevent overstocking. There is a need for all staff to be facilitated with training in the Protection of Vulnerable Adults so that they are aware of the local joint procedure. Each service user’s weight should be checked and monitored on a regular basis. Crosby Close (1 2) DS0000019317.V276001.R01.S.doc Version 5.1 Page 6 A quality assurance programme based on seeking the views of service users and other relative parties must be developed as a matter of urgency. It is important that all interested parties are enabled to give their opinions and raise any issues regarding Crosby Close. A report should be compiled and an action plan developed to address any of the issues raised. 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. Crosby Close (1 2) DS0000019317.V276001.R01.S.doc Version 5.1 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.V276001.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1-4 Adequate information was available to current and prospective service users and their families. Assessments of needs were carried out to ensure that staff have sufficient information on each person’s needs before they move into the home. However, these must be signed by the person carrying out the assessments. EVIDENCE: A satisfactory ‘Statement of Purpose’ and ‘Service User’s Guide’ is in place which contains all of the information required by this Standard. A copy of the guide was given to each service user and is kept in their bedrooms. Crosby Close provides services for people with learning and physical disabilities who also have sensory impairments. The majority of the members of staff have many years of experience in working with people with learning disabilities and the manager is also a registered nurse in this field of care. Relevant training and courses were being facilitated and attended by staff (except those recommended in Standard 23). The home has an admissions policy. Admissions are planned and agreed by a multi-disciplinary team including the service user/relatives or representatives. The home does not provide emergency admissions. Crosby Close (1 2) DS0000019317.V276001.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8 & 9 Care plans were detailed and comprehensive. These were ‘person centred’ and included information on all assessed health care needs, social needs and risk assessments were carried out with regular reviews undertaken. Good interaction between staff and service users was noted. Service users were treated with respect and assisted to make choices about their lives and to participate in community activities wherever possible. EVIDENCE: Each service user has a care plan generated from the Care Management Assessment and the services own assessment, which covers all aspects of personal and social support, and healthcare needs. Staff from the home carry out an annual whole life review of each service user’s care plan with the involvement of the service user, their relatives and other professionals involved in their care. Care plans were also reviewed at least every 6 months and updated to reflect any changing needs. Crosby Close (1 2) DS0000019317.V276001.R01.S.doc Version 5.1 Page 10 Service users are provided with assistance and support as far as it is practical in helping them to make a decision or choose, but it was acknowledged that service users were generally unable to decide for themselves due to severe learning difficulties and difficulties in communication. Crosby Close (1 2) DS0000019317.V276001.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11-17 Service users were encouraged to make choices in relation to their food, clothes and activities to optimise their abilities in developing their skills. They were also encouraged and supported to pursue social and leisure activities as stated in their individual care plan. Individual service users weight should be checked and monitored on a regular basis to ensure nutritional needs are being met. EVIDENCE: Service users attend the ‘Butterwick’ day centre at different times of the day as per their individual activity programme. All other social activities attended by services users were planned and organised by the staff and recorded in their care plans. These included visits to local places of interest, parks, cafés, shopping, theatres etc. Staff enable service users to engage in other activities as much as possible, both indoors and outdoors. There were a variety of activities provided in the home, which included watching videos, relaxing in the sensory room, playing board games etc. Crosby Close (1 2) DS0000019317.V276001.R01.S.doc Version 5.1 Page 12 It was noted that staff were interacting with the service users in an appropriate manner, with respect and courtesy. There is a no smoking policy in place. A four weekly rotational menu is in place. Meals were offered three times daily and the main cooked meal is in the evening. Service users were offered a choice of suitable menus, which meet their dietary needs and individual preferences. However, individual service users weight was not checked and monitored on a regular basis. Crosby Close (1 2) DS0000019317.V276001.