Inspection on 03/03/09 for Crosshill House

This inspection was carried out on 3rd March 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Crosshill House 19/03/08

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 06/08/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Crosshill House Crosshill House Market Square Barrow On Humber North Lincolnshire DN19 7BW     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jane Lyons     Date: 0 3 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Crosshill House Market Square Crosshill House Barrow On Humber North Lincolnshire DN19 7BW 01469531767 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Oakhills Residential Homes Ltd care home 14 Number of places (if applicable): Under 65 Over 65 12 14 dementia old age, not falling within any other category Additional conditions: 0 0 The maximum number of service users who may be accommodated is 14 The registered person may provide personal care (excluding nursing) and accommodation to service users of both sexes whose primary care needs on admission to the home are within the following categories: Dementia (Code DE) 12; Old Age, not falling within any other category (Code OP)14 Date of last inspection Brief description of the care home 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 Care Homes for Older People Page 4 of 33 Brief description of the care home floor and three further separate toilets. Crosshill House has one lounge and a separate dining room. The garden is enclosed and well maintained with a large pond and mature plants and trees. 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 management at the home. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. This inspection report is based on information received by the Commission for Social Care Inspection CSCI from the last twelve months including information gathered during a site visit to the home which took approximately eight hours. Throughout the day we spoke to people staying in the home to gain a picture of what life is like at Crosshill House during their stay. We also had discussions with the new owners, care staff, the cook, the visiting hairdresser and two visiting district nurses. Care Homes for Older People Page 6 of 33 We looked at assessments of need made before people were admitted to the home and the homes care plans to see how those needs were to be met while they were staying there. Also examined were medication practices, activities provided, nutrition, complaints management, staffing levels, staff recruitment, staff training, how the home monitors the quality of service provided and how the home is managed overall. We also checked with people to make sure that privacy and dignity is maintained, that people can make choices about aspects of their lives and that the home ensures they are protected in a safe, clean environment. We observed the way staff spoke to people and supported them and checked out with them their understanding of how to maintain privacy, dignity, independence and choice. The home changed ownership in June 2008, throughout this inspection visit there was evidence to support improvements made over the last twelve months towards the administration systems, the facilities and overall management of the service. The new management at the home are tackling the improvement work with enthusiasm, thoroughness and are committed to getting it right. We would like to thank the people who were staying at Crosshill House, the staff team and the management for their hospitality during the visit and also thank the people who spoke with us. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? They have developed more up to date information about the services provided so that people considering moving into the home are better informed. Systems to manage and support peoples moving and handling needs have been completely reviewed, equipment has now been provided and is being utilised where needed, staff have all received training in how to use the equipment properly to make sure people who use the service and staff are kept safe. Aspects of the care documentation have improved such as risk management, daily records, communication records and review records however the absence of care plans mean there are risks that people wont receive all the care they need. The home now provides a range activities and entertainments within the home which better meet individuals interests and expectations. Staff are proactive in encouraging and enabling people to take part in activities that interest them. A lot of refurbishment and redecoration of the facilities has taken place, many people commented about the improvements especially the garden areas. They have also made sure that the home is kept clean and tidy. Problems around odour management have been dealt with effectively by reviewing individuals needs regarding continence support, replacement of carpets and regular cleaning practices. The management have consulted 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. There are systems in place now to manage complaints properly, people tell us that the management are very approachable and they would discuss issues with them if they arose. Care Homes for Older People Page 8 of 33 Staff have received training in safeguarding adults and the staff at the home understand how to report any concerns of this nature. This will help ensure people who use the service are protected from harm. They have ensured peoples safety is better protected by providing radiator covers to all uncovered radiators and by checking the hot water temperatures at outlets accessible to people who use the service. The homes recruitment practices have improved and all police checks are obtained prior to new staff commencing work. This helps protect people who use the service. There have been improvements in ensuring references are in place but this is not consistent, improvements needed are covered in the next section. All the staff have received much more training to make sure they are skilled and equipped to do their job properly and safely. New staff have received induction training which helps them understand their role and ensures they know how to care for people properly. Staff now access regular sessions with their manager so they can discuss aspects of their work and training needed to make sure their work is of a consistent standard. