Inspection on 20/09/05 for Crosshill House

This inspection was carried out on 20th September 2005.

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

Other inspections for this house

Crosshill House 03/03/09

Crosshill House 19/03/08

Crosshill House 01/02/07

Crosshill House 21/02/06

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 Kate Emmerson Unannounced Inspection 20th September 2005 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.V253663.R01.S.doc Version 5.0 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.V253663.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Crosshill House Address Crosshill House Market Square Barrow On Humber North Lincolnshire DN19 7BW 01472 852896 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 Mrs Margaret Bray Care Home 11 Category(ies) of Old age, not falling within any other category registration, with number (11) of places Crosshill House DS0000063764.V253663.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5 January 2005 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. Crosshill House DS0000063764.V253663.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over one day in September 2005. To find out how the home was run and if the people who lived there were pleased with the care they got the inspector spent time in the home watching how the care was given. The inspector spoke to the person who owned the home, the deputy manager and 2 of the staff working in the home at the time of the inspection. The inspector spoke to 5 people who lived in the home and were able to answer some questions about the home. Paper work kept in the home was also seen, this was to see if the checks to make sure staff are safe to work in the home were done before they started and that they had been trained to their job safely. Paperwork was looked at to make sure that the home and the things used in it were safe and were regularly checked. The home had undergone a change of ownership since the last inspection but had continued to provide good quality individualised care. What the service does well: The home provided very homely and comfortable surroundings. It was well maintained and exceptionally clean and tidy. There was an emphasis on to providing individualised care to the service users and the service users spoken with all enjoyed living at the home and described the care they received as ‘wonderful’ and ‘fantastic’. They said that the carers ‘couldn’t do enough for them’ and described them as ‘kind and considerate’. They confirmed that could choose their own routine for getting up and going to bed and how they spent their day. The service users said the food was very good and that they had choices at each mealtime. The staff were aware of the service users likes and dislikes and one service user said that he had never been given anything he didn’t like because of this. There were mixed opinions about the activities available in the home but all said you could join in if you wished and records confirmed the variety of activities that was available. The activities were arranged to meet individual requirements and service users had plenty of opportunity to go in to the local community either to the shops, church or to join in local events. Crosshill House DS0000063764.V253663.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: They must provide more information to the service users about the service they provide and the terms and conditions that apply if they decide to live in the home. They must keep better records about the care service users need and keep them up to date by checking them every month. They must make sure that service users are not put at risk of getting pressure sores by completing risk assessments and plans of care. They must also assess if service users are safe to look after their own medicines. They must make sure that any allegations of abuse are properly dealt with by bringing their polices and procedures up to date. They must make sure that staff do not start work until checks on their work history, identity and criminal record have been completed. They must make sure that they involve the service users in looking at the quality of the care they provide in the home. They must update risk assessments for the home to make sure that the home is safe for the service users and staff. They must also make sure that the fire alarm and emergency lights are checked and in working order more often. Crosshill House DS0000063764.V253663.R01.S.doc Version 5.0 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. Crosshill House DS0000063764.V253663.R01.S.doc Version 5.0 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.V253663.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3 There was adequate information about the home available for prospective service users but this was being updated to fully meet the standards and regulations. Contracts/statement of terms and conditions had not been provided to the recently admitted service users as these were being updated with the new providers details. All service users had had an assessment completed and the new assessment format should provide a greater insight into service users needs and a basis for improved risk management. EVIDENCE: The new providers were updating the information provided about the home for prospective service users. An example of the new document in its draft state was available for the inspection. Although there were some minor omissions the document was informative and written in plain English. To fully meet the standard and the regulations the information must include the address of the Crosshill House DS0000063764.V253663.R01.S.doc Version 5.0 Page 10 registered provider, information regarding the manager, the most recent inspection report and service users views of the home. The new providers, to address issues from the previous inspection report, had introduced a new format for assessment and care planning. This had only been implemented just prior to the inspection and only one assessment had been completed using the documentation. The assessment will assist in gathering in-depth information on the service users needs and identify risks relating to falls and mobility. The deputy manager also stated that the contract/terms and conditions was being updated with new providers details and hadn’t been provided to the two most recently admitted service users and written conformation had not been provided to them that the home could meet their needs. Crosshill House DS0000063764.V253663.