Inspection on 19/03/08 for Crosshill House

This inspection was carried out on 19th March 2008.

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

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 01/02/07

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 Stephen Robertshaw Key Unannounced Inspection 19th March 2008 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 Crosshill House DS0000063764.V360857.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.V360857.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.V360857.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st February 2007 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 people who use the service 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. 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 £328.25 to £360.00 per week and that there are additional charges for hairdressing, private chiropody and beauty treatments from the visiting therapist. Crosshill House DS0000063764.V360857.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. The site visit took place over one day in March 2008. Surveys were posted out prior to inspection; one was returned from a relative, some of the comments have been included in this report. Mrs Jane Lyons carried out the visit. During the site visit we spoke to the owner, three care staff, the cook, six people who use the service and two relatives to find out how the home was run and if the people who lived there were satisfied with the care and facilities provided. We were also able to speak to a district nurse, G.P., district nursing assistant and the hairdresser during the visit. We also looked around the home and looked at lots of records, for example; people’s care plans and risk assessments, daily records, supervision schedules, menus, and other records relating to the running of the home. Information received by the Commission over the last few months was also considered in forming a judgement about the overall standards of care within the home. Prior to the visit the inspector referred to notifications sent to the Commission for Social Care Inspection, the event history for the home over the past year and the completed Annual Quality Assurance Assessment document (preinspection questionnaire), all of which forms part of this inspection. The manager for the home left in July 2007 and since that time the owner has taken on this role; there was a lot of evidence that many of the management and administration systems have not been fully maintained in this time and a new manager for the service needs to be recruited to make the required improvements to the running of the home which will better protect the health, welfare and safety of those people who use the service. This said all the people spoken to during the visit said how happy they were at the home and how satisfied they were with the standards of care. What the service does well: The staff were very friendly and helped the people who live there in a dignified and respectful manner. Comments in a relatives survey included “My relative has been in the home for ten years, we are all very happy with the care, they are all so kind”. Crosshill House DS0000063764.V360857.R01.S.doc Version 5.2 Page 6 People who live at the home have good access to health professionals and are able to access external services such as dentists and opticians. Meals are well presented and offer people at the home a choice and variety of different foods. Visitors to the home are made welcome and the home has a very relaxed, friendly atmosphere. All of the people admitted to the home had had their needs fully assessed to make sure that the staff were able to look after them properly. People said they were happy with their bedrooms and could bring in their own possessions, making it feel more like home. What has improved since the last inspection? What they could do better: They could provide more up to date information about the services provided so that people considering moving into the home are better informed. People’s care plans must improve; some records did not have enough information about all the needs of individuals. This means the home was not able to show that all aspects of the health and personal care needs of individuals were identified and planned for. They must ensure that activities within the home meet individual’s interests and expectations and that staff are proactive in encouraging and enabling people to take part in activities that interest them. The way the home manages medication must be improved to ensure that it is recorded and stored properly. They must fully investigate all complaints and maintain more detailed records of investigations. The home must make sure that all staff members receive training in how to protect vulnerable adults from abuse. A new manager needs to be recruited for the home so that improvements can be made to the management and administration systems, which will better protect the health, welfare and safety of the people who use the service. They must control unpleasant odours in the home. Crosshill House DS0000063764.V360857.R01.S.doc Version 5.2 Page 7 The management need to consult more regularly with the people who live in the home, their representatives and other interested parties, so they can have a say in how the home is run. A report needs to be produced to show how they have done this and what improvements have been made. They must make sure that recruitment processes protect people who use the service. They must obtain relevant police checks and references from recent employers before employment of staff. New staff need to do basic training (induction) in how to work with older people within 6 weeks of starting the job. They must provide evidence that staff have received mandatory training and regular supervision to ensure that staff work safely and consistently. They must ensure that people who live in the home are protected from accidental scalds by providing radiator covers to all uncovered radiators and by checking the hot water temperatures at sink outlets accessible to people who use the service. They must carry out more regular checks and keep more detailed records on bed rails provided to individuals to protect their safety. 