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 33 Care Homes for Older People Page 10 of 33 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Proper pre - admission procedures are in place and followed so that people who are thinking about moving into the home can feel confident that their needs will be met. Evidence: The home has a statement of purpose and a service user guide which give information about the home. The documents are informative and written in plain English, they have been updated to show changes in management and staffing. The service user guide has been developed to include a copy of the previous inspection report and peoples views on the services provided at the home. People spoken with confirmed that they had received adequate information about the home before they moved in. The home offers visits and trial stays so people can assess the services provided by the home. Most people said they had moved into the home as they had previously lived in the village and it was close to their relatives and friends. Care Homes for Older People Page 12 of 33 Evidence: We looked at a sample of files which belong to people who are staying at the home and we saw that these contained a range of assessments undertaken by the home. The assessments cover all aspects of health and personal care needs. In addition to this, information is also requested from the family and health and social care professionals where possible so that the home has as much information about the prospective individual prior to their admission. The format of the current assessment records is mainly tick box in style and advice was given to develop the documentation to allow for more descriptive details of the persons needs and how they would like their assistance to be given. Wherever clients are referred through the Local Authority the home has obtained copies of relevant assessment reports and care plans. The assessment process also takes account of peoples cultural and social needs. This information is recorded and made available to carers so they have a good understanding and know how people wish to be addressed and their preferred lifestyle. There was evidence to demonstrate that care staff are now accessing a range of service specific training, this will help ensure that they have the skills to enable them to deliver up to date care methods and have a better understanding of the varied conditions common to older people. The management are in the process of applying to change their registration so they can accept people with needs associated with dementia, records show that five staff had completed a training course in dementia with the remainder of staff scheduled to attend this course. The home does not provide intermediate care dedicated to accommodate individuals with intensive rehabilitation needs so standard six is not applicable. Care Homes for Older People Page 13 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People feel happy with the standards of care they receive and feel they are treated with respect, but some of the care documentation remains inadequate and places them at risk of not receiving all the care they need. Improvements have been made to aspects of the medication systems which better promotes peoples health and welfare, but further improvements are needed. People are treated with respect and dignity in all aspects of their daily living. Evidence: Since the last inspection the new management at the home have reviewed all the care documentation, care files for three of the people living at the home were sampled during this inspection visit. Examination of the care files showed that although many aspects of the recording systems had improved significantly, within the documentation review the management had removed a core component of the recording process and none of the care files contained care plans which describe peoples needs and the care support required by Care Homes for Older People Page 14 of 33 Evidence: staff to meet these needs. The absence of care plans which describe how peoples care needs are to be met by staff leaves people at risk of not receiving the care they require. For instance, a new person had recently been admitted to the home with complex needs around their tissue viability and skin care support; staff and management told us that the person needed to be turned in bed every two hours during the day but this care was not required overnight due to the pressure relieving mattress in place. However discussions with the visiting district nurse identified that the two hourly position change was required during the day and night. This issue was addressed during the visit and appropriate care support put in place to support the individuals needs. We discussed the improvements needed regarding the provision of detailed care plans with the management, more descriptive assessment information would be beneficial in providing person centred information. The management confirmed they would address this shortfall as a matter of priority. As previously stated other aspects of the care files had improved. The standard of daily recording was good, staff were describing how peoples health and personal needs had been met they were also describing in detail how people had spent their time. The use of risk assessment documentation to form a basis for care was much more consistent, all files seen contained risk assessments to cover areas such as mobility falls pressure damage and nutrition. The risk assessment documentation generally provides detailed action plans to support the care required to maintain peoples health welfare and safety in each area assessed. Records show that they have been reviewed regularly and updated to reflect any changes in need. Entries in the care files detail where individuals have specific nutritional needs and also note their likes