Inspection on 01/02/07 for Crosshill House

This inspection was carried out on 1st February 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Crosshill House 03/03/09

Crosshill House 19/03/08

Crosshill House 21/02/06

Crosshill House 20/09/05

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

CARE HOMES FOR OLDER PEOPLE Crosshill House Crosshill House Market Square Barrow On Humber North Lincolnshire DN19 7BW Lead Inspector Mrs Eileen Engelmann Key Unannounced Inspection 1st February 2007 09:30 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 Crosshill House DS0000063764.V329335.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. Crosshill House DS0000063764.V329335.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Crosshill House Address Crosshill House Market Square Barrow On Humber North Lincolnshire DN19 7BW 01469 531767 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) Oakhills Residential Homes Ltd Position Vacant Care Home 11 Category(ies) of Old age, not falling within any other category registration, with number (11) of places Crosshill House DS0000063764.V329335.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st February 2006 Brief Description of the Service: Crosshill House is a small homely residential home that is situated in the centre of Barrow on Humber close to local amenities. These include a post office, church and chapel, library and shops. It is registered to offer care and support to eleven people over the age of sixty-five years who do not fall into any other category. The home comprises of two storeys that are serviced by a passenger lift. There are seven single bedrooms and two shared rooms, none of which are en-suite. However the service users have the use of two assisted bathrooms, one on each floor and three further separate toilets. Crosshill House has one lounge and a separate dining room that leads out onto the garden via patio doors and a ramp. The garden is enclosed and well maintained with a large pond and waterfall. The home is spotlessly clean, tastefully decorated and has a family feel. Information about the home and its service can be found in the statement of purpose and service user guide, both these documents are available from the manager of the home. The latest inspection report for the home is kept in the manager’s office and copies are available on request. Information given by the manager within the Pre-Inspection Questionnaire indicates the home charges a range of fees from £312.00 to £337.00 per week and that there are additional charges for hairdressing, private chiropody and beauty treatments from the visiting therapist. Crosshill House DS0000063764.V329335.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out with the person who owns the home, the manager, staff, relatives and residents of Crosshill House. The inspection took place over 1 day and included a tour of the premises, examination of staff and resident files and records relating to the service. Staffs on duty, five of the residents and two visitors were spoken to; their comments have been included in this report. Information was gathered from a number of different sources before the inspector visited the home. Questionnaires were sent out to a selection of residents and staff and their written response to these was good. The inspector received 9 from staff (53 ) and 8 from residents (73 ). The owner of the home completed a pre-inspection questionnaire and returned this to the Commission within the given timescale. The owner and manager of the home have worked hard to meet requirements and recommendations made in the previous report (February 2006). Residents and relatives have expressed their satisfaction regarding the care given, service received and the living environment of the home. Overall there is a move forward to provide individualised care within a safe, comfortable and homely setting. Priority must be given by the owner and manager to address the requirements made in this report around staff training/supervision, registering the manager with the Commission and developing the Quality Assurance System. What the service does well: Residents are given up to date information about the facilities and services available to people living within the home, and the staff and manager will also talk through the information with those who find reading difficult. Residents have good access to professional medical staff and are able to access external services such as dentists and opticians. Residents commented that they are offered a good choice of meals and they enjoyed the quality of food. Specific wishes were catered for and they had plenty to eat and drink throughout the day. Residents are provided with a warm, safe and comfortable environment that welcomes visitors and makes them feel at home. The home is clean and staff work hard to make sure the building is odour free. Crosshill House DS0000063764.V329335.R01.S.doc Version 5.2 Page 6 Residents said they are happy with their bedrooms and can bring in their own possessions, making it feel more like home. What has improved since the last inspection? What they could do better: Staff training is in place, but uptake of this has been patchy over the past year. This may affect the competency of the staff and impact on the care of the residents. The manager needs to monitor this and improve the number of the staff completing the training to ensure high standards of care are achieved. Supervision of staff has lapsed and needs to be restarted to ensure that the quality and continuity of care is maintained and the health, safety and welfare of the residents is promoted and safeguarded. The monitoring and assessment of how well the service is meeting the needs of the residents must be carried out on a regular basis, and include views and comments from the residents, relatives and other people who use the service, and those professionals who give advice and assistance in meeting the healthcare needs of the