Inspection on 21/02/06 for Crosshill House

This inspection was carried out on 21st February 2006.

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 01/02/07

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 Kate Emmerson Unannounced Inspection 21st February 2006 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.V286006.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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.V286006.R01.S.doc Version 5.1 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 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.V286006.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th September 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.V286006.R01.S.doc Version 5.1 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 February 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 3 of the staff working in the home at the time of the inspection. The inspector spoke to 4 people who lived in the home and were able to answer some questions about the home and 2 visitors. 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 continued to provide good quality individualised care. What the service does well: What has improved since the last inspection? The owners of the home have continued to review of all the paper work and records in the home and improve them. Crosshill House DS0000063764.V286006.R01.S.doc Version 5.1 Page 6 They have redecorated five bedrooms and fitted new carpets. They had continued to look at the training the staff needed and had either completed or arranged for more training to be done. They had improved the information available about the service and the terms and conditions that apply if they decide to live in the home. . They had involved the service users in looking at the quality of the care they provide in the home. They had updated the risk assessments for the home to make sure that the home is safe for the service users and staff. They had also made sure that the fire alarm and emergency lights were checked and in working order more often. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Crosshill House DS0000063764.V286006.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Crosshill House DS0000063764.V286006.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 There was adequate information about the home available for prospective service users to make an informed choice. Contracts/statement of terms and conditions had been provided to the service users. EVIDENCE: The providers had updated the information provided about the home for prospective service users. An example of the new documents was available for the inspection at the time of the inspection and further updated information was provided prior to writing this report. The documents were informative and written in plain English. To fully meet the standard and the regulations the service users guide must include the most recent inspection report and service users views of the home. The documents were displayed in the reception area and were provided in each bedroom for the service users. The contract/terms and conditions had been updated with new providers details and had been provided service users together with written conformation that the home could meet their needs. The contract required the addition of Crosshill House DS0000063764.V286006.R01.S.doc Version 5.1 Page 9 the room to be occupied and fees payable by whom, the provider completed this and the updates were provided to the Commission prior to writing this report. Crosshill House DS0000063764.V286006.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Service users health and care needs were met although the plans of care did not adequately support the care provided. There were adequate procedures for the safe handling of medication in the home. Service users felt that their privacy was upheld and their privacy was respected. EVIDENCE: The new proprietors had developed a new care plan format to address the issues from previous inspections. These provided improved assessment and risk assessment processes. Care plans were not fully developed for all the needs identified. For example a care plan had not been developed for catheter care where a service user had a catheter in situ. There was evidence that dietary likes and dislikes were recorded and a comprehensive nutritional screening tool was used. However Crosshill House DS0000063764.V286006.R01.S.doc Version 5.1 Page 11 where a service user had a problem eating the nutritional assessment had not been fully completed and a plan of care had not been developed Weights were routinely recorded on a monthly basis for those who could stand unaided. Provision of seated scales should be provided to ensure that all service users can be weighed. The daily care records were very detailed and there was evidence that care plans 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 acting 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 were no service users who were identified as at risk of pressure sores. Care files detailed that service users had access to community NHS services such as opticians, dentists, chiropodists, hospital outpatients, audio clinics etc. The acting 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. The new providers had further improved the written policies and procedures for the management of medication. The acting 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 at the time of the inspection but provided further information in the form of a basic procedure to the Commission prior to writing the report which detailed how a service users wishing to self medicate would be assessed and supported. Staff administering medication had received a 3 hour training session in the safe handling of medication by an external provider and had been due to commence a twelve week accredited course at the college, however this had had not commenced at the time of writing the report. The records relating to the ordering, receipt, administration and disposal had been improved and clear records were maintained. Crosshill House DS0000063764.V286006.