and dislikes. Records show that people are weighed regularly(seated scales) have been purchased, nutritional needs are monitored, intake levels recorded and specialist advice is sought where necessary. Continence is promoted discreetly by providing toileting assistance at appropriate intervals, some people have been assessed by the community continence advisor and are provided with aids such as continence pads. A number of individuals have medical conditions that impact on mobility, there was very good evidence from records and discussions with staff that the systems to manage peoples moving and handling needs had been completely reviewed, equipment had now been provided and was being utilised where needed, staff had all received training in how to use the equipment properly to make sure people who use the service and staff were kept safe. Annual reviews take place to discuss peoples care with their family and others who are involved in their care. Information about peoples wishes prior to and following their death is included in the care file where people have chosen to discuss this aspect of their care. Care Homes for Older People Page 15 of 33 Evidence: Care records show that peoples health is monitored and people have access to health care facilities and any relevant specialists that are necessary, the staff support people in attending appointments. Healthcare information is recorded in the care records about why people are attending appointments and outcomes from these. The records are well maintained, this information needs to be linked into the care plans when developed, which will help in making sure that everyone is aware of the persons health needs and how these are to be met. One person told us They always get the doctor if Im not well. During the visit we spoke to a two district nurses who visit the home regularly, comments include The changes in the homes management have been very positive, the home has come on in leaps and bounds. They work well with us and always communicate any changes and There is a lovely atmosphere in the home again, all the residents are very satisfied with the care they receive and their well being is paramount to all the staff. People looked clean, well dressed and had received a good level of personal care. Comments received during the visit from people who use the service show that they are very satisfied with the care and support offered by the staff. Comments included The girls are all wonderful and look after us all really well and you cant fault the care here, everyone is very kind, courteous and helpful. We looked at the medication systems during the inspection visit which showed that improvements had been made in some areas, but further improvements are needed to ensure people are safe and their health needs are well protected. The management understand that the medication policies and procedures require some updating to reflect all current good practice guidance and confirmed this work was scheduled to take place in the near future. Checks on medication administration records show that each person gets the medication they need at the right time and staff make sure that accurate records are kept. 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. Storage has been reviewed and improved, internal and external medications are now stored separately. Stock control was noted to be good. It is good practice for the temperature of the medication storage area to be monitored regularly to ensure that medications are being stored at the correct temperature and are safe. Controlled medication storage has been reviewed, a new cupboard has been provided and sited in a different area, however the cupboard had been secured to a shelf which does not meet current regulations and should be securely affixed to a wall. People are encouraged to be as independent as possible in controlling their own medication, risk assessments and monitoring systems are in place for those who can self medicate. Care Homes for Older People Page 16 of 33 Evidence: All care staff have received medication training under the new ownership this includes a course provided by an external trainer and supervised medication rounds. Discussions with the registered provider revealed that the course was not accredited and advice was given to enrol staff at a local college to complete The safe handling of medications course which is accredited and provides training on all aspects of medication administration needed. Care Homes for Older People Page 17 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People now benefit from a choice of activities in the home and are encouraged to pursue their own interests. Meals served at the home are of a good quality and offer choice to ensure people receive a balanced diet. Evidence: Crosshill House is a small, friendly home with a welcoming and family orientated atmosphere. People told us that they are able to exercise choice in all their daily routines one person said I choose how I spend my time and I do what I want. There is a very close knit community around the home and people who use the service continue to receive visits from local church representatives, families and friends; some of the people continue to access regular trips out with relatives and friends, 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. Everyone spoken to throughout the visit told us how much the social aspect of the care support at the home had improved under the new ownership. One of the visiting health professionals commented Its really nice to see people occupied again, enjoying Care Homes for Older People Page 18 of 33 Evidence: a variety of activities and going out on trips. People we spoke to also told us that activities are now arranged regularly and how much they enjoyed taking part. One person said Theres a lot more going on now, I really enjoyed the flower arranging and the beauty sessions. One of the senior care staff has been given the responsibility for organising activities in- house, entertainment and trips into the local community. There is now a monthly theme to the social programme which is usually