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.V360857.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.V360857.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, 5 and 6 People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. Although some of the information about the home needs to be updated, the home’s pre admission assessment processes made sure that people knew the home could meet their needs. EVIDENCE: The home had a statement of purpose and a service user guide, which gave information about the home. The documents were informative and written in plain English, however both these documents now need to be updated to show changes in management and staffing. The service user guide had been reviewed to include information on the non- smoking policy however it needed to include a copy of the previous inspection report and people’s views on the services provided at the home. Crosshill House DS0000063764.V360857.R01.S.doc Version 5.2 Page 10 People stated that they had received adequate information about the home before they moved in. The home offered visits and trial stays so people could assess the services provided by the home. There was signed evidence in individual’s files of agreement to the contract/statement of terms and conditions. Two care files of the people who been admitted more recently were checked. These provided evidence that people had had their needs assessed by the owner prior to admission to the home. There were a number of documents including pre admission assessments and risk assessments completed as part of the assessment process and these were used in a consistent way. The home had also obtained social service assessments and care plans to help inform the assessment process. Staff confirmed that they were provided with information about people’s needs prior to their arrival. All the current people who use the service were female. The owner confirmed that they were of a white/ British nationality, but the home would assess any person with specific cultural or diverse needs on an individual basis. People are unable to make a choice of staff gender when deciding whom they would like to deliver their care, as the home currently employs only female staff. Comments from surveys and discussions during the day indicated that people were very pleased with the standards of care being given and have very good relationships with the staff. One individual said, “The girls are excellent, I am very happy here at the home.” The home does not provide intermediate care dedicated to accommodate individuals with intensive rehabilitation needs, so standard six is not applicable. Crosshill House DS0000063764.V360857.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. People who use this service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to this service. People felt happy with the standards of care they received and felt they were treated with respect, but some of the care documentation remains inadequate and places them at risk of not receiving the care they need. Some deficiencies in the transcribing and recording of medicines could place people at risk of not having their health needs met. EVIDENCE: Care files for three of the people living at the home were examined. Although during the visit there was no indication that people’s health and care needs were not being met the standard of the care documentation had fallen since the previous inspection and was found to be very inconsistent. In all files examined care plans had not been developed to support all areas of need, for example the assessment and daily records indicated one individual required support with problems associated with confusion, personal care, continence Crosshill House DS0000063764.V360857.R01.S.doc Version 5.2 Page 12 and falls prevention however only one care plan was in place which had briefly detailed a combined support plan for aspects of mobility and continence. Another individual’s plan did not detail the support required for personal care, falls prevention or the support with dizziness/ chest plain the individual had been experiencing, which had led to a hospital admission. There was evidence that not all the care plans had been evaluated on a regular basis; changes in people’s health were not always identified and plans had not been updated to reflect these changes for example one individual’s needs had changed regarding her diabetes yet the care plan had not been updated. Staff had completed detailed records after each shift and also maintained records of communications with the relatives and health care professionals. The use of risk assessment documentation to form a basis for care was also inconsistent; although all files seen contained risk assessments to cover areas such as mobility, falls, pressure damage and nutrition many of these had not been reviewed regularly for example in one file there was a falls risk assessment dated 19/01/06 with a risk rating of “low” however the individual had fallen in early March 2008 yet the assessment had not been updated. There was however evidence in two files that moving and handling risk assessments had been regularly reviewed. Entries in the care plans detail where individuals have specific dietary needs and also note their