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18-20 Staff assist service users to attend to their personal care and treat them with dignity and respect. There was good record keeping of service users health care needs. However, regular monitoring and audits of medicines must be carried out to prevent any over stocking. EVIDENCE: Personal care and support were provided to service users in the privacy of their bedroom. The staff operate a flexible approach for service users to retire to bed and to get up in the morning. Additional specialist support and advice was provided as needed from a physiotherapist, speech therapist and other professionals. A key worker system is in place and all service users have a care manager. Each service user receives an annual health check and those who suffer from epilepsy have a 6 monthly check carried out at the epilepsy clinic from Community Learning Disability Team (CLDT). Records in relation to the administration and management of medicines were kept in good order but this system was not monitored and audited as required in the last inspection to prevent any over stocking. Crosby Close (1 2) DS0000019317.V276001.R01.S.doc Version 5.1 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22-23 Service users were encouraged and enabled to make their views and concerns known. The home has a complaints procedure and staff were aware of. Training in ‘Protection of Vulnerable Adults’ should be provided to all staff so that they are aware of the joint agency procedure. Difficulties in signing cheques on behalf of service users must be rectified. EVIDENCE: A complaints procedure in a booklet format for service users, which states that all complaints are acknowledged within 3 days and fully investigated and responded to within 21 days. Neither the home nor the CSCI have received any complaint since the last inspection. A ‘Whistle Blowing’ policy is in place to ensure the safety and protection of service users (including passing on concerns to the CSCI), in accordance with the Public Interest Disclosure Act 1998 and Department of Health Guidance No Secrets. There is also a policy on physical intervention and restraint. Staff spoken to during the inspection were aware of the contents of these policies. However, they have not attended the training in Protection of Vulnerable Adults. It was noted that staff were having difficulties in signing service users cheques when required and that one of the service users money was still kept at her last place of residence. Crosby Close (1 2) DS0000019317.V276001.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24-30 The home provides a comfortable and well-maintained environment for the service users. Staff maintain a good standard of cleanliness and hygiene EVIDENCE: The home meets the required standards in providing living space for service users. The premises were safe, accessible, comfortable, clean and free from offensive odours. Each room has sufficient light, heat and ventilation. The home uses its own transport for service users to access local amenities and relevant support services. All rooms are for single accommodation. Service users’ bedrooms included all the necessary furniture and lockable storage space for the safekeeping of personal belongings and valuables. Each bedroom is attractively decorated and personalised with the individual’s belongings. The home has central under floor and ceiling heating and the temperature in each room can be adjusted to required level by thermostatic control. Staff encourage service users to bring and/or choose their own furniture and can decorate and personalise their rooms, as they wish subject to fire and safety regulations. Crosby Close (1 2) DS0000019317.V276001.R01.S.doc Version 5.1 Page 16 The home has four bathrooms which include ‘Whirlpool baths and Jacuzzi’ in each bungalow and four shower facilities. Both the toilets and bathrooms are lockable to provide privacy. Appropriate aids and equipment for people with physical disabilities including electric hoists are available within the home. Environmental control systems include extractors in each bathroom and smoke and fire alarms in each room. The home does not have a call alarm system but every bedroom has an intercom system, which is used at night. There is a ‘sensory room’ with a waterbed plus sensory and plastic sparkly lighting used for daytime activity. The local council provides 24 hours service in an emergency and carries out all repair works details of which were kept in the maintenance book. Magnetic devices were fitted to the lounge and kitchen doors to maintain them in an open position that comply with fire safety requirements. Adequate laundry facilities with a modern domestic washing machine which has sluicing and variable programmes at different washing temperatures were provided. The home has written policies and procedures giving guidance on the control of infection for the protection of both service users and staff. Crosby Close (1 2) DS0000019317.V276001.