associated with the time of year and holidays etc, for example Valentines Day and love in February, Marchs theme is Spring and April is Easter celebrations. The staff maintain an activity book which details social events and activities arranged and people who have participated. There was evidence in care files of personal profiles and social needs assessments, care plans now need to be developed to support how the home will meet peoples individual needs. Photographs of people participating in entertainment at the home are displayed on a notice board in the hall. Cultural and religious needs are responded to with services for different faith groups held at the home. Although few relatives visited during the inspection, there was good evidence from records and discussion with staff and people who use the service that many peoples relatives and friends regularly visit the home. People who use the service clearly enjoy and value the contact from their families and friends. The home has organised a number of outings to get out and about in the community,including visits to a local garden centre and lunch at a local restaurant. One person told us that the staff help her go for a walk around the village regularly which she really enjoys, The girls are lovely and push me round, I love going into the village. The home has started to produce a monthly newsletter, a number of people were observed reading the recently issued second edition and told us about the advertised forthcoming trip to The Deep which they intending going on. All the comments received during the visit confirmed that the standard of the meals had improved. Comments included The food is excellent, there have been a lot of improvements, we get much more choice now and You cant fault any of the meals, the cook is wonderful. People are consulted on admission regarding their dietary needs and preferences. Menus are planned over a four week period with input from the people who use the service and knowledge of needs and preferences. The cook visits each person daily to discuss menu choices. The kitchen was very clean and tidy and all associated records for the safe handling of food were maintained. People were observed enjoying their lunch meal in a relaxed and comfortable atmosphere. The meal served was hot, nicely cooked and well presented. We observed staff assisting people to eat in a sensitive and dignified way. Care Homes for Older People Page 19 of 33 Evidence: The cook told us that specialised diets currently provided are diabetic and fortified diets. Records show that staff working in the kitchen area hold current basic food hygiene certificates. Records to support the safe management of food are in place and up to date. Care Homes for Older People Page 20 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Crosshill House are protected by the service and listened to. Evidence: People and their representatives have been provided with a copy of the homes complaints procedure, which is also on display in the entrance hall. The procedure provides people with clear information. Those people spoken with during the day confirmed they knew who to go to if they were unhappy about something. The home has not received any complaints since the new ownership in June 2008.We have not received any complaints. Discussions with the management demonstrate that they have systems in place to manage complaints effectively. The home provides training for all staff in safeguarding procedures that protect people from abuse or neglect. It was evident from discussions that staff are knowledgeable about safeguarding adults reporting procedures and know what to do if they witnessed anything that concerns them. All incidents relating to people who use the service are recorded and maintained on file. Appropriate notifications are made promptly to relevant agencies. The management have made two safeguarding referrals since June 2008, evidence from the safeguarding team at North Lincolnshire Local Authority support appropriate action taken by the home with these matters. Care Homes for Older People Page 21 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Many aspects of the environment have improved and the home now offers people a very safe comfortable and homely place to live. Evidence: When the new owners took over in June 2008, they inherited a home which was in need of a lot of upgrading and attention. Their commitment is clear with all the improvements made to date, which include replacement of carpeting throughout most of the ground floor following feedback from staff, relatives and health care professionals that the carpet pile affected peoples ability to mobilise with equipment and the busy pattern did not aid in the prevention of falls. A new has been boiler fitted, all communal areas redecorated and refurbished, new beds, a television and compact disc player for the lounge, low surface temperature covers for all radiators accessible to people and locks to all peoples private accommodation. An ongoing maintenance and redecoration programme has been developed which includes the kitchen, all bedrooms and other areas in the home such as bathrooms, toilets and upstairs hallway. A new extension to provide two further bedrooms and a conservatory was underway during the visit. People spoken to were looking forward to the new facilities and told us that the works programme had not caused any disruption to their daily living. The dining room has been moved to the front of the building which has proved successful, the room is more easily accessible for people to use. Care Homes for Older People Page 22 of 33 Evidence: The management have implemented new infection control practices, good systems appeared in place to control the spread of infection, antibacterial hand gel is placed at points throughout the home with advice to visitors on infection control. Records show that staff have not recently accessed training in infection control, however the management confirmed that this would be included in this years training programme. The home was very clean and tidy and there were no unpleasant odours noted