Inspection on 04/07/07 for Crosby Lodge

This inspection was carried out on 4th July 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

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

CARE HOMES FOR OLDER PEOPLE Crosby Lodge 2-2a Fitzharris Avenue Charminster Bournemouth Dorset BH9 1BZ Lead Inspector Martin Bayne Key Unannounced Inspection 4th July 2007 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Crosby Lodge DS0000069179.V345156.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Crosby Lodge DS0000069179.V345156.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Crosby Lodge Address 2-2a Fitzharris Avenue Charminster Bournemouth Dorset BH9 1BZ 01202 517186 01202521502 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) Peter Graham Oliver Ms Jing Zhang Care Home 26 Category(ies) of Dementia (5), Dementia - over 65 years of age registration, with number (26), Mental disorder, excluding learning of places disability or dementia (5), Mental Disorder, excluding learning disability or dementia - over 65 years of age (26) Crosby Lodge DS0000069179.V345156.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Brief Description of the Service: Crosby Lodge is located in a quiet residential area of Charminster, Bournemouth, within easy reach of local shops, churches, library and doctors surgeries etc. Buses run nearby to other areas of Bournemouth and beyond. The town centre and seafront are less than two miles away. On street parking in the vicinity of the Crosby Lodge is available for visitors. The home is registered to accommodate up to 26 older people with mental disorders and/or dementia. (Variations to registration have been granted for the admission of five service users under the age of 65 years.) Crosby Lodge comprises two separate houses situated next door to each other. Both have ramped access to the front door and a stair lift is available at 2A to assist access between floors. Accommodation at 2A includes a lounge and small separate dining room, four double and six single bedrooms and No 2 includes a lounge and separate dining room, two double and eight single bedrooms. There are no en-suite facilities, but sufficient communal bathrooms and WCs are available. The home has a well maintained garden, which is planted to provide year round interest and is mostly accessible to wheelchairs. An attractive park lies on the opposite side of the road, with a bowling green, tennis courts etc, and seating. Crosby Lodge provides 24-hour personal care, all meals, laundry and domestic services. Small pets may be permitted, by agreement. Crosby Lodge DS0000069179.V345156.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection of the home that took place between 9am and 4:30pm, the aim of which was to evaluate the home against the key National Minimum Standards for Older People and also to follow up on the three requirements and four recommendations made at the last key inspection in January 2007. Discussions were held with Mr Oliver, the Registered Provider and also with ‘Cathy’ Jin Zhang, the Registered Manager about progress since the last inspection. Records were seen concerning care planning for residents, medication administration, staff recruitment and other documents that provided evidence of how the home was complying with standards. Residents were spoken with individually in the lounge area of one of the houses and in the dining room of the other house. A tour of the premises was made and three members of staff were spoken with. Comment cards were completed for and returned for all residents, some had assistance from staff in completing the form. Six comment cards were sent out to relatives and six to health and care professionals who have contact with Crosby Lodge. Feedback from the comment cards was used to form judgements contained in this report. What the service does well: There was positive feedback from residents able to give an account of life in Crosby Lodge. The home is run in the interests of residents. Crosby Lodge DS0000069179.V345156.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 Lodge DS0000069179.V345156.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Crosby Lodge DS0000069179.V345156.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from an assessment of need being carried out prior to their being offered a place at the home. EVIDENCE: Since the time of the last inspection four new residents had been admitted to the home, three people over the age of 65 and one person under that age. At the time of inspection there were 17 residents accommodated in the home. Three of the newly admitted residents were used to track the records and paperwork that the home must maintain on their behalf as evidence of the care that is provided in the home. Crosby Lodge DS0000069179.V345156.R01.S.doc Version 5.2 Page 9 In the case of two people admitted who are over the age of sixty-five who suffer from dementia, their families were involved in choosing the placement, making a visit to the home. In all cases the Registered Manager had visited the person referred and carried out an assessment of need. The record of these assessments was held on the person’s file and covered all of the topics detailed within the Standards. The home had also obtained a copy of the care management assessment and care plan developed by care managers. The home does not provide an intermediate care service. Crosby Lodge DS0000069179.V345156.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents health needs were being met at the home through good care planning and medication administration. EVIDENCE: The personal files and care plans were seen for the three residents tracked through the inspection. Within each file there was a photograph of the resident, key information and contacts together with various assessment recording sheets and care plans. Assessments covered all key areas of need such as; nutrition, physical health, emotional needs and cognitive functioning, life style and skin care. At the last inspection a recommendation was made that the home work with Social Services to develop better care plans and a requirement that risk assessments be developed as to how risk of harm to Crosby Lodge DS0000069179.V345156.R01.S.doc Version 5.2 Page 11 residents be minimised or reduced. It was found at this inspection that the care plans were improved especially regarding how the staff were to meet the mental health needs of residents. A new care planning recording system is being introduced that covers all the areas of personal care and