residents. The results of these audits must be documented and show how the home has altered its practices and service based on the outcomes of these audits. The inspector would like to thank everyone who completed a questionnaire and/or took the time to talk to her during this visit. Your comments and input have been a valuable source of information, which has helped create this report. Crosshill House DS0000063764.V329335.R01.S.doc Version 5.2 Page 7 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. Crosshill House DS0000063764.V329335.R01.S.doc Version 5.2 Page 8 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 Crosshill House DS0000063764.V329335.R01.S.doc Version 5.2 Page 9 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): 1, 2, 3, 4, 6. Quality in this outcome area is good. All residents undergo a full needs assessment and are given sufficient information about the home and its facilities prior to admission, to enable them to be confident that their needs can be met by the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The statement of purpose and service user guide is found within each resident’s bedroom and copies are available from the manager. Each of the documents is produced in a clear print version. In the last report (February 2006) a requirement had been made for the service user guide to ‘contain the most recent inspection report and residents views of the home’. At the time of this visit the manager was in the process of putting information from the latest satisfaction questionnaires into the guide and the inspection report was seen. This requirement has now been met. Crosshill House DS0000063764.V329335.R01.S.doc Version 5.2 Page 10 Information from the surveys shows that the majority of residents received sufficient information to make an informed choice about the service before accepting the placement offer. These individuals have also received a contract/statement of terms and conditions from the home. One individual said ‘previous to my coming into the home, my family had been to visit and were very pleased with the home and its facilities’. Each resident has their own individual file and four of those looked had a need assessment completed by the funding authority and the home has also completed its own needs assessment before a placement was offered to the resident. The home develops a care plan from the assessments, identifying the individual’s problems, needs and abilities using the information gathered from the resident and family. Information from the Pre-Inspection Questionnaire completed by the manager and discussion with the residents, indicates that eight of the residents are female and three are male. Everyone is of a white/British nationality, but the home would assess any person with specific cultural or diverse needs on an individual basis. Discussion with the manager indicated that the home looks after a number of people from the local community, although placements are open to individuals from all areas. Residents are unable to make a choice of staff gender when deciding whom they would like to deliver their care, as the home has only female care staff. The manager said this was due to a lack of suitable male applications when jobs are advertised. The staff training files and the training matrix show that new staff go through an induction before starting work and that the home has a training programme in place. Information from the files and matrix indicates that the majority of staff are up to date with their basic mandatory safe working practice training, and the manager said she is looking into providing training in more specialised subjects linked to conditions of old age. The employment records show that the manager is using a selective approach to recruitment; ensuring new staff have the right skills and attitude to meet the needs of the residents. Comments from the relatives and residents surveys indicate they are pleased with the care being given and have a good relationship with the staff. One individual said ‘I love living at this home, the staff are wonderful and the service is excellent’. The home does not accept intermediate care placements so standard six is not applicable to the service provided. Crosshill House DS0000063764.V329335.R01.S.doc Version 5.2 Page 11 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 and 10. Quality in this outcome area is good. The health, personal and social care needs of the residents are clearly documented and are being met by the service and staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the last inspection in February 2006 the new owner was busy developing a care plan format to improve the documentation of residents’ care. A requirement to improve the care plans was also made in the report. At this visit the inspector found care plans to be well-written and informative, with evidence of input from the residents into their own plans. This requirement is now met. Individual care plans are in place for all residents and the four examined set out the health, personal and social care needs identified for each person. The plans looked at have been evaluated on a monthly basis and any changes to the care being given is documented and implemented by the staff. Risk Crosshill House DS0000063764.V329335.R01.S.doc Version 5.2 Page 12 assessments were seen to cover pressure sores, nutrition, moving/handling and activities of daily living. Information about the resident’s social interests, likes and dislikes, spiritual needs and wishes regarding death and dying are included within the individuals care plan. The funding authorities are carrying out yearly reviews of the care plans and the minutes of these meetings show that residents have input to this process (where possible), and family/representatives are also invited to the reviews with the resident’s permission. Residents or their representative have signed the care plans at the point of their being written to show they agree with the