likes and dislikes. The staff weigh everyone on a monthly basis, the staff confirmed all individuals were able to use the “standing” scales in the home; the recommendation made for the owner to provide seated scales will remain in this report. At the time of the visit there were no nutritional concerns for any of the people who lived in the home. There was evidence that care staff observed for any signs of potential damage to skin during their day-to-day support of people and would record any problems in diary notes. The owner confirmed that any issues relating to tissue viability or continence promotion were discussed with the District Nurse and they would provide the required aids. There were no people who were identified as at risk of developing pressure sores. All people spoken to said they had good access to their General Practioner, chiropodist, dentist and optician, with records of their visits detailed in the care plans. Relatives confirmed that the staff always informed them of any changes, such as illnesses and falls. During the visit we spoke to a district nurse, district nursing assistant and General Practioner who were visiting individuals at the home; all confirmed their satisfaction with the standards of care and communication with the home. Medication policies and procedures were in place which generally covered all aspects of the system; these would now benefit from review to include all Crosshill House DS0000063764.V360857.R01.S.doc Version 5.2 Page 13 recent guidance from the updated Royal Pharmaceutical Society procedures issued in 2007. Storage of medications would improve with the separation of internal and external medications. Controlled medication was stored in a digital locked safe which is mounted onto a filing cabinet this does not meet the updated regulations for controlled medication storage. The temperature of the medication storage area should be monitored regularly to ensure it does not exceed the manufacturer’s guidance. Examination of the medication administration records evidenced some gaps in signatures. A recommendation made at the previous visit 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, had not been actioned. The home had not obtained written confirmation of the dose required where warfarin was prescribed, this is recommended. Evidence from observation of practise, discussion with people and staff indicated that people’s privacy and dignity were respected. Staff were observed to be kind, use people’s preferred term of address and knock on bedroom doors before entering. A relative said ‘everyone is very well looked after here’ another said there was ‘very good care, everyone is helped and treated with respect’. Crosshill House DS0000063764.V360857.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 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People are enabled to keep in contact with family and friends and they receive a healthy, varied diet according to their assessed needs and choices. Although some people were supported to participate in activities in the community there were very limited opportunities for people to have their social needs met in the home. EVIDENCE: Crosshill House is a small, friendly home with a welcoming and family orientated atmosphere. People confirmed that they were able to exercise choice in all their daily routines, one individual said “Its very relaxed here, most of us are fairly independent and the staff are there to help us when we need it.” There is a very close- knit community around the home and people who use the service continue to receive visits from the church, families and friends; some of the people continue to access regular trips out with family and friends Crosshill House DS0000063764.V360857.R01.S.doc Version 5.2 Page 15 such as outings to the shops, for lunch and to the local Methodist Chapel. One individual attends art classes at a neighbouring village each week. People spoken with stated that there was very little social stimulation at present in the home, ‘Not much going on in the home” and “We don’t have a lot of activities, I get a bit bored sometimes”. This was confirmed in discussions with the owner and staff. Staff felt that their time was taken up caring for individuals and there was little time to arrange activities. Although there was evidence in care files of personal profiles and attempts made to find out people’s interests and hobbies, their needs were not assessed in any meaningful way. This means that members of staff were unaware of individual’s capabilities to participate in activities and were unable to plan a programme of events to meet their needs. The home now has a cat, which everyone spoken to confirmed they liked. The hairdresser visits the home weekly and a local minister visits the home regularly for ecumenical services. 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. All the comments received from surveys and during the visit confirmed that the home provided a high standard of meals, which people really enjoyed. Comments included “The food is very good, you can order what you like, if you don’t like what’s on the menu, have something else.” and “The cook is lovely, she always cooks interesting and tasty food” The meal served during the visit looked appetising and well presented. The majority of people have meals in their own rooms and four people used the sitting room, all meals were provided on trays, which were attractively presented with condiments, tray cloths and napkins. The owner confirmed that although the dining room was still used, this was mainly on Sundays and special occasions as many people now preferred to use the sitting room. The kitchen was very clean and tidy and all associated records for the safe handling of food