Inspection on 29/08/07 for Crossways

This inspection was carried out on 29th August 2007.

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

Other inspections for this house

Crossways 23/06/06

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 29 August 2007 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.V343367.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Crossways DS0000006508.V343367.R01.S.doc Version 5.2 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.V343367.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for a maximum of 39 service users in the category of OP (older people not falling within any other category). 15th March 2007 Date of last inspection Brief Description of the Service: Crossways is a registered care home, providing accommodation for 39 older people. It is run by CLS Care Services, a not for profit organisation which runs a number of homes in the northwest of England. The home was purpose built in the 1980s and has single bedrooms on the ground and first floors. Two of the bedrooms are large enough to be used as doubles or twins if required. The home is located in a well- established residential area. It has a small courtyard and garden area for the people who live at the home and their visitors to 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. There is good access to all areas of the building and there is a passenger lift. There are a number of sitting and dining areas. Bedrooms are comfortable, well furnished and many contain a lot of peoples’ own personal belongings and items of furniture. The range of fees for this home is £353-91- £480.00 per week. This figure was given on 24 April 2006. Additional charges are made for newspapers, hairdressing, toiletries, holidays and a contribution towards outings. People interested in moving into the home are able to read the latest CSCI inspection report, which is available in a copy of the service user guide for the home in the entrance hall. A copy of this guide is also in each 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.V343367.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced visit by one inspector took place on the 29 August 2007 and lasted 6 hours. This visit was just one part of the inspection. Before the visit the home manager was also asked to complete a questionnaire to provide up to date information about services in the home. CSCI questionnaires were also made available for people that live in the home, families, and health and social care professionals such as doctors, nurses and social workers to find out their views. Other information received by CSCI since the last inspection was also reviewed. During the visit, various records and the premises were looked at. A number of people who live in the home and relatives were also spoken with and they gave their views about the service, which 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 good improvement to the way care plans are written and reviewed. People that live in the home confirmed that they are involved in development of their care plans so they know what care they will be given and can say how they would prefer things to be done for them. Crossways DS0000006508.V343367.R01.S.doc Version 5.2 Page 6 Apart from two minor errors, there are improvements to the way medicines are managed in the home. This ensures that people that live in the home receive their medication safely and as prescribed. Improvement to the inside of the home can be seen in a number of areas. The garden has been developed and some sitting out areas with patio furniture created, providing better facilities for people that live in the home. 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. The summary of this inspection report can be made available in other formats on request. Crossways DS0000006508.V343367.R01.S.doc Version 5.2 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.V343367.R01.S.doc Version 5.2 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. 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. People’s needs are fully assessed before they move into the home. This means that people can be sure that these needs can be met when they move into the home and are planned for before they move in. EVIDENCE: The manager or a senior member of staff visits people who have expressed a wish to move in to the home to carry out an assessment of their needs to make sure they can be met at Crossways. Records and discussions with people who live at the home and their visitors confirmed that this was done. Four care plans were seen and all contained assessments completed before the person moved into the home. This assessment, plus any other information received from social services or the health services, is used to help develop the person’s plan of care. Crossways DS0000006508.V343367.R01.S.doc Version 5.2 Page 9 The files of four people that live in the home were checked. Assessment documents were thorough, dated and signed, providing good information about the person’s needs. Crossways DS0000006508.V343367.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who live in the home are well looked after, ensuring their health, social and personal care needs are met. EVIDENCE: Care plans seen were had improved since the last inspection. They were up to date and reviewed monthly, with any changes recorded, so that staff are always aware of people’s changing needs. There is a very good ‘life profile’ document in each of the plans seen, with information about the person’s life before they moved to the home, which enables the care staff to have a greater understanding of each person. There was evidence that the care plans had been discussed with the people concerned, who had signed to indicate their agreement. One person said, “We see the care plan so we know what is going on”. Two people recalled the review of their care plans, and one visiting family said they are fully involved in any review held regarding their relative. One relative praised the way that staff keep her informed by saying “They keep me Crossways DS0000006508.V343367.R01.S.doc Version 5.2 Page 11 well informed and let me know when the doctor has been to see my mum”. One person that lives in the home said “Staff look after us well when we are poorly”. As well as a plan of care, all files seen contained risk assessments, falls risk assessment, malnutrition risk assessment, risk of pressure sores, moving and handling information, depression screening tool, communication information, nurse or GP interventions plus a ‘life profile’. Care plan audits are carried out, and some areas that were identified by the manager as needing attention had been completed. Some plans had been written in a person centred way with or by the