content, and there is evidence that residents are consulted on a regular basis about their care, especially when staff are completing the monthly evaluations. Five residents said that they have good access to their GP’s, chiropody, dentist and optician services, with records of their visits being written into their care plans. They all have access to outpatient appointments at the hospital and records show that they have an escort from the home if wished. Responses to the surveys indicated that the residents and relatives are satisfied with the level of medical support given to the people living at the home. Two individuals commented that ‘my Doctor and the District nurse visit when I need them’ and ‘if the Doctor is unavailable then the problem is with their end not the home’. Entries in the care plan detail where individuals have specific dietary needs and also note their likes and dislikes. The staff weigh everyone on a regular basis and discussion with the manager indicated that steps have been taken to ask the local doctors surgery if those who cannot weight bear can be weighed there. At the time of this visit there were no nutritional concerns for any of the residents who lived in the home. The recommendation made in the last report for the owner to provide seated scales will remain in this report. Pressure areas are monitored carefully and proactive measures include risk assessments and special mattresses and seat cushions. Information from the care plans indicates that there is at least one resident with pressure sores, and these are being treated by the district nurse. A discussion took place between the inspector, owner and manager about recent Department of Health guidance around a possible Flu Pandemic in 2009. The need for an emergency plan for the home in the event of a Flu crisis was spoken about and the inspector advised that the provider access the guidance for care homes from the Department of Health website. Since the last visit in February 2006 the home has sent the Commission a basic procedure detailing how residents wishing to self-medicate would be assessed and supported. At the time of this visit all those spoken to preferred that the staff administered their medication. Crosshill House DS0000063764.V329335.R01.S.doc Version 5.2 Page 13 A requirement was made in the last report (February 2006) for all staff to receive accredited training. Information given in the Pre-inspection Questionnaire indicates that this is planned for 2007, but has not yet taken place. This requirement will remain in this report. Checks of the medication records at this visit showed that staff are recording more consistently on the charts and there is only one area that could be improved as a matter of good practice. ∗Where staff are handwriting medication onto the sheets (transcribing), they should have two staff sign the entry to indicate they have both witnessed that the information on the sheet is correct. The home did not have any controlled drugs on the premises at this visit. Resident and relative comments show they are very satisfied with the care and support offered by the staff. Chats with the residents revealed that they are happy with the way in which personal care is given at the home, and they feel that the staff respect their wishes and choices regarding privacy and dignity. Two individuals spoken to said ‘ the staff are lovely, they are always around to offer help and support when we need it and are very considerate of our feelings’. One individual spoken to is new into the home, they said ‘the staff have been extremely good at helping me settle into my room and are friendly, kind and take the time to talk to me every day’. Crosshill House DS0000063764.V329335.R01.S.doc Version 5.2 Page 14 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 and 15. Quality in this outcome area is good. Residents are provided with choice and diversity in the meals and activities provided by the home. Relatives and visitors are made welcome at the home and good links to the community enrich the residents social and leisure opportunities. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Crosshill House is a small, friendly and well-run home, with a welcoming and family orientated atmosphere. Discussion with the residents found that everyone is extremely happy with the care they receive and the surroundings that they live in. One individual said ‘ I love it here at the home, my room is wonderful and the staff are very attentive. The food is very good and I have put weight on since coming here. I like to spend time in the lounge chatting to my friends and also enjoy time in my room doing puzzle books, reading and watching my videos. My family visit regularly and we all have a good laugh with the staff. I am so happy here and cannot fault the home’. Other individuals spoken to commented that ‘ we are pretty independent here and the staff support us to do as much as we can for ourselves’. ‘I like to go Crosshill House DS0000063764.V329335.R01.S.doc Version 5.2 Page 15 outside into the garden whenever the weather permits and I have no problems with access even though I use a Zimmer frame to walk with’. There is a very close-knit community around the home and residents continue to receive visits from the church, families and friends. Individuals say they enjoy trips out shopping, going to the local Methodist chapel and seeing family members. Major Christian festivals (Easter and Christmas) and birthdays are celebrated within the home and families are encouraged to join in with these events. A beautician visits weekly to do nails and hand massage, whilst the hairdresser comes in to do haircuts, sets and perms. The home has a pat-a-dog lady who attends every Thursday, one resident uses Hearing Books for the Blind and the mobile library visits the home every fortnight. Discussion with the residents indicates that they have good contact with their families and friends. Everyone said they were able to