were maintained. Crosshill House DS0000063764.V360857.R01.S.doc Version 5.2 Page 16 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 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home ensured that the people were made aware of the complaints procedure and had the opportunity to raise issues. Although procedures and some staff training were in place to protect individuals from harm, the failure to investigate concerns and allegations fully may leave people at risk. EVIDENCE: The home had appropriate policies and procedures for dealing with complaints. The complaint procedure was made available to people in information provided and was also displayed in the home. All people who live in their home and relatives spoken with during the visit confirmed that felt able to raise issues. The staff had access to a copy of the multi agency safe guarding adult’s policy and procedures; the home had also developed their own detailed safeguarding policy, which linked in with this document. There were policies on restraint, dealing with aggression, whistle blowing and managing finances in place. Not all staff members have received training in safeguarding adults from abuse. Crosshill House DS0000063764.V360857.R01.S.doc Version 5.2 Page 17 In discussion, staff showed a good understanding of the safeguarding adults procedure; they confirmed that they had reported concerns regarding a colleague’s attitude to the owner, which had been dealt with promptly with noted improvements. On discussion with the owner, she confirmed that staff had raised issues around one of the staff member’s conduct in that she had been abrupt towards some of the people who use the service. The owner said she had addressed the issue however there were no formal records to support any management action taken , nor had the staff member concerned received regular supervision to monitor improvements in their standards of communication. Crosshill House DS0000063764.V360857.R01.S.doc Version 5.2 Page 18 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 and 26 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provided a very comfortable and homely environment. It was generally clean and tidy although odour management in one area and aspects of maintenance were now impacting on the overall quality of the environment. EVIDENCE: Generally the standard of cleaning in the home had been maintained however there was an unpleasant odour in one of the bedrooms which was also noticeable in the hall area and this did not provide a positive welcome. Although people spoken to all said that they were happy with the cleanliness of their rooms and a relative wrote “I never go into the home without it always smells fresh and clean.” Crosshill House DS0000063764.V360857.R01.S.doc Version 5.2 Page 19 New carpets had been provided throughout the communal areas of the home apart from this there was little evidence of any redecoration or refurbishment taking place since the previous inspection and a number of areas such as bathrooms and some people’s bedrooms were looking tired. Many of the towels were very worn and the lavatory seats in two toilets were very chipped and worn and needed replacement. One of the individual’s bedroom windows had been taped up during the winter due to the draught however this meant that the individual was not able to open the window to ventilate the room. Off cuts of carpet left over from the refitting had been stored in a bathroom, the owner said they were to be fitted in the staff areas; alternative storage must be found. There had been no progress in the provision of privacy locks on individual’s bedroom doors which now needs to take place. Low surface temperature radiator covers were missing from the radiators in the ground floor corridor and in the sitting room; a risk assessment was in place to support the use of a thermostatic valve on the corridor radiator due to space restrictions. People who use the service commented on how happy and settled they were at the home, many people spend the majority of time in their rooms which were seen to be personalised to the extent chosen by the individual. All of the rooms in the home had a call bell system in them. People who use the service confirmed to the inspector that when the call bell was activated the staff were generally quick to respond. Discussion with the staff indicated that there was satisfactory provision of protective clothing. All the people who currently reside at the home needed minimal assistance with moving and handling; staff provided support with equipment such as lifting belts and a turntable. The home does not have provision of a hoist which must be considered to meet the changing needs of the individuals and for use in emergencies following falls etc. All areas in the kitchen were found to be clean and tidy, a number of the kitchen cupboards require repair/ replacement where cupboard handles and doors were broken. The dishwasher had broken down during the visit which the owner arranged to be repaired. The gardens at the home are at the rear of the property and are very attractive with a pond and lots of mature plants and trees. Many of the people who live at the home said how much they like to sit out in the gardens when the weather is nice. Crosshill House DS0000063764.V360857.R01.S.doc Version 5.2 Page 20 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 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The numbers of staff and skill mix provided in the home were sufficient to meet people’s needs. There were gaps in training and practice that the manager needs to address to ensure all staff members are equipped to complete their roles and carry them out safely. The recruitment processes lack a robustness that is