person concerned. They were a good account of their needs and how they were to be met. There has been a good improvement in the standard of care planning since the previous inspection and an improvement in the management auditing of these. The medication system at the home has given some concern in the past, but this has improved over the last year. A random inspection took place on 15/03/2007 to check on medication requirements made at the previous inspection. These were all met. A new medication room has been created and new systems and procedures put into place. This has been carried out to ensure that people that live in the home receive their medication as prescribed and in a safe manner. On this visit, medication systems seen were in good order, apart from two recording errors on the medicine administration sheets. The storage of medication was fine with access only to authorised senior staff. No large stocks of medication are being held. A fridge was available for medication that needed to be kept cool. Policies and procedures are available, and staff confirmed that these are followed. There is extra security for controlled drugs, with a register kept as required. Written comments received from two of the GPs that care for people that live in the home were very positive. One wrote, ““Provides a warm, caring environment. Residents’ rooms are comfortable and personalised. Crossways benefits from being a small unit and provides a family life environment. Staff are friendly and caring”. Another wrote, “Very good home – staff caring and attentive”. Crossways DS0000006508.V343367.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live in the home are given the opportunity to choose their lifestyle, social activities and food from a wide range. This means that they have some control over their lives. EVIDENCE: The activities available in the home were discussed with a number of people who live there. They said the activities co-ordinator was on holiday for a couple of weeks, but he had pre-arranged a programme of activities, which was displayed on notice boards, to take place during his absence. Some of these were ‘visiting’ activities such a lady who undertakes tai chi, and the staff group arranged others. One person said “We have been to Blackpool, Llandudno and the zoo this year”. People also said that musical entertainers visit regularly, and mystery tours are arranged. Some people go out of the home on a ‘one-to-one’ basis with the activities co-ordinator. All people that live in the home spoken with said that the food was good, with plenty to choose from. The cook confirmed that he visits each person daily to find out what they would like to eat from the menu of the day. On the day of Crossways DS0000006508.V343367.R01.S.doc Version 5.2 Page 13 inspection, there was a choice of smoked haddock, sausages and gravy or omelette. Two people had chosen to have none of these, and the cook had prepared alternatives in advance for them. This shows that the diverse needs of some people can be met in relation to food. Vegetables were available in dishes on tables for people to help themselves. Lunchtime was a pleasant, relaxed occasion with no evidence that people were rushed or hurried whilst eating their lunch. Care staff were seen to offer discreet assistance when necessary. Visitors spoken with confirmed that they are encouraged to visit as often as possible and at any time. Crossways DS0000006508.V343367.R01.S.doc Version 5.2 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. 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. Arrangements for making complaints and protecting people who live in the home from abuse are satisfactory, so they are not at risk from harm or poor practice. EVIDENCE: All families and visitors spoken with said they would be happy to mention any concerns they had to the staff at Crossways. One relative said that communication between them and the staff was very good, and staff responded promptly to any concerns or queries that they had. The complaints procedure is available in the service user’s guide, a copy of which is in each bedroom and the entrance hall. Information regarding how to contact the CSCI is displayed. People who live in the home said they knew who to speak to if they had any concerns. CSCI has not received any complaints about the home since the last inspection. The information sent to CSCI before this visit took place indicated that the home has received and investigated three complaints in the past year. Two referrals have been made under Safeguarding Adults procedures, and these were dealt with appropriately by the manager. Policies and procedures Crossways DS0000006508.V343367.R01.S.doc Version 5.2 Page 15 for safeguarding people who live in the home are in place. Care staff have received training on awareness of adult abuse. Crossways DS0000006508.V343367.R01.S.doc Version 5.2 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. 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. Crossways provides an adequate standard of accommodation for people who live there, and the further planned refurbishment, when complete, will provide a better, more homely environment EVIDENCE: Since the previous inspection, there has been an improvement to the environment and facilities for people who live in the home, although some areas are still in need of attention. The garden areas have been much improved, providing a pleasant area for people to sit outside. A number of bedrooms have had new washbasins fitted and the smoking room has been refurbished. There is some new carpet in the home. Work is planned to continue with the refurbishment when a grant is received. Crossways DS0000006508.V343367.R01.S.doc Version 5.2 Page 17 A requirement made at the previous random inspection to improve the state of the walls in the first floor dining room has still not been completed, and the wallpaper is still ripped off in places. The manager said that work had been delayed, but was due to commence on 30 August. In paperwork sent to CSCI before the inspection, the manager wrote, “We have considerably improved the internal decoration of the majority of the bedrooms. We need to extend this now to the remainder of the communal areas. We have replaced furniture and carpets and some lounge areas have also been redecorated. The front garden area has been fenced and the patio replaced with new garden furniture. Refurbishment to upstairs dining area and open brickwork to lounges is to be addressed by plastering then redecoration to make them warmer and more welcoming environments.” The manager also wrote that “further redecoration to the communal areas of the home would enhance the atmosphere making them warm and friendly”. Further improvement is therefore planned, which will provide a more comfortable and homely environment for people that live in the home. The standard of cleanliness throughout the home is satisfactory, with no noticeable odours. Policies and procedures are in place for the control of infection and health and safety, protecting staff and people who live in the home. Crossways DS0000006508.V343367.