Inspection on 23/06/06 for Crossways

This inspection was carried out on 23rd June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Crossways 29/08/07

Crossways 19/01/06

Crossways 07/07/05

Crossways 18/11/04

Crossways 15/07/04

Crossways 24/02/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Crossways Station Road Lostock Gralam Northwich Cheshire CW9 7PN Lead Inspector Bronwyn Kelly Unannounced Inspection 23 June 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 Crossways DS0000006508.V289767.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. Crossways DS0000006508.V289767.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Crossways Address Station Road Lostock Gralam Northwich Cheshire CW9 7PN 01606 45559 01606 46059 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) www.clsgroup.org.uk CLS Care Services Limited Mrs Annette Needham Care Home 39 Category(ies) of Old age, not falling within any other category registration, with number (39) of places Crossways DS0000006508.V289767.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. This home is registered for a maximum of 39 service users in the category of OP (older people not falling within any other category). The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidance which may be issued through the Commission for Social Care Inspection. 19th January 2006 Date of last inspection Brief Description of the Service: Crossways is a registered care home, providing accommodation for 39 older people. It is managed by CLS Care Services, a not for profit organisation which manages a number of homes in the northwest of England. The home, purpose built in the 1980s, provides single bed roomed accommodation on the ground and first floors. Two of the bedrooms are large enough to be used as doubles if required. The home is located in a wellestablished residential area. It has a small courtyard and garden area for residents use. Local community amenities such as shops, churches and bus stop are within a short walking distance. There are good links with the local community and relatives of service users. Service users have access to all areas of the building and there is a passenger lift to the first floor. There is a variety of sitting and dining areas including a smoking lounge. Services users bedrooms are comfortable, well furnished and many contain a lot of the residents own personal belongings and items of furniture. The range of fees for this home is £343.34 - £470.00 per week. This figure was given on 24 April 2006. Additional charges are made for newspapers, hairdressing, toiletries, holidays and a contribution towards outings. Prospective residents are able to read the latest CSCI inspection report, which is available in a copy of the Service User Guide in the entrance hall. A copy of this guide is also in each resident’s bedroom. Other information about the home and CLS is available in leaflets on display in the hall. These outline the lifestyle that residents can expect when they move into the home. Crossways DS0000006508.V289767.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 seven and a half hours on two days. A tour of the building took place, checking on bedrooms, bathrooms and shared areas of the home. A variety of records were examined as part of the inspection. Part of the process of the inspection is to listen to the views of the residents that live in the home and listen to the views of their relatives and visitors. On this occasion, four residents were spoken with privately and group discussions took place in lounge and dining areas with a number of other residents. Three visiting relatives were happy to give their views of the home during the inspection. The views of the manager, two care staff, three care team leaders and a care assistant from an agency were listened to. A number of CSCI’s comment cards were sent to the home before the inspection for residents and relatives to complete. Nine comment cards were received from the residents and five from relatives. Their views have been included in the report. What the service does well: What has improved since the last inspection? Since the last inspection, there has been a good improvement to the way medication is handled, administered and stored within the home. This has provided more protection for the residents. Crossways DS0000006508.V289767.R01.S.doc Version 5.1 Page 6 There has been some improvement in the frequency of reviews of residents’ care plans, mainly due to auditing by the manager. Since the last inspection, there has been improvement to the environment of Crossways, providing better facilities for residents. 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. Crossways DS0000006508.V289767.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 Crossways DS0000006508.V289767.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): 3. (Standard 6 does not apply, as intermediate care is not provided.) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ needs are assessed before they move into the home. This ensures that the resident and their family know that these needs can be met when they move into Crossways. EVIDENCE: The files of four residents were checked, including the resident who had been most recently admitted. The manager or a member of the senior staff visit each prospective resident in their own home or hospital and carry out an assessment, to ensure their needs can be met at the home. These assessments were seen on a number of care plans. Written assessments are sometimes provided by health and social care professionals to give the home additional information about the care needs of new residents. When the resident moves into the home, this information is used to develop a plan of care. Crossways DS0000006508.V289767.R01.S.doc Version 5.1 Page 9 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a care planning system in place, which is improving to provide staff with the information they need in order to meet the social and health care needs of the residents. Personal support is provided in a way that enables residents to have privacy and dignity in their lives. Improvements have been made to the procedures for administering medication, which has helped ensure residents’ good health and safety. EVIDENCE: The care plans of four residents were read. All contained risk assessments and moving and handling information, providing safeguards for residents. Residents’ care plans have continued to improve over the last two inspections. The manager has started auditing them regularly and staff are working towards ensuring the plans are accurate, up to date and contain all the relevent information. The manager’s audits have highlighted the fact that care plans have not been reviewed on a regular basis and two of the care plans seen had not been updated. More information has been included on residents social needs and how these can be met. Crossways DS0000006508.V289767.R01.S.doc