see visitors in the lounge or in their own room and they could go out of the home with family or staff would take them into the town. Visitors were seen coming and going during the day, staff were observed making them welcome and there clearly was a good relationship between all parties. Discussion with the manager indicated that no one at the home is currently using an advocacy service, although these have been accessed in the past. It is recommended that advocacy information such as addresses and contact details of local services be put into the service user guide. Five residents who were spoken to are well aware of their rights and said that they had family members who acted on their behalf and took care of their finances. Information from the pre-inspection questionnaire indicates that the home does not hold responsibility for anyone’s finances; residents either see to their own affairs or have a named representative. Details about this can be found in the individuals care plan. All the residents said that the home encouraged them to bring in small items of furniture and personal possessions to decorate their bedrooms. Comments from the surveys received from staff, residents and relatives indicate that overall there is a good level of satisfaction with the meals provided by the home. One individual said ‘ the meals are very good, like being at home only better’. Another commented that ‘ we have a very good cook, she makes us interesting meals that taste wonderful’. Crosshill House DS0000063764.V329335.R01.S.doc Version 5.2 Page 16 Observation of the midday meal showed it to be well prepared and presented, and the trays going out to those in their rooms were attractive and contained condiments, tray clothes and napkins. Staff were organised when serving the meal and a number of individuals were seen to offer assistance to residents who need help with eating and drinking. Menus are available on the dining tables and jugs of squash were seen in the dining room and lounge. Residents said ‘we can help ourselves or the staff will get us a glass and those who need assistance have regular drinks offered’. Crosshill House DS0000063764.V329335.R01.S.doc Version 5.2 Page 17 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 and 18. Quality in this outcome area is good. The home has a satisfactory complaints system with some evidence that residents feel that their views are listened to and acted upon. Staff and residents are confident about reporting any concerns and the manager acts quickly on any issues raised. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Checks of the complaints record shows that the home has not had any formal complaints since the last inspection. Discussion with the manager indicates she would deal with any ‘niggles or grumbles’ on a daily basis. The home has a complaints policy and procedure that is found within the statement of purpose and service user guide. It is also on display within the home. Five residents showed a clear understanding about how to make their views and opinions heard and said ‘the manager listens to our concerns and will take action were necessary to resolve the issues raised’. The staff on duty displayed a good understanding of the vulnerable adults procedure and three residents spoken to said they ‘felt safe at the home’. Staff training files show that Protection of Vulnerable Adults from Abuse training has taken place and is an ongoing process, and information from the staff surveys indicates they are confident about the whistle blowing procedure Crosshill House DS0000063764.V329335.R01.S.doc Version 5.2 Page 18 and discussing any concerns with the management team. The requirement in the last report (February 2006) for adult protection training is now met. Crosshill House DS0000063764.V329335.R01.S.doc Version 5.2 Page 19 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, 24, 25 and 26. Quality in this outcome area is good. The standard of environment within the home is good, providing residents with an attractive and homely place to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has an ongoing programme of routine maintenance and decoration that ensures the environment is kept safe and well presented. It is recommended that the manager formally record this. Decoration throughout the building is to a high standard and bedrooms have their own colour schemes and furnishings. Since the last visit in February 2006 the home has purchased new commodes for two rooms, bedroom carpets, bed linen and curtains have been renewed and repainting of the bedrooms has been ongoing. An organ and a DVD player have been bought Crosshill House DS0000063764.V329335.R01.S.doc Version 5.2 Page 20 for the lounge area, a new bath lift purchased for the downstairs bathroom and numerous items of kitchen equipment obtained. Five residents spoken to were very pleased with their individual rooms and said that they had ‘brought in a number of personal possessions to make them feel more at home’. Double rooms are supplied with privacy curtains/screens that can be drawn across the room when individuals are receiving personal care. The owner must look at the provision of bedroom door locks and keys for each of the rooms, the manager said that this has been discussed with the residents and she is in the process of documenting in the care plans where residents have chosen not to have these fitted. It is recommended that the owner should supply as standard, lockable facilities and privacy locks to bedroom doors when current occupants vacate the bedrooms. A requirement in the last inspection report (February 2006) states that the owner must provide low surface temperature radiators or radiator guards in all areas accessed by residents. Checks at this visit show that this requirement has been met. The environment is clean, warm and comfortable and no malodours were present. Comments from the surveys indicates that the residents find the home to be spotlessly clean and are