required to fully ensure the safety of people who use the service. EVIDENCE: People who live at the home and their relatives said that the staffing arrangements in the home were generally very good and some very positive comments about the staff were received; “ The girls are wonderful and they make this home what it is” and “ We are well looked after- its like home from home”. The staffing levels at the home must be assessed using Department of Health Guidelines, this is based on the dependency of the people accommodated in the home at one time. At the time of the visit there were two care staff on duty 24 hours a day. The owner was currently providing all management support and her hours were supernumerary to these figures. The home employs a full time cook however the care staff were responsible for all cleaning and laundry Crosshill House DS0000063764.V360857.R01.S.doc Version 5.2 Page 21 duties. Observation of the staff during the visit showed that the home was quiet, calm and well organised. The home employs 12 care staff. The owner confirmed that three of the staff had gained NVQ level 2 and a further three staff had nearly completed the course; this means the home was on target to have 50 of the care staff qualified in the near future. Discussion with the owner, staff and checks of the staff files found that the home had not implemented the Skills for Care Induction programmes for new staff. The home provided a very basic induction to the home on the first day of work, records were not always signed off. Discussions with staff and examination of records evidenced that little training had been provided to staff since the previous inspection, other than the NVQ course that three staff were accessing. None of the staff were up to date with mandatory training in fire safety, moving/ handling, first aid or food hygiene. The owner stated she had arranged for a training company to provide these courses to all the staff in April 2008. Existing staff had been provided with safeguarding adults training however staff employed since February 2007 now needed to access this course; staff responsible for administering medications need to access accredited training. It was clear that the owner needed to carry out an audit of all training provided to staff (some new staff have accessed some training courses at their previous workplace) and develop an up to date training plan for all staff which includes general and service specific courses as well as the mandatory training they need to access as priority. Discussions held with the NVQ assessor during the visit confirmed that the three staff she was currently working with were very enthusiastic students, as part of the course she had observed their practise which had been very positive. The home had appropriate recruitment policies and procedures in place that included grievance, disciplinary measures and equal opportunities. Checks of three staff files indicated that some of the homes recruitment practises remained inconsistent; two of the files seen were in order and contained all the relevant checks and records however with one file, references were not obtained from the previous employer and the staff member had commenced work prior to the relevant police check being in place. This does not afford adequate protection for the people who use the service. It was clear from the information in the files that some staff had been employed after a clear povafirst check but prior to the return of the criminal Crosshill House DS0000063764.V360857.R01.S.doc Version 5.2 Page 22 record bureau check. This is acceptable practise but stringent supervision arrangements must be in place. The owner was advised to audit all files to ensure that all the required information has been obtained to meet Schedules 2 and 4 of the Care Home Regulations. Crosshill House DS0000063764.V360857.R01.S.doc Version 5.2 Page 23 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. This judgement has been made using available evidence including a visit to this service. There was no registered manager at the home and many of the management and administration systems have not been maintained adequately since the previous manager left which could leave the people’s health and safety at risk, this said people who lived at the home considered that they had appropriate opportunities and that the home was generally well run in their best interests. EVIDENCE: The home’s manager resigned from her post in July 2007 and since that time the owner has been providing all management support. From discussions with the owner and examination of various records there was evidence that many of the administrative and management systems had not been maintained within Crosshill House DS0000063764.V360857.R01.S.doc Version 5.2 Page 24 this time which could leave people at risk of not receiving the care they needed and that their health and safety was not fully protected, this said all people spoken to confirmed their high level of satisfaction with the service, staff and facilities. Staff spoken to said that moral was generally good, the owner provided “hands on” support when needed and if issues arose she dealt with them promptly and effectively. Staff meetings had not been held so regularly, the last one being in May 2007. People who use the service said that they have regular meetings, where they were able to express their opinions on the home and the owner listens to their views; records showed that meetings had been held in June and November 2007. People spoken to said that ‘ the manager comes round to see us every day and we can discuss anything with her during the visit’. There was little evidence that the owner had maintained the quality assurance programme since the previous