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35 & 36 There was an adequate number of staff rostered on duty on days and at nights. Staff spoken to were aware of the needs of the service users and felt well supported in their work. EVIDENCE: Staff were aware of and promoted the main aims and values of the home including the key worker system. Staff confirmed that they have received a job description on starting employment and they undergo a period of induction, which included working along side a senior care staff. There are no volunteers currently working at the home. Registered nurses confirmed that they adhered to the professional codes of conduct set by the NMC (Nursing Midwifery Council). Staff were knowledgeable about the needs of service users and the home facilitated training including developing skills in communication, supporting people with epilepsy, feeding and sensory awareness, massage therapy, risk assessment, supervision, ‘person-centred planning’ and ‘whole life review’. A good professional relationship is maintained with GPs, dieticians, physiotherapists, speech therapists and staff working in other care homes and the local community. Crosby Close (1 2) DS0000019317.V276001.R01.S.doc Version 5.1 Page 18 Staff received structured induction training when first appointed. This included training on the principles of care, safe working practices, the organisation and the worker’s role, the experiences and particular needs of the service user group. Within 6 months of employment each staff member completes a ‘Personal Development Portfolio’. Regular staff meetings and shift handovers are undertaken. There were regular informal discussion and supervision where information is shared and channelled. All staff have had regular, recorded formal supervision meetings with the manager and an annual appraisal in the form of a performance review’. Crosby Close (1 2) DS0000019317.V276001.R01.S.doc Version 5.1 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37-43 The management within the home is effective in ensuring that the needs of the service users were being met and that the home was meeting its aims and objectives. A quality assurance system based on seeking the views of service users and other relative parties must be developed. Fire drills must be carried out on a regular basis to ensure both the safety of service users and staff. EVIDENCE: Staff spoken to said that they were happy to be working at the home and that the manager enabled them to support service users in meeting their needs. She was also approachable, supportive and encourages staff to develop their skills and to keep abreast of development in this field of care. The processes of managing and running the home were open and transparent. The manager holds regular staff meetings. The policies and procedures were kept in the office and were available to staff. Staff spoken to said that they adhered to the policies and procedures of the home. Crosby Close (1 2) DS0000019317.V276001.R01.S.doc Version 5.1 Page 20 All staff complete the statutory training to maintain safe working practices and the manager complies with all relevant legislations to safeguard the health, safety and welfare of service users and staff. All staff who handled food have undertaken food and hygiene training. However, fire drills were not carried on a regular basis but fire alarm tests and emergency light checks were done. Accidents, injuries, incidents of illness were recorded and reported. The service has an insurance cover for legal liabilities to employees, service users and third party persons to a limit commensurate with the level and extent of activities undertaken or to a minimum of £5 million and expires in August 2006. A quality assurance programme has yet to be developed. This has been outstanding for a number of inspections and must be addressed as a matter of urgency. It is important that the service provider gathers and considers the views of all stakeholders with an interest in Crosby Close, a report is compiled and an action plan is developed to action any issues arising from the quality monitoring. Crosby Close (1 2) DS0000019317.V276001.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 3 2 2 3 3 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 X 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 x LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 3 2 3 3 2 3 Crosby Close (1 2) DS0000019317.V276001.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard YA2 YA20 Regulation 14(1)(a) 13(2) Requirement Pre-admission assessments reports must be signed by the person completing the forms. Regular audits of medicines must be carried out and records kept (Outstanding from last inspection). Difficulties in signing service users cheques and management of service users money must be rectified. A quality assurance programme must be developed based on seeking the view of service users and any other parties (Outstanding from last inspection). Fire drills must be carried out on a regular basis. Timescale for action 24/02/06 01/03/06 3 YA23 17(2)Sch 4(9) 24 24/02/06 4 YA39 01/04/06 5 YA42 23(4)(e) 17/02/06 Crosby Close (1 2) DS0000019317.V276001.R01.S.doc Version 5.1 Page 23 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 Refer to Standard YA23 YA17 Good Practice Recommendations Training in Protection of Vulnerable Adults and Dementia should be provided to all staff. Service users’ weight must be monitored on a regular basis. Crosby Close (1 2) DS0000019317.V276001.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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