Version 5.1 Page 10 The residents confirmed that they have regular visits from a chiropodist, dentist and optician and that a doctor is called when they feel unwell. A separate section of each resident’s care plan is used for recording any medical interventions, which enables effective monitoring. Referrals are made to other health care specialists as and when required. The staff spoken with displayed a good understanding of the importance of ensuring privacy and dignity when delivering personal care to the residents. Induction training for new members of staff includes privacy and dignity. CSCI’s pharmacy inspector visited Crossways on 24 August 2005 and 13 April 2006. She found a number of concerns at the way the medication was stored, administered and recorded and a requirement was made. Since then, a number of improvements and changes have been implemented. A new medicines storage room has been created, senior staff who administer medication have all received training and regular audits are taking place by the manager. As a result, the way the recording, handling, safekeeping, safe administration and disposal of medication is organised has greatly improved. Further changes to improve the supply of medication are planned to take place during July. Crossways DS0000006508.V289767.R01.S.doc Version 5.1 Page 11 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, 13, 14, and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The choices of activities available over the past few months do not meet the individual needs and wishes of all the residents. The dietary needs of residents are well catered for, providing a good choice and quality of food. EVIDENCE: At the last inspection, it was noted there has been considerable improvement in the provision of social and leisure activities available for residents. A new activities co-ordinator had been appointed, who had encouraged the residents to be involved in all aspects of planning their daily lives in the home. Unfortunately, the organiser has been off sick for the last few months, and the residents were quite vocal in saying how much they missed the various activities that were arranged with them. The care staff group have arranged some activities where possible, but they are relying heavily on agency staff due to sickness, and have not had the time to arrange as much as they would have liked. Three relatives commented: • “Not enough entertainment” • “A little music sometimes would help break the long day” • “A little more could be done to occupy residents”. Crossways DS0000006508.V289767.R01.S.doc Version 5.1 Page 12 Some comments from the residents included: • “We have missed the activities co-ordinator – he used to arrange visits to the civic hall tea dance, concerts, canal trips, quizzes and games”. • “Activities – not much at present”. In answer to the question on the comment card ‘Are there activities arranged by the home that you can take part in’ one resident replied “Not at the moment”. The manager commented that the activities co-ordinator is hoping to return to work in the near future. Meanwhile, residents’ wishes regarding how they spend their leisure time should be met. The daily menus each have two or three choices at each meal, and the cook has flexibility within the menu choices to meet the individual needs of residents. One resident said “ You can have something light like a poached egg if you have a funny tummy”. Another said “Lovely food – they make me a chicken leg when it is fish as I don’t like fish”. There are two dining areas in the home and food is served from a hot trollies. Some residents choose to have their meals in their bedroom. The food served for lunch looked appetising and well cooked, with plenty available for second helpings for those who wanted some more. The residents spoken with said the food was good. One resident was enjoying lunch with her daughter, who said this was a regular occurance. Family and friends can visit at any time, and residents know they can entertain visitors in their own room. Crossways DS0000006508.V289767.R01.S.doc Version 5.1 Page 13 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints procedure ensuring that any concerns of residents or their families are dealt with promptly and correctly. Arrangements for protecting residents from abuse are satisfactory so residents are not at risk from harm or poor practice. EVIDENCE: The complaints procedure is available in the service user’s guide and a copy is displayed in the entrance hall. Information regarding how to contact the CSCI is also displayed. CLS encourages residents and visitors to express any comments they have about the service provided, and comment cards are on display in the entrance hall. CSCI has not received any complaints about the home since the last inspection. The pre inspection questionnaire indicated that the home has received seven minor complaints in the past year and all were dealt with within twenty-eight days. None of the residents spoken with has made any complaints, but all knew who to speak to if they had any concerns. Staff receive training in adult protection during their induction to the home and as part of their NVQ training. This is updated by in-house training and staff have all recently attended a course. During discussion, staff demonstrated an awareness of the issues surrounding adult protection and the actions to be Crossways DS0000006508.V289767.R01.S.doc Version 5.1 Page 14 taken if abuse was suspected. Policies and procedures are in place as required. Systems are in place to help residents with their financial affairs, which are in line with CSCI recommendations. Residents who are unable to look after their own affairs may keep their money centrally in a CLS residents’ savings bank account and accrue interest. Details can be accessed for each resident at any time on the home’s computer. Crossways DS0000006508.V289767.R01.S.doc Version 5.1 Page 15 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 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Recent investment is improving the environment for residents, providing a better standard of accommodation with more facilities. EVIDENCE: Over the last year there has been considerable improvement to the environment of Crossways. • One lounge has been completely refurbished with new decoration, carpets and furniture. • New dining tables and chairs have been purchased for throughout the home. • The corridors downstairs have been re-decorated. • All bathrooms have now been refurbished and toilets repainted. • 20 bedrooms have been redecorated and new bedcovers purchased. • A lawn at the front of the home has been fenced for security and new garden chairs and tables purchased. Crossways DS0000006508.V289767.R01.S.doc Version 5.1 Page 16 There are plans to continue the improvement to the environment. The upstairs corridor is in the process of being decorated, and further