manager had left; the management need to consult more regularly and formally with the people who live in the home, their representatives and other interested parties, so they can have a say in how the home is run. A report needs to be produced to show how they have done this and what improvements have been made. Discussion with the owner indicated that the home does not have anything to do with the handling of people’s personal allowances. Fee payments are all paid directly into the Company’s account by ‘BAC’S’ system. People are supplied with wall safes in their rooms to keep money and personal valuables secure. Policies and procedures required review to ensure they met current legislation and good practice guidance, particularly some of the key policies such as medication and moving/ handling. Examination of a sample of staff supervision records evidenced that staff had not been accessing regular sessions; eight staff had accessed sessions in June 2007 and one staff member had accessed a session in December 2007. All care staff must access at least six sessions per year. None of the care staff had accessed an appraisal with the owner to formally discuss and identify their training needs. Maintenance certificates were in place and up to date for all the utilities and equipment within the building. Fire safety checks had been carried out although the fire risk assessment had not been reviewed since 2006. The fire alarm went off during the inspection visit; staff generally responded well and the owner advised staff regarding their responses. Crosshill House DS0000063764.V360857.R01.S.doc Version 5.2 Page 25 Accident books were filled in appropriately and regulation 37 reports completed and sent on to the Commission where appropriate. One individual had bed rails fitted, there was no risk assessment in place to support use, neither were protective covers in place. Guidance issued by the Medical Devices Agency details that the risk assessments should be detailed and cover areas of assessment such as: type of rail used, height of bed, distance from the headboard to the rail, height of mattress etc. and that protective covers should be used to reduce risk of injury. The owner must ensure bed rail protectors are provided, risk assessment documentation is in place and that the rails are checked regularly to ensure their safety. Although there was evidence that staff were monitoring all bath water temperatures ,checks were not carried out on hot water temperatures at sink outlets which people had access to, this must take place to ensure the safety of people in the home. Mandatory training provision had not improved although the owner confirmed that training in fire safety, moving/ handling, first aid and food hygiene had been arranged for the following month. Induction training was not adequate to ensure that staff work safely. Crosshill House DS0000063764.V360857.R01.S.doc Version 5.2 Page 26 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 2 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X 2 X 2 STAFFING Standard No Score 27 2 28 2 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 2 1 X 3 1 X 2 Crosshill House DS0000063764.V360857.R01.S.doc Version 5.2 Page 27 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 OP1 Regulation 4 Requirement The registered person must update the statement of purpose to provide details of the current management and staffing arrangements in the home. This will better ensure that people or their representatives have access to all the information they need to help them decide if the home is right for them. The registered person must ensure that the service users guide must contain the most recent inspection report and people’s views of the home. This will better ensure that people or their representatives have access to all the information they need to help them decide if the home is right for them. The registered person must ensure that people’s care programmes are sufficiently detailed to identify all care needs; they are updated to reflect current care needs and have clear directions for staff to follow. This will better ensure DS0000063764.V360857.R01.S.doc Timescale for action 30/06/08 2. OP1 5. 30/06/08 3. OP7 15 31/05/08 Crosshill House Version 5.2 Page 28 4. OP8 12 and 13 5. OP9 13(2) 18(1) 6. OP9 13(2) 7. OP9 13(2) 8. OP12 16 (2)(m)(n) 9. OP18 13(6) 18(1) people’s care needs are all documented and met. The registered person must review all current risk assessments for the following areas: tissue viability, falls and nutrition. Where necessary risk assessments must be revised and updated. The registered person must ensure they are agreed to by the people who use the service or their representative. This will better ensure their rights, health and safety. The registered person must ensure that staff administering medication have received accredited training. This will better ensure they are competent in their practise. (Timescales of 01/06/06and 01/07/07 not met). The registered person must ensure that staff complete the medication administration charts in accordance with the homes procedures. This will better ensure that people receive the medication they need. The registered person must provide appropriate storage for controlled medications. This will better ensure the safety and security of these medications. The registered person must ensure that social needs assessments take account of people’s capabilities in participating in activities and that the provision of activities is improved and tailored to meet the individual needs identified. The registered person must ensure that all staff receive training in safeguarding adults from abuse. This will provide better protection for people DS0000063764.V360857.R01.S.doc 31/05/08 