in any areas of the home. People who we spoke with told us the home is spotlessly clean and my room is always cleaned regularly. People also told us they were happy with the laundry arrangements. Discussion with the staff and management indicates that there is a wide range of equipment provided to help with the moving and handling of people and to encourage their independence within the home. As previously described in section two of this report, new moving and handling equipment has been provided, which includes a mobile hoist, bath hoist, slide sheets and moving belts, which all the care staff have been trained to use safely. Pressure relieving mattresses and cushions are provided by the community services, where people are deemed at risk of developing pressure sores. The bedrooms seen were personalised and reflected the tastes and preferences of their occupants. People are able to bring personal items with them on admission and can install a private telephone line if they wish. Privacy locks on doors to peoples private accommodation had been provided although they had not been provided to all bathroom and toilet doors, which was pointed out by one of the individuals, this was passed onto the management who confirmed that the issue would be addressed. Kitchen areas were visited during this inspection; the units are domestic in style and are in need of replacement which has been identified in the maintenance programme with work scheduled to take place later this year. The cook confirmed that the food budgets had been reviewed and increased significantly since the new ownership and the quality of the meals reflected this. Records to support the safe management of food were in place and up to date. 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; the new owners have carried out a significant amount of work to clear overgrown areas, clean the pond, prune plants and trees and provide new fencing. Many people spoken with commented on all the improvement works carried out at the home and in particular the garden, these include the new owners are very good, there has been a great improvement everywhere and they have done wonders with the garden, we can see all the bulbs this year and Care Homes for Older People Page 23 of 33 Evidence: theyve put out new bird feeders and If anything needs doing, its done now, I told them about a light bulb yesterday and it was changed straight away. Care Homes for Older People Page 24 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Crosshill House are supported by a dedicated staff team. Staff have received much more training relevant to their role. Overall the recruitment practices are much safer however closer scrutiny to the number of references received for new staff will help in making sure that people are not at risk from unsuitable workers. Evidence: The home has a stable staff team. Discussions with staff and people who use the service and from observation during the day evidenced that there are enough staff rostered to meet peoples needs. At the time of the visit there were eleven people residing at the home, staffing levels remain the same as at the previous inspection with two staff rostered each shift one of those on night duty providing sleeper cover. Staff told us they had enough time to carry out their tasks and spend time with people which was observed during the day. The staffing levels at the home should be assessed using Department of Health Guidelines, The Residential Forum a dependency tool, which provides the number of hours needed from the dependency scores of each individual accommodated at the home. The new owners are currently providing all management support, they have appointed a deputy manager and they all work in a supernumerary capacity. The home employs a full time cook and kitchen assistants, the care staff are responsible for all cleaning and laundry duties. Observation of the staff during the visit showed that the home was quiet, calm and well organised. Care Homes for Older People Page 25 of 33 Evidence: All people spoken to during the day were extremely complimentary about the staff at the home. The staff are marvellous, they are so kind and helpful and go out of their way to make sure we are all well looked after. This was the comment from one person and reflected the general view about staff from the considerable feedback given during the inspection. The home employs ten care staff. Records show that the 40 of the care staff have qualified at NVQ in care at level 2 or 3, and three further staff are currently working towards this qualification. Induction programmes for new staff starting work at the home have improved and staff now complete a more thorough and structured induction programme. Advice was given to the owners to check that the current programme in place does meet all the National Training Organisation, Skills for Care common induction standards. We saw evidence that new staff had completed the programme and their work had been signed off on completion. We spoke to a new member of staff during the visit who told us that the staff team were very welcoming and she had been well supported. We saw evidence that significant improvements have been made to the staff training programme to ensure people who use the service are supported by skilled and competent staff. The focus has been to provide staff with mandatory training in moving / handling, fire safety and food hygiene and records show this is now up to date. The owners have first aid certificates and this training is planned for the remainder of staff later in the programme. Staff have also received training in safeguarding adults from abuse and medication, although staff still need to complete an accredited medication course. Service specific training in falls prevention, continence and dementia have also been provided. The programme includes courses on health/ safety, infection control, tissue viability and death and loss which will be provided to staff over the next year. Views expressed by staff on this inspection indicated that they are feeling well supported, that they are receiving good