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff have received training to help them develop their skills and provide safe care. Recruitment procedures are thorough enough to ensure that the people who live at the home are protected from possible harm or poor practice. EVIDENCE: Further recruitment of staff over the past few months has meant that the home is now fully staffed apart from one vacancy. As a result, agency staff are now only used to cover for sickness and holidays. This means that people who live in the home receive better continuity of care. One person who lives in the home felt that staffing was still a problem and wrote in a questionnaire, “The home tries to care well, but due to holidays, ill health and low staff levels, it is hard for them and us on occasions. Many new people are admitted who need greater care”. However, following discussions with the manager and staff and observations in the home, it was evident that the present staffing levels do match the dependency needs of the people that live in the home. In paperwork received from the manager prior to the inspection, she wrote, “Last year we had a very big problem with major illnesses within the team. We are now applying the final pieces to recruiting adequate supernumerary staff to enable us to manage Crossways DS0000006508.V343367.R01.S.doc Version 5.2 Page 19 to cover for adhoc sickness and annual leave without having to rely on agency staff”. Other comments written by people that live in the home include: • “I am happy and I like the staff here” • “If I need support, I get it immediately” • “All the staff are fine” • “I find the staff most responsive and they are so caring” Other comments in surveys suggested that people that live in the home are happy with the way staff support and listen to them. The staff at Crossways have been continuing with their training. To date, 13 of the 25 permanent care staff group hold a minimum of NVQ level 2 and six care staff have started their training. Two of the three ‘bank’ staff have also commenced their training. This means that people that live in the home are cared for by a competent staff group. Regular in-house training for staff continues according to need. 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 POVA and CRB checks having been obtained before the staff member started working in the home. This provides a level of security and safety for residents and helps to protect them from possible harm. Equality and diversity within the home can be seen in the way the staff treat people as individuals with different needs. The home strives to meet these needs as appropriate, and provide the necessary care to enable each person to live their chosen lifestyle. The manager has attended an equality and diversity training course and is cascading this down to other staff in the home through supervision and training sessions. Crossways DS0000006508.V343367.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management of the home is improving, which means that the home is run in a better way for the people that live there. EVIDENCE: The manager of the home has now completed the registered managers award qualification and the company that runs the home – CLS Care Services – has achieved the Investors in People Award. The manager is committed to promoting equality and diversity within the home and meeting the individual needs of the people that live there. Following continued senior management support from CLS, the management of Crossways has improved over the past year. Better systems and procedures Crossways DS0000006508.V343367.R01.S.doc Version 5.2 Page 21 are in place, and are being followed to ensure the home is well run for the people that live there. The manager supervises the senior staff, who in turn supervise the care staff. This process has not been running well over the past year, but is now showing signs of improvement. Some management input is still needed to ensure that all staff receive supervision, ensuring that a competent staff group cares for people that live in the home. Senior staff spoken with felt more supported over the last year, and welcomed some of the new systems that had been put into place to enable them to have greater control over their areas of work. People that live in the home and their relatives completed a satisfaction survey last year. The results were collated and a summary made available for the service users’ guide, detailing any actions that may or may not be needed. A new survey is in the process of being developed for this year. The home works to a satisfactory system for safeguarding residents’ money and clear records with receipts are kept. Policies and procedures for safeguarding residents’ money provide security. The information provided from the home before the inspection visit showed that equipment and installations at the home are serviced regularly. A handyman is employed at the home to attend to maintenance issues such as checking fire safety equipment, water temperatures and other health and safety matters, providing a safe environment for people who live in the home and staff. Crossways DS0000006508.V343367.R01.S.doc Version 5.2 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 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 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 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 2 X 3 Crossways DS0000006508.V343367.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action 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 OP9 Good Practice Recommendations The manager should ensure that all staff follow the policies and procedures for the administration of medication, so that there are no errors in the recording on the medicine administration sheets. The programme of maintenance and renewal of the fabric and decoration of the home should continue, to provide better facilities for people that live in the home. The manager should ensure that staff supervision arrangements are carried out at the recommended intervals, so that all staff have the opportunity to discuss their work and their personal development within Crossways. 2 3 OP19 OP36 Crossways DS0000006508.V343367.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Crossways DS0000006508.V343367.R01.S.doc Version 5.2 Page 25 - 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!