emotional support. Risk assessments were also more detailed and provided better guidance on how staff were to reduce the risk of harm, not merely recording the risks themselves. In each case a moving and handling assessment had also been carried out. Each resident is registered with a GP and there was evidence within the files tracked through the inspection that GP visits were arranged when there were health issues identified by the staff. There was also recorded evidence that other health needs such as chiropody and dentistry were being met. The issue of the restrictions on particular residents to go out of the home unaccompanied due to their dementia and the locking of the front door to ensure their safety was discussed within the context of the Mental Capacity Act 2005. It was found that the Registered Manager was aware of the legal framework under which decisions should be made and how to record this information. During the inspection six residents were spoken with about their experience of living in the home. In general comments about the standards of care were positive with residents informing that they had no complaints about the way they were treated. They said that the staff were kind and courteous and there was respect for the privacy and dignity. The returned comment cards also corroborated this. At a pharmacy inspection carried out last year there was a requirement that action be taken to ensure that residents are only administered medications for which they had been prescribed. One of the senior staff who was ordering medication at the time of inspection informed that medication administration had been tightened up through staff training in medication administration and also through strict adherence to the home’s updated policies and procedures. By these means there was now no longer sharing of creams, a practice that had been found at the last inspection. The medication administration records for all of the residents were seen and it was found that there were no gaps within the records. Allergies were recorded on the top of the recording sheets and a photograph of each resident was at the front of each recording sheet to ensure that medication is administered to the right resident. At the last inspection a recommendation was made that where staff have to hand write entries onto the recording sheet a second person checks and signs the record. It was found at this inspection that this practice had been adopted. Crosby Lodge DS0000069179.V345156.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ recreational and social needs are assessed and met. Visitors are made welcome and residents are provided with a balanced and nutritious diet. EVIDENCE: Residents’ lifestyle choices and leisure interests are assessed and recorded as part of the admission process to the home. The Registered Manager reported that the home had tried to extend the range of leisure and recreational interests for the residents. The home had recently arranged an outing for residents to go to Poole Park and another outing to Christchurch Quay is being arranged when the weather improves. On the day of inspection an outside entertainer was visiting the home and singing to a large group of residents in the main lounge. The Registered Manager informed that the home has a range of board games and puzzles available and an outside person visits the home for a craft session each week. One resident spoken with had just Crosby Lodge DS0000069179.V345156.R01.S.doc Version 5.2 Page 13 returned from a walk and another said that she had little jobs such as laying tables that she enjoyed doing to keep busy. Comment cards returned by residents informed that recreational needs were being met. There were two comment cards provided by outside professionals that informed that activities could be improved and provided on a more individual basis. Spiritual needs of residents are assessed and the manager informed that any identified needs would be met by arranging for clergy or religious leaders to visit the resident concerned. One resident accommodated at the time of inspection goes out to church each Sunday. Residents spoken with informed that they were able to receive visitors when they wished and they were supported to keep in contact with families and friends. The residents spoken with informed that the standard of food provided in the home was satisfactory and there were no complaints about the food. This was also reported through the returned comment cards. The inspector had a midday meal at the home, which was of a good standard. The records of food were seen and there was better recording of what each resident had eaten than at previous inspections. A good choice is offered to residents for breakfast, a choice of the main meal at midday and some choices for evening meals. The records demonstrated that the home provided a balanced and varied diet to residents. When residents are admitted they are asked about food likes and dislikes as part of the admission process. Crosby Lodge DS0000069179.V345156.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and relatives have access to the complaints procedure and also benefit from the staff being trained in adult protection. EVIDENCE: Since the time of the last inspection there have been no complaints made to the management of the home and none brought to the attention of CSCI. The home maintains a log for the recording of complaints and how these have been investigated. The complaints procedure is detailed within the Service User Guide and also the Terms and Conditions of residence. Residents or their relatives have access to these documents and so are informed of how to complain. The home has copies of all the relevant policies and procedures for the protection of vulnerable adults and all the staff have now received training in adult protection. Crosby Lodge DS0000069179.V345156.