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 and 9 Service users health and care needs were met although the records did not adequately support the care provided. A new format for care planning was in the process of being implemented and should address these issues. Medication procedures did not adequately support service users to self medicate but otherwise there were adequate procedures for the safe handling of medication in the home. EVIDENCE: Care files included a range of information to assist in identifying needs to be met. For example, personal details, individual profiles, local authority care plans, clinical care plans for district nurse recommendations, records of monthly weights, accidents, complaints, visits by and to professionals, activities and daily records. The information had been streamlined into sections, enabling it to be easily readable. The care plan itself was a basic self-care checklist that was developed 2-3 days after admission. Care plans examined showed that they covered nutrition, Crosshill House DS0000063764.V253663.R01.S.doc Version 5.0 Page 12 personal hygiene, dressing and mobility. The format did not allow detail beyond a few words and could not be easily updated if one need changed. The new proprietors had developed a new care plan format to address the above issues and one care plan had been partially completed on this format. The deputy manager stated that the new format would be put in place for all service users and hoped to have this completed by October 2005. A service user had been recently admitted for respite but had not had a care plan developed. The daily care records were very detailed but there was evidence that care plans had not been consistently evaluated on a monthly basis. 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 deputy manager 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 was only one service user who was identified as at risk of pressure sores and although aids had been provided to minimise the risk a care plan had not been developed. Care files detailed that service users had access to community NHS services such as opticians, dentists, chiropodists, hospital outpatients, audio clinics etc. The manager stated that most of these services could be provided in the home. Each care file had records of GP and district nurse visits. All service users were registered with a GP. There was evidence that dietary likes and dislikes were recorded and a comprehensive nutritional screening tool was used. Weights were routinely recorded on a monthly basis for those who could stand unaided. Provision of seated scales should be considered. The new providers had further improved the written policies and procedures for the management of medication. The deputy manager stated there were no service users self-medicating at the time of the inspection. The home did not have a system in place to assess if a service user would be safe to self medicate. Staff administering medication had received training in the safe handling of medication and were due to commence a twelve week accredited course at the college. Crosshill House DS0000063764.V253663.R01.S.doc Version 5.0 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 14 The care provided in the home was tailored around individual needs and preferences. EVIDENCE: The service users stated that they enjoyed living in the home and stated that their individual needs were met. They stated that they always had a choice at meal times and that ‘the food was fantastic’. There was a range of activities available in the home and the local community that service users were assisted to access if they wished. Church services were provided once a month in the home and one of the service users attended the local chapel on a regular basis. The service users had access to talking books and daily papers and service users were able to visit the mobile library service which visited the village one a fortnight. Records of activities were maintained. The new proprietor stated that they wished to further develop the activities available in the home and was to arrange meetings with the service users to discuss this further. The service users likes and dislikes were recorded and one service user stated that staff always gave him the foods he liked. Crosshill House DS0000063764.V253663.R01.S.doc Version 5.0 Page 14 Service users were aware that there were records held and how to access these if they wished. Crosshill House DS0000063764.V253663.R01.S.doc Version 5.0 Page 15 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Adequate protection for service users was not provided due to deficiencies in the homes polices and procedures and staff recruitment practises. EVIDENCE: The home had a standard adult protection policy that needed to be individualised to enable staff to respond appropriately. The home had obtained a copy of the Local Authority’s policy and procedure for the protection of vulnerable adults and the homes policy and procedure must be linked to this. The proprietor stated that the homes policy and procedure was being reviewed and updated. The manager stated that the staff group had received training in the protection of adults from abuse since the last inspection and further training was booked for the end of October 2005. There had been no allegations or incidents of abuse at the home. The Inspector was informed that no monies were held at the home on behalf of the service users. Service users themselves, with the assistance of their families, handle finances. The homes recruitment procedures did not afford adequate protection for service users as staff were employed before all the required checks had been completed. Crosshill House DS0000063764.V253663.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 25 and 26 The home provided a well maintained, homely environment which was exceptionally clean and tidy. EVIDENCE: Crosshill House is situated in the centre of Barrow close to all the local amenities, which includes shops, post-office, churches and hairdressers. There was parking at the front of the building in a small square. The home and grounds were well maintained. To the rear of the building, there was a lawned area with mature plants, shrubs and trees, a patio area and a garden pond with a waterfall. The home had appropriate aids and adaptations throughout that suit the needs of the current service users. It had a covert camera restricted to the entrance area of the home for security purposes only. The home was clean and tidy and free from unpleasant odours. Crosshill House DS0000063764.V253663.R01.S.doc Version 5.0 Page 17 There had been improvements in systems to control infection although the written policies and procedures for infection control did not link and support practise in this area. The proprietor stated that she had implemented systems to minimise the risk of Legionella although she had not received the certificate to evidence this at the time of the inspection. Crosshill House DS0000063764.V253663.R01.