work to another corridor where the wallpaper ‘border’ has been peeled off is planned. There are plans to ‘brighten’ some of the lounge areas and repair a stained lounge ceiling following a leak. There are also plans to provide a raised flowerbed and extended patio area to the front of the home and improve the garden area around the main entrance. A tour of the building took place. Many of the bedrooms have been personalised by the residents, and some have brought in possessions, including furniture. Residents spoken with were satisfied with their bedrooms. Commodes were provided for some residents who were unable to use the shared toilets at night. Some areas of the home used by residents were in need of tidying. Wheelchairs and a shower chair were stored in one lounge and a refrigerator for the staff was in use in another residents’ lounge. This lounge was also being used to store some of a resident’s own furniture until a bigger bedroom became available. This does not provide a comfortable, homely lounge environment for the residents. The manager said the home was short of storage space. The pre inspection questionnaire stated that the fire prevention officer visited on 27/10/05 and the environmental health officer on 16/03/06 and that all requirements had been implemented. Crossways DS0000006508.V289767.R01.S.doc Version 5.1 Page 17 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The high number of agency staff used to cover long term staff sickness has meant that residents have not received consistent care. However, the manager has plans for improvement, which should result in better outcomes for the residents. The procedures for the recruitment of staff are robust, providing safeguards to people living in the home. EVIDENCE: The rota showed that sufficient staff are on duty at any one time to care for the residents. The numbers of agency staff are considerable, and the pre inspection questionnaire showed that in an eight-week period before the inspection, agency staff covered 149 shifts. This is due to long term sickness of five members of the care staff team. The manager has interviewed for some temporary staff to ease the situation. The residents made some comments on the staffing situation including: • The staff are good, but there is a lot of agency staff” • “The girls (she was referring to the permanent staff) are always so busy as the agency staff do not know the residents”. • “Always short staffed. Lots of new ones – don’t know them” There is a group of staff that have worked at the home for many years, and this has helped some residents with all the staff changes. Residents were very complimentary about the staff. One resident said “Nothing is too much trouble Crossways DS0000006508.V289767.R01.S.doc Version 5.1 Page 18 for the staff – they are very kind”. Another said, “If I’ve needed attention, it’s been there for me” and “The carers are very kind”. Some of the staff spoken with were concerned at the number of agency staff that were having to be used. Staff are encouraged and supported in pursuing NVQ qualifications and are working towards the target of 50 trained care staff. This was 35 on the day of this visit. One member of staff has almost completed her training and a further eight staff are working towards their qualification. Many of the general domestic staff are undertaking NVQ training in housekeeping. Good policies and procedures are in place for the recruitment of staff. Four staff files were seen and each contained evidence of an interview, two references and the necessary CRB checks having been obtained before the staff member commenced duties. Evidence was seen to show that all staff working in the home have had a Criminal Records Bureau check completed. Crossways DS0000006508.V289767.R01.S.doc Version 5.1 Page 19 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 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager is experienced and supported by a staff team who are working to improve the quality of life for residents in the home. Opportunities are given to residents to express a view on the running of the home and services received. Policies and procedures for safeguarding residents’ money provide security. EVIDENCE: At the previous inspection, a recommendation was made to consider ways of ensuring that various aspects of the running of the home are up to date and in good order, such as care plan reviews, staff fire training and staff supervision. CLS have provided senior management support to the home manager and there is evidence of some improvement in the management of the home. The manager has almost completed her training for the registered managers award. Crossways DS0000006508.V289767.R01.S.doc Version 5.1 Page 20 A quality assurance system is in place, and residents and/or their families have completed a satisfaction questionnaire. The results of this survey have been collated and a summary is available in the service users’ guide. Residents and relatives meetings are held on a two monthly basis, enabling them to voice an opinion about life at Crossways. Staff supervision on a one to one basis has started, but not all care staff are receiving this on a regular basis yet. There are good policies and procedures in place to safeguard the residents’ financial interests. Health and safety matters are given good attention. There are policies and procedures in place and evidence that staff work in ways to promote the well being of residents. Crossways DS0000006508.V289767.R01.S.doc Version 5.1 Page 21 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 Crossways DS0000006508.V289767.R01.S.doc Version 5.1 Page 22 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 OP7 Regulation 15(2) Requirement Residents’ care plans must be kept under review. Original timescale of 31/03.06 was not met. Suitable provision should be made for storage within the home so that residents’ lounges are not used for storage purposes. Sufficient permanent staff must be working in the home to ensure the health and welfare of residents and their continuity of care without relying so heavily on agency staff. Timescale for action 30/10/06 2 OP19 23(l) 31/08/06 3 OP27 18 30/10/06 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 OP12 Good Practice Recommendations Residents should be consulted about their social interests and activities, and arrangements made to meet these. DS0000006508.V289767.R01.S.doc Version 5.1 Page 23 Crossways 2 3 4. OP19 OP28 OP36 The programme of maintenance and renewal of the fabric and decoration of the home should continue. The home should continue to support staff to achieve the target of 50 of care staff with NVQ level 2 or above. Supervision arrangements should be in place for all staff. Crossways DS0000006508.V289767.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT 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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