01/07/08 31/05/08 31/07/08 01/07/08 15/06/08 Crosshill House Version 5.2 Page 29 10. OP16 22 11. OP19 23 12. OP25 13(4) 13. OP24 23 and 12(4) living at the home. The registered person must ensure that all concerns/ allegations received by the home are fully investigated and records are maintained to support all action taken. This will better ensure the people who live and work at the home are better protected. The registered person must ensure that repair works to the window in the individuals private accommodation are carried out. This will better ensure the comfort of the person residing in the room. The registered person must provide low surface temperature radiators or radiator guards in all areas accessed by people who use the service. This will better ensure their safety. The registered person must ensure that doors to people’s private accommodation are fitted with locks suited to their capabilities and accessible to staff in emergencies. A structured process of fitting locks to doors to begin by timescale for action date. This will better promote the privacy and dignity of people who live at the home. The registered person must ensure mal odours in the home are investigated and eliminated. This will improve people’s comfort and dignity. The registered person must make sure that staffing levels are accurately calculated using the Residential Forum and implemented to make sure that people’s needs are met. DS0000063764.V360857.R01.S.doc 31/05/08 15/07/08 15/06/08 01/07/08 14. OP26 16(2) j and k. 31/05/08 15. OP27 18(1)(a) 31/05/08 Crosshill House Version 5.2 Page 30 16. OP29 17,19 and 13(4) 17. OP30 12, 18, 18. OP30 12 and 18 19. OP30 12,18 20. OP31 8 The registered person must ensure that new staff do not start work at the home until a satisfactory police check has been received. This will better protect the people who live at the home. 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 people who use the service. This programme must include mandatory training in safe working practices, general courses and specialist training on the elderly, and diseases relating to old age and dementia. This will better ensure that staff are competent to carry out their role and the health, welfare and safety needs of people at the home are better protected. ( timescales of 01/06/06 and 01/07/07) were not met). The registered person must ensure that new staff complete induction training, allied to Skills for Care common induction standards within six weeks of commencing employment. So that staff are clear about their roles and responsibilities and that they can look after people properly. The registered person must provide evidence that all staff have completed training in mandatory areas of moving/ handling, food hygiene, fire safety and first aid. This will better protect the health and safety of the people who use the service. A manager must be recruited and registered with the Commission; timescale of DS0000063764.V360857.R01.S.doc 15/05/08 31/05/08 30/06/08 15/06/08 15/07/08 Crosshill House Version 5.2 Page 31 21. OP33 24 22. OP33 24 23. OP36 18 24. OP38 13(4) 25. OP38 13(4) 01/07/07 not met. The registered manager must ensure that the quality assurance programme is re started and maintained. This will show how the home has consulted with people who use the service, their representatives, staff and stakeholders to influence the running of the home. 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 people who use the service ( timescales of 01/09/06 and 01/07/07 were not met). 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. This is to make sure that policies and procedures are consistently implemented and continued staff development. Timescale of 01/09/07 not met. The registered person must ensure risk assessments accurately determine whether an individual initially requires bed rail provision and evaluations must determine the continued need for them. Bed rails and protectors must be fitted and checked in line with manufacturers instructions and Medical and Healthcare products Regulatory Agency (MHRA) guidelines. This will ensure the safety of the people who use the service is better protected. The registered person must DS0000063764.V360857.R01.S.doc 31/07/08 31/07/08 15/07/08 31/05/08 31/05/08 Page 32 Crosshill House Version 5.2 ensure that hot water temperatures at sink outlets accessible to people who use the service are checked regularly to ensure they do not exceed 43degs C. This will better ensure the safety of the people who use the service. 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. 4. Refer to Standard OP8 OP9 OP9 OP9 Good Practice Recommendations The registered person should provide seated scales and a mobile hoist. Temperature monitoring of medication storage areas should be maintained. Internal medications should be stored separately from external medication preparations. 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 formally record the ongoing programme of routine maintenance and renewal carried out within the home; which should include towels and lavatory seats as priority. The manager should ensure a reference is obtained from the staff member’s most recent employer. 50 of care staff should achieve an NVQ 2 by the July 2008. The manager should ensure the home’s policies and procedures are updated to comply with current legislation and guidance. The manager should review the homes fire risk assessment. 5. OP19 6. 7. 8. 9. OP29 OP28 OP33 OP38 Crosshill House DS0000063764.V360857.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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.V360857.R01.S.doc Version 5.2 Page 34 - 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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