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13 and 15 Service users maintained contact with family and friends and the local community as they wished. Service users received a balanced and nutritious diet, which met their individual preferences. EVIDENCE: The service users were able to receive visitors in their own bedrooms or communal rooms. There were no restrictions on visiting except where service users requested this and information on visiting arrangements was recorded in the service users guide. Visitors confirmed that they were made to feel welcome when visiting the home and stated that the staff communication was good. Meals continued to be highly praised by service users spoken to. Service users stated that nothing was too much trouble for staff and individual’s preferences were provided for. All spoken with said the food was very good. There was a 3-week rotating menu provided. Breakfast could consist of hot or cold meals. Lunch was a set meal, but preferences were recorded on care plans and staff were aware of peoples likes and dislikes, alternatives were Crosshill House DS0000063764.V286006.R01.S.doc Version 5.1 Page 13 prepared as required. Records must be kept of the alternatives provided to the main menu. The dining room was small but beautifully decorated and looked out onto the garden and pond. There was one table that seated six people although there was room for another table as required. The service users used the dining room or choose to eat their main meal in their rooms or the lounge. It was noted that portion size was appropriate to service user needs and those requiring assistance were supported by carers in a sensitive and patient manner. The kitchen was extremely clean and tidy. Crosshill House DS0000063764.V286006.R01.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 There was a robust system in place to manage complaints. There was improvement in the homes policies and procedures and staff training to protect service users from abuse but further training must be provided and recruitment procedures still need to improve if full protection is to be provided. EVIDENCE: Crosshill House DS0000063764.V286006.R01.S.doc Version 5.1 Page 15 There was a detailed complaints policy and procedure in place and this was displayed in the main entrance hall where service users, relatives and visitors to the home could see it and was included in information provided to the service users. It detailed who to complain to and timescales to achieving resolution. The acting manager stated there had been no complaints registered at the home since the last inspection. There had been one complaint recorded at the Commission since the last inspection. This was referred to the provider for investigation, a full report into the investigation was provided to the Commission, the complaint was not upheld. The home had a basic adult protection policy that a the time of inspection needed to be linked to Local Authority’s policy and procedure for the protection of vulnerable adults. An updated policy and procedure was provided to the Commission prior to writing the report and the acting manager had had a meeting with the Local authority Protection of Vulnerable Adults Coordinator to discuss her procedures. The acting manager stated that the staff group had received training in the protection of adults from abuse since the last inspection in October 2005. Records provided showed that a third of the staff still required training in this area. 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. Although there was some improvement, the homes recruitment procedures still did not afford full protection for service users, as there was some evidence that staff were employed before all the required checks had been completed. Crosshill House DS0000063764.V286006.R01.S.doc Version 5.1 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 and 25 The home provided a well-maintained, homely environment, which was exceptionally clean and tidy. Service users health and safety may be put at risk, as radiator cover/low surface temperature radiators were not fitted through out the home to protect service users from accidental scalds. EVIDENCE: A partial tour of the building was completed. All areas seen were exceptionally clean and tidy and well maintained. The bedrooms are personalised to individual tastes and communal areas are arranged to be very homely. There was a rolling programme of maintenance and renewal. The acting manager stated that 5 bedrooms had been redecorated and new carpets had been fitted. Some of the beds had been replaced and a new call system had been fitted. The proprietor stated that she had implemented systems to minimise the risk of Legionella and provided the certificate to evidence this. Crosshill House DS0000063764.V286006.R01.S.doc Version 5.1 Page 17 A radiator cover/low surface temperature radiator was not fitted in the lounge to protect service users from accidental scalds. Crosshill House DS0000063764.V286006.R01.S.doc Version 5.1 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 had improved but deficiencies in meeting mandatory requirements and TOPSS standards may put service users health and safety at risk. 