satisfied with the laundry service provided by the home. Crosshill House DS0000063764.V329335.R01.S.doc Version 5.2 Page 21 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 and 30. Quality in this outcome area is adequate. Staff morale is high resulting in an enthusiastic workforce that works positively with residents to improve their whole quality of life. Improvements are needed to staff training to ensure every member of staff has the necessary skills and knowledge to meet the needs of the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Comments received from the residents, relatives and staff were positive about the staffing levels, and everyone was satisfied that there were sufficient people on duty to meet the needs of the residents. One relative said that ‘my aunt has been at the home for 10 years and it has been the happiest time of her life’. Staff morale on the whole is good, and individuals said that there is a good working atmosphere at the home. At the moment there two care staff on duty 24 hours a day. The manager’s hours are supernumerary to these figures. Observation of the staff showed that the home is quiet, calm and well organised. Information from the pre-inspection questionnaire and staff rotas about the number of staffing hours provided and the dependency levels of the residents, Crosshill House DS0000063764.V329335.R01.S.doc Version 5.2 Page 22 was used with the Residential Staffing Forum Guidance and showed that the home is meeting the recommended guidelines. Discussion with the manager and checks of the staff files found that the home has obtained the Skills for Care Induction packs for all the staff. These are in the process of being introduced and implemented. The requirement in the last inspection report (February 2006) around this area of practice has now been met. Two out of the fourteen staff employed at the home have achieved a National Vocational Qualification in Care (14 ) and the manager said other staff are going through the training process. It is recommended that at least 50 of care staff achieve the level 2 qualifications by the end of 2007. The home provides a basic mandatory staff-training programme and there is a need for more specialised training to be offered that reflects the different care needs of the client group. Information in the staff training files indicates uptake of training has been patchy over the past 12 months and the manager must make sure that everyone attends. The training matrix shows the following attendance figures Falls (43 ), Continence (43 ), Fire (100 ), Moving and Handling (75 ), adult protection (75 ), food hygiene (50 ), Health and safety (28 ), Infection control (28 ), COSHH (28 ), Dementia (7 ). There is no evidence that staff have received training around equality, diversity and disability rights and this should be included in the rolling programme of staff training and development. A requirement in the last inspection report (February 2006) was for the registered person to ensure all staff had mandatory updates in safe working practices. The training matrix shows that not all staff have achieved attendance for these training sessions, therefore the requirement will remain in this report. A monitoring system should be put in place to assess the skills and knowledge of the staff, and determine how successful the training has been. The home has an equal opportunities policy and procedure. Information from the staff personnel and training records and discussion with the manager, shows that that this is promoted when employing new staff and throughout the working practices of the home. The manager said that the home has tried to recruit male carers in the past as she is aware that all of the staff are female, but this has proved difficult as there have been few suitable applicants. She is aware that this may affect resident’s wishes regarding gender choice for giving of personal care, and this is discussed before an individual is offered a placement at the home. Crosshill House DS0000063764.V329335.R01.S.doc Version 5.2 Page 23 Comments from the manager indicate that all of the residents are from a white British background, but the home is able to offer a range of services when they are approached from someone of another culture or ethnic group. Checks of four staff files indicates that the manager has been auditing and improving the staff files as requested in the last inspection report (February 06). The requirement around this aspect of practice has now been met. Start dates for the employees were found in three of the four files looked at and cross checking with old rotas indicated that all had their interview process, police/CRB checks, written references, health checks and past work history obtained and agreed as satisfactory before the person started work. The home has been using the process of obtaining the Protection of Vulnerable Adults first check for all new starters before receiving the Criminal Records Bureau check. It was discussed with the manager that this was only to be done in extreme circumstances where the home was desperately short of staff, and should not become a regular part of the employment process. Crosshill House DS0000063764.V329335.R01.S.doc Version 5.2 Page 24 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, 36 and 38. Quality in this outcome area is adequate. The management team has a good understanding of the areas in which the home needs to improve. The owner and manager must plan and set out how these improvements are going to be resourced and managed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager of the home, Elaine Fisher, is an experienced person who has been employed at the home since January 2006. She is doing the Registered Managers Award, but has not yet applied to the Commission for Registration. The owner must ensure the manager’s application is completed and sent off as soon as possible. Crosshill House DS0000063764.V329335.R01.S.doc Version 5.2 Page 25 