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides a suitable and homely environment, however residents would benefit from hand drying facilities being provided in the upstairs bathroom in No. 2 and a lock being fitted on the bathroom door. EVIDENCE: The home is comprised of two separate houses and provides a ‘homely’ environment. As part of the inspection a tour of the building was made. It was noted that residents were allowed to personalise their rooms and records are kept of furniture and valuables that they bring into the home. The home Crosby Lodge DS0000069179.V345156.R01.S.doc Version 5.2 Page 16 was found to be clean throughout and there were no adverse odours in the building. At the last inspection a recommendation was made that hand drying facilities, preferably paper towels be provided in the bathrooms. It was found that in one bathroom upstairs in No.2 there was no soap, no hand drying facilities and also no lock on the bathroom door. The manager informed that the lock had jammed and had to be removed by a carpenter. It was agreed that a suitable lock would be fitted and that soap and paper towels be provided. As mentioned earlier in the report the issue of ensuring safety of residents through the locking of the front door was discussed. Commodes are provided to residents within their rooms as appropriate. In No 2 there is a sluicing area, however no such facility is available in No 2a. After discussing the arrangements for cleaning commodes it was agreed that the Registered Manager would liaise with the infection control nurses as the best means to clean these in line with infection control measures as the inspector was concerned that current arrangements could pose a cross contamination risk. Following a visit from the Environmental Health Officer, work has been carried out in the kitchen in No 2 to meet requirements. A new sink has been fitted for hand washing and light covers fitted to the florescent lighting. Mr Oliver reported that a new floor was to be laid in this kitchen area. At the last inspection it was agreed that a ‘star’ lock fitted on one of the resident’s bedroom would be removed. It was found at this inspection that action had been taken as agreed. A requirement was also made concerning the locking of the store cupboard where cleaning and other potentially dangerous chemical are stored. It was found that there had been compliance and the door is kept locked at all times to protect residents. Crosby Lodge DS0000069179.V345156.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from the home being staffed at levels that meet needs of residents and through staff being recruited in line with good practice and legislation. EVIDENCE: The Registered Manger reported that since the last inspection there have been some changes to the staff team with four new members of staff being recruited. At the last inspection it was reported that due to lower occupancy levels, during the afternoon period in No 2, staffing had been reduced to one person on duty between 2pm and 8pm. Previous levels of two on duty throughout the day in this building have now been re-instated. The home now provides two care staff on duty in both houses between 8am to 8pm. During the evening and night period, there are two awake members of staff on duty in No 2a and one awake member of staff in No 2. The Registered Manager informed that these staffing levels met the needs of the residents currently accommodated. Crosby Lodge DS0000069179.V345156.R01.S.doc Version 5.2 Page 18 The staff recruitment files for three of the new members of staff recruited since the last inspection were seen. All of these workers were from overseas and copies of work permits were held on their files. It was found that POVAFirst checks, the check against the register of adults deemed unsuitable to work with vulnerable adults had been taken up before new staff started working in the home. A Criminal Record Bureau check had also been undertaken and a copy held in their files. It was found that references had been taken up as required and also the requirements and records required to be undertaken under Schedule 2 of the Regulations, had been complied with. It was found on one staff application form that the person although asked had not given the reason for leaving their last place of work involving vulnerable adults. The Registered Manger had gained this information as part of the interview and it was agreed that in future this information should be recorded. Concerning staff training, at the last inspection a requirement was made that the home provide training to staff on the Mental Capacity Act 2005. It was found that two staff had already undertaken this training and another twelve were booked to attend, thus meeting the requirement. A training analysis form was seen for mandatory training. All staff were found to have received training in core mandatory training, mainly in-house training videos. 12 of the 16 staff are now trained to the equivalent standard of NVQ level 2 or above. The Registered Manager and another senior member of the staff are booked to attend a team leader course. Crosby Lodge DS0000069179.V345156.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 35 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed and run in the interests of the residents. EVIDENCE: The Registered Manager has now completed NVQ level 4, the Registered Manager’s Award. Mr Oliver, the Registered Provider also works in the home most days and is very involved managing the business. The improvements noted throughout the report testify to the efforts made by the management to bring the home up to the National Minimum Standards. Good feedback from Crosby Lodge DS0000069179.V345156.R01.S.doc Version 5.2 Page 20 those residents able to give an account of what it is like to live in the home inform that the home is run in the interests of the residents. The records for one of the resident’s money that is held by the home was seen. The records were full detailing money deposited, withdrawn and the balance of money held. The resident and Mr Oliver signed whenever transactions had taken place. The fire logbook was seen and informed that tests and inspections to the fire safety system were taking place to the required timescales. Information was provided through the dataset of other health and safety tests and inspections. There were no hazards identified during the inspection. The requirement made at the last inspection that the door to the cupboard where potentially harmful cleaning products are stored be locked had been complied with. Crosby Lodge DS0000069179.V345156.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Crosby Lodge DS0000069179.V345156.R01.S.doc Version 5.2 Page 22 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2. 3. Refer to Standard OP10 OP19 OP26 Good Practice Recommendations Action should be taken to ensure privacy and dignity concerning the bathroom door in No 2. A new floor surface should be laid in No 2 in order to meet requirements of the Environmental Health Officer. The Manger should liaise with the Health Protection Agency on procedures for cleaning commodes in No 2. 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