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.V286006.R01.S.doc Version 5.1 Page 19 The home employs 13 care staff. The acting manager stated that none of the staff had gained NVQ level 2 and the new manager had completed NVQ level 3. She stated that 3 staff had almost completed NVQ 2 and a further 3 were due to commence the training towards this award at the end of February 2006. Two staff were training for the Registered Managers Award at the time of inspection. The home had appropriate recruitment policies and procedures in place that includes grievance, disciplinary measures and equal opportunities. There had been some improvements in the recruitment practises but start dates were not always clearly stated and therefore it could not readily be assessed if all checks had been completed before staff had commenced work. In one file the two references had been provided by the applicant and had not been applied for by the home and one was not dated. In another file an application form had not been completed so checks on employment history had not been completed. This does not afford adequate protection for the service users. The acting manager 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. The training in the home had improved and the home had a training plan, which showed that training was booked in first aid, diabetes, pressure area care, palliative care, communication and dementia awareness. Although records of training provided were maintained the home did not have an overview of the training completed. This was provided prior to writing this report and showed some deficiencies in mandatory training provision including that a third of the staff had not received mandatory training in moving and handling The home provided a very basic induction to the home on the first day of work but had not implemented induction and foundation training to TOPSS standards. Crosshill House DS0000063764.V286006.R01.S.doc Version 5.1 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 and 38 An experienced person had been employed to manage the home. The service users were involved in monitoring the quality of the care provided. Further development of these processes will ensure that the home will continue to develop in their best interests. The health, safety and welfare of the service users were promoted and protected in the main, however some deficiencies in staff training may leave the service users health and safety at risk. EVIDENCE: A new manager Elaine Fisher had been employed since 2 January 2006. Elaine stated she has had 13 years experience in care and 5 years experience as shift leader in a 34 bedded home. She has NVQ 2 and 3 and has commenced the Crosshill House DS0000063764.V286006.R01.S.doc Version 5.1 Page 21 Registered Managers Award. She had improved some of the systems in the home since her employment. The providers will need to apply to the Commission for Elaine to become the Registered Manager. A system of measuring the quality of the care provided had been developed and service user satisfaction questionnaires had been completed. These showed 100 satisfaction with the service provided. Satisfaction questionnaires had been provided to visiting professional and family and friends of the service users with a small response at the time of inspection. Room audits had also been completed. The policies and procedures were had been reviewed and improved and a new format for assessment and care planning had been developed. Results of questionnaires and audits and action plan arising form these should be published for the service users and an annual report developed. The home had a good range of policies and procedures that promote the safety and well being of service users and of staff. Up dated risk assessments for fire and the environment were provided to the commission Prior to writing this report. Individual risk assessments had been completed for the service users. General maintenance work was carried out as and when identified and the home was physically well maintained inside and out. Emergency lighting, fire alarm testing had been carried out on a consistent basis since the last inspection. The new proprietors had made the home a non-smoking environment. Mandatory training provision had improved although there were still some staff who had not completed moving and handling and fire safety training. First aid training was arranged for the end of February to ensure that there would be one staff member trained in first aid on every shift. Induction training was not adequate to ensure that staff work safely. Crosshill House DS0000063764.V286006.R01.S.doc Version 5.1 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 3 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X 2 X STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X X X 2 Crosshill House DS0000063764.V286006.R01.S.doc Version 5.1 Page 23 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 5 Requirement The registered person must ensure that the service users guide must contain the most recent inspection report and service users views of the home. (Previous timescale 01/02/06 not met) 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. (Previous timescale 01/01/06 not met) The registered person must ensure that staff administering medication have received accredited training. The registered person must ensure that all staff receive training in protecting vulnerable adults from abuse. The registered person must provide low surface temperature radiators or radiator guards in all areas accessed by service users. The registered person must audit all staff files to ensure that they contain all the information DS0000063764.V286006.R01.S.doc Timescale for action 01/05/06 2 OP8OP7 15 01/05/06 3 OP9 13(2) 18(1) 13(6) 18(1) 13(4) 01/06/06 4 OP18 01/05/06 5 OP25 01/05/06 6 OP29 19 01/05/06 Crosshill House Version 5.1 Page 24 7 OP30 18(1) 13(4) and (5) 8 OP33 24 required to meet Schedules 2 and 4 of the Care home Regulations. Records must evidence the date staff commenced employment. The registered person must ensure that induction and foundation training are provided to TOPSS standards and mandatory training is provided to all staff employed in 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 service users. 01/06/06 01/09/06 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.V286006.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Hessle Area Office First Floor 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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