Staff spoke highly of the manager saying that ‘ the manager is very good at her job; she handles issues well and deals with them quickly. We are offered support and advice when needed’. Comments from the residents and staff indicate that they have regular meetings, where they are able to express their opinions on the home and the management team listens to their views. The residents spoken to said that ‘ the manager comes round to see us every day and we can discuss anything with her during the visit’. Feedback is sought from the residents and relatives through satisfaction questionnaires, although there is no annual report produced as part of this process to highlight where the service is going or indicate how the management team is addressing any shortfalls in the service. The annual report must be developed to ensure the service meets the resident’s needs and is run in their best interests. This is an outstanding requirement from the last inspection report (February 06) and time was spent with the manager discussing how this could be achieved. Policies and procedures have been reviewed and update, new processes for care plans and medication have also been implemented. Improvements to staff employment practices and staff training processes have been seen, although further work in these areas is needed. The inspector has heard residents expressing a high level of satisfaction with the service, staff and facilities throughout this visit. Residents, visitors and staff are pleased with the management and the way the home is run. Discussion with the owner and manager indicated that the home does not have anything to do with the handling of residents’ personal allowances. Fee payments are all paid directly into the Company’s account by ‘BAC’S’ system. Residents are supplied with wall safes in their rooms to keep money and personal valuables secure. Checks of the staff supervision files show that these are not up to date nor are regular sessions recorded. Comments from the staff and discussion with the manager indicate that informal supervision is ongoing, but formal written supervision needs to be undertaken. Staff said that they feel supported and can obtain help and advice from the manager at any time. Maintenance certificates are in place and up to date for all the utilities and equipment within the building. Accident books are filled in appropriately and regulation 37 reports completed and sent on to the Commission where appropriate. Staff are able to access safe working practice training although uptake has not always been as good as it should be over the past year. The manager has completed generic risk assessments for a safe environment within the home. Crosshill House DS0000063764.V329335.R01.S.doc Version 5.2 Page 26 Risk assessments were seen regarding fire, moving and handling and daily activities of living. Crosshill House DS0000063764.V329335.R01.S.doc Version 5.2 Page 27 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 3 3 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 3 3 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 3 Crosshill House DS0000063764.V329335.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) 18(1) Requirement The registered person must ensure that staff administering medication, have received accredited training (given timescale of 01/06/06 was not met). The registered person must ensure that there is a training programme in place that ensures staff fulfil the aims of the home and meet the changing needs of the residents. This programme must include mandatory training in safe working practices, especially moving and handling, specialist training on the elderly, and diseases relating to old age and dementia. (given timescale of 01/06/06 was not met). A manager must be registered with the Commission. The registered person must compile an annual report detailing the outcome of the review of the quality of care and provide a copy of this to the Commission and the service users (given timescale of 01/09/06 was not met). DS0000063764.V329335.R01.S.doc Timescale for action 01/07/07 2. OP30 12, 18, 01/07/07 3. 4. OP31 OP33 8 24 01/07/07 01/07/07 Crosshill House Version 5.2 Page 29 5. OP36 18 Care staff must receive formal supervision at least six times a year, which covers all aspects of practice, the philosophy of the home and the career development needs of the individual. 01/09/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP8 OP8 OP9 Good Practice Recommendations The registered person should provide seated scales. The provider should ensure the home has an emergency crisis plan for the possible Flu Pandemic by the end of 2007. Where staff are hand-writing medication onto the sheets (transcribing), they should have two staff sign the entry to indicate they have both witnessed that the information on the sheet is correct. The manager should put advocacy information such as addresses and contact details of local services into the service user guide. The manager should formally record the ongoing programme of routine maintenance and renewal carried out within the home. The owner should supply as standard, lockable facilities and privacy locks to bedroom doors when current occupants vacate the bedrooms. 50 of care staff should achieve an NVQ 2 by the end of 2007. Staff should receive training around equality, diversity and disability rights and this should be included in the rolling programme of staff training and development. The manager should achieve The Registered Managers award by the end of 2007. 4. 5. 6. 7. 8. 9. OP14 OP19 OP24 OP28 OP30 OP31 Crosshill House DS0000063764.V329335.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Hessle Area Office First Floor 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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 Crosshill House DS0000063764.V329335.R01.S.doc Version 5.2 Page 31 - 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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