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 The numbers of staff and skill mix provided in the home were sufficient to meet service users needs. Staff training was now planned to ensure mandatory requirements would be met. Staff recruitment procedures did not afford adequate protection for the service users. EVIDENCE: Following the change in ownership of the home the staffing levels must now be assessed using Department of Health Guidelines. This is based on the dependency of the service users accommodated in the home at one time. The staff rota showed that there was at least two care staff on duty throughout the day. All carers are over the age of 18 years and the manager confirmed that those left in charge of shifts are over the age of 21years. Crosshill House DS0000063764.V253663.R01.S.doc Version 5.0 Page 19 The home employs 16 care staff. The proprietor stated that one member of staff had gained NVQ level 2 and one had completed NVQ level 3. Two staff were training for NVQ 2 and 2 were training for NVQ 4 at the time of inspection. The home had appropriate recruitment policies and procedures in place that includes grievance, disciplinary measures and equal opportunities. However the proprietor was not able to provide evidence that the policies and procedures were being adhered to consistently and that all the required checks were obtained before staff were employed. There was no evidence that two written references and proof of identity had been obtained for two of the five files checked and in three cases Criminal Record Bureau checks had not been obtained before employment. This does not afford adequate protection for the service users. The home had a training plan and training was booked for moving and handling, infection control, personal care, continence management and bereavement. The new proprietors had developed an induction programme but this had not been implemented fully at the time of the inspection. Crosshill House DS0000063764.V253663.R01.S.doc Version 5.0 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 The new proprietors and deputy manager were sufficiently experienced to support the home and be responsible for the day-to-day management until a new manager is recruited. Although a formal system to measure the quality of care provided the new proprietors were reviewing all the systems in the home. A more formal system, which involves the service users, will ensure that the home will continue to develop in their best interests. Service users were encouraged to manage their own finances. Staff supervision had commenced. The health, safety and welfare of the service users were promoted and protected in the main, however since the new proprietors had taken over fire equipment checks had not been adequately completed to ensure that any problems could be identified. Crosshill House DS0000063764.V253663.R01.S.doc Version 5.0 Page 21 EVIDENCE: At the time of writing the report the Commission had been informed that the registered manager had left her employment. The proprietors were actively seeking to employ a new manager. The home was to be supported by the proprietors and the deputy manager until a new manager could be recruited. The deputy manager had many years experience working in the home and had gained NVQ level 3 in care. A system of measuring the quality of the care provided had not been developed at the time of the inspection but the policies and procedures were under review and a new format for assessment and care planning had been developed. The home had no involvement in any of the service users finances. The service users were encouraged to manage their own finances or their family assisted them. There was some evidence that the new proprietors had commenced staff supervision. This must be completed consistently for all staff at least six times a year. The home had a good range of policies and procedures that promote the safety and well being of service users and of staff. Risk assessments for fire and the environment were available but the new proprietor had not made themselves aware of the documents and the fire risk assessment required updating as recommended by the fire officer at a visit prior to the inspection. Individual risk assessments had been completed for the service users. General maintenance work was carried out as and when identified and the home is physically well maintained inside and out. Service records relating to electricity and the lift were in place and up to date. Emergency lighting, fire alarm testing had not been carried out on a consistent basis since July 2005. Crosshill House DS0000063764.V253663.R01.S.doc Version 5.0 Page 22 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 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 3 X X X X X 3 3 STAFFING Standard No Score 27 3 28 1 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Crosshill House DS0000063764.V253663.R01.S.doc Version 5.0 Page 23 Are there any outstanding requirements from the last inspection? Not applicable as there are new proprietors since last inspection. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 4 and 5 Requirement The registered person must ensure that the statement of purpose includes the address of the registered provider and information regarding the manager. The service users guide must also contain this information and the most recent inspection report and service users views of the home. The registered person must provide all service users with a copy of its contract or terms and conditions. The registered person must confirm in writing to the service user that following assessment the home can meet their needs. The registered person must ensure that care plans are completed for all service users which detail all their care needs and how these will be met. These must be evaluated monthly and updated as necessary. The registered person must ensure that risk assessments DS0000063764.V253663.R01.S.doc Timescale for action 01/02/06 2 OP2 4 01/02/06 3 OP2 14(d) 01/02/06 4 OP7 15 01/01/06 5 OP8 15 01/01/06 Crosshill House Version 5.0 Page 24 6 OP9 13(2) 7 OP18 13(6) 8 OP25 13(3) 9 OP28 18(1) 10 OP29 19 11 OP33 24 12 OP38 23 and care plans are completed for those at risk of pressure sores. The registered person must implement a system to assess the competency of service users to self medicate. The registered person must develop the homes policy and procedure and ensure that this links to the Local authority procedure for referral and investigation. The registered person must provide evidence to the Commission of the controls to minimise the risk of Legionella. The registered person must ensure that staff are accessing NVQ level 2 training in sufficient numbers to achieve 50 of staff trained to NVQ Level 2. The registered person must ensure that written references, proof of identity and Criminal Record Bureau checks are obtained before employment of staff. The registered person must develop a formal quality and maintain a system to review and improve the quality of care in the home. There must be evidence of consultation with service users and their representatives and other stakeholders. A report must be compiled of the review and provided to the Commission and the service users. The registered person must review and update as necessary the environmental and fire risk assessments. The registered person must ensure that the fire alarms are tested at least weekly and the emergency lighting at least monthly and that records are DS0000063764.V253663.R01.S.doc 01/02/06 01/02/06 01/01/06 01/02/06 20/09/05 02/02/06 01/01/06 13 OP38 23(4) 20/09/05 Crosshill House Version 5.0 Page 25 maintained. 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 Refer to Standard OP8 Good Practice Recommendations The registered person should provide seated scales. Crosshill House DS0000063764.V253663.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Crosshill House DS0000063764.V253663.R01.S.doc Version 5.0 Page 27 - 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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