training, supervision and encouragement to develop their skills and potential. Care Homes for Older People Page 26 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have confidence in the new management at the home. Quality monitoring systems allow individuals and their families to comment on and in part affect the way in which the service is operated. The environment is safe for people and staff because appropriate health and safety practices are carried out. Evidence: The home changed ownership in June 2008, shortly after the last key inspection visit. The new owners Jane and Emma Grey have experience in management in NHS settings, and working and providing training in care services. When they took over the home they inherited a considerable back log of work and improvements were needed to all aspects of the management, administration and facilities. There is very good evidence from this inspection that they are committed to providing a service which is well run, provides high standards of care and has the individual at the heart of all they do. They are tackling the improvement work with enthusiasm, thoroughness and are committed to getting it right. All staff and people spoken with during the visit were Care Homes for Older People Page 27 of 33 Evidence: very complimentary about the new owners, comments include You can talk to them, they really listen and want to help us, we also have fun now and I cant explain enough how much this home has improved, nothing has been skimmed over, they put their heart and soul into it and Everything has changed for the better, staff moral is fantastic, we are floating on cloud nine now. There is no registered manager in post, discussions with the owners identified that they have appointed a deputy manager who they are currently working closely with to provide coaching and management training with a view that she will apply for the position later this year. We advised that in principle this was acceptable in the short term however significant delays in providing a registered manager for the service could result in the owners fitness to be questioned, which they confirmed they understood. There was good evidence that the management have introduced a number of quality assurance and monitoring systems, which involves people who live in the home, carers, family, staff and other professionals such as doctors and district nurses, giving their views about the home. Surveys have been issued to all parties, the results analysed and an improvement plan drawn up. Regular bi- monthly meetings are held with residents and families, the meetings are minuted and copies of the minutes are displayed on the notice board, we saw minutes of the recent meeting where the survey results and improvement plan had been discussed. There are regular monthly staff meetings as well as additional meetings where issues arise in between if needed. Senior staff have been given designated lead roles in areas of management and practice which appears to be working well, these areas include health safety, medications, care plans and moving and handling. Audits of key areas now need to be carried out which will also support the quality monitoring process. The returned surveys generally show that people are very satisfied with the service. The management are aware that all the policies and procedures in the home now require review and up dating to ensure they meet current legislation and good practice guidance. They confirmed that this work is planned over the next few months. People are protected by the way their finances are dealt with as two peoples records were checked and found to be correct, safe and good records kept. Health and Safety is now managed well. Maintenance certificates are in place and up to date for all the utilities and equipment within the building. The premises are maintained to a safe and comfortable standard with a rolling programme of maintenance, a handy person employed acts promptly to address repairs. The hot water temperatures at outlets throughout the home are now monitored each month, the nature of the old building means the temperatures can fluctuate, staff are aware of Care Homes for Older People Page 28 of 33 Evidence: this and records show that where the temperature has risen slightly above the maximum of 43deg C, the plumber has been called in to either adjust or replace the thermostatic valve. Fire safety is good, the fire risk assessment has been reviewed and up dated. Tests on equipment are undertaken and regular fire drills for staff are carried out. The fire officer has visited recently and the deputy manager reported that he is very satisfied with the systems in place. Risk assessments for safe working practices and to support the care delivery to people who use the service are kept updated. Records are made of all incidents to relevant authorities. There were no bed rails in use at the time of the visit however the management confirmed that the use of bed rails would be supported by risk assessments and regular safety checks. Care Homes for Older People Page 29 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 The registered person must ensure that care plans are developed and put in place which identify all individuals care needs and have clear directions for staff to follow. This will better ensure peoples care needs are all documented and met. 30/06/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 3 The assessment documentation should be developed to include more descriptive detail about peoples needs and how they would like to receive their care. Improvements are needed to the management of medications such as up dating all policies and procedures, transcribed records to be witnessed, temperature monitoring of the medication storage room, for staff to access an accredited medication course and for the controlled medication cupboard to be securely affixed to the wall. Continue to develop and embed the quality assurance Page 31 of 33 2 9 3 33 Care Homes for Older People programme. Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 33 of 33 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!