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Inspection on 04/11/05 for Crossways Care Nursing Home

Also see our care home review for Crossways Care Nursing Home for more information

This inspection was carried out on 4th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home continues to provide good information for service users who are considering a move into the home. The information provided includes a service users guide and a statement of purpose. During the inspection, the service users commented favourably on the care they receive at The Crossways. This was confirmed by observations of the staff team and the service users during the inspection, which showed that the service users are treated with respect. The staff team at the home also commented on the good relationship that they have been built up between relatives and staff at the home. The majority of the staff team at the home have all worked at the home for sometime which provides continuity for service users.

What has improved since the last inspection?

Since the last inspection the home has replaced fire exit doors with alarmed "push bar" types with should make it safer and easier for service users and staff to exit the building in an emergency situation. The home continues to provide varied and nutritional meals for the service users at the home. The service users commented on how much they enjoyed have a glass of wine or a sherry with their meal.

What the care home could do better:

Although there has been an improvement in the number of staff supervision sessions occurring they are still not happening as frequently as they should. The home manager has taken action to deal with this issue and is confident that the situation will have been resolved by the next inspection. The manager should also ensure a fire risk assessment is completed by the home.

CARE HOMES FOR OLDER PEOPLE Crossways Care Nursing Home Crossways 17 Overton Road Sutton Surrey SM2 6RH Lead Inspector Deborah Yapicioz Unannounced Inspection 4th November 2005 08:20 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 Care Nursing Home DS0000036868.V262932.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Crossways Care Nursing Home DS0000036868.V262932.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Crossways Care Nursing Home Address Crossways 17 Overton Road Sutton Surrey SM2 6RH 020 8642 0955 020 8642 0955 crosswaysnursinghome@blueyonder.co.uk 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) Crossway Nursing Home Mrs Alison Churchill Care Home 33 Category(ies) of Dementia - over 65 years of age (0), Old age, registration, with number not falling within any other category (0) of places Crossways Care Nursing Home DS0000036868.V262932.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Intermediate care may be provided for up to five service users. Date of last inspection 22nd August 2005 Brief Description of the Service: Crossways Nursing home is owned by Dr and Mrs Koa Hung Yu and is registered with the Commission for Social Care Inspection to provide nursing care for up to thirty-three older people with numerous conditions associated with old age and dementia. Since Dr and Mrs Yu took over ownership of the home on 31st January 2003 a great deal of work has been put into the renewal of the fabric of the building to bring it in line with the National Minimum Standards. The registered providers are also in the process of building an extension to the home. The Crossways is a large Edwardian three-storey house with a twelve bed roomed annexe which was added in 1998. The home has surrounding gardens and is situated in a quiet residential street close to the centre of Sutton. There is a spacious dining room on the ground floor and two lounges. The kitchen and laundry areas are clean and well equipped. There is ample space for parking vehicles at the front of the property. The home is also close to rail and bus links Crossways Care Nursing Home DS0000036868.V262932.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the homes second inspection for the year 2005/6. The inspection was unannounced and took place at 8.20 on the morning of 4th November 2005. The home was inspected under the National Minimum Standards Care Homes for Older People. A previous inspection took place on 22nd August when most of the standards that the Commission for Social Care Inspection considers as key standards were inspected. Methods of inspection included meeting with the service users, a partial tour of the premises, and observations of contact between staff and service users, meeting with the manager and other members of staff. The home is currently undergoing a refurbishment and part of the building is being extended and improved to provide additional rooms and facilities. The inspector would like to thank the service users, the staff team and Ms Churchill for their help in facilitating the inspection. Overall the inspection confirmed that the home continues to provide a good standard of care to the people living there. What the service does well: What has improved since the last inspection? Since the last inspection the home has replaced fire exit doors with alarmed “push bar” types with should make it safer and easier for service users and staff to exit the building in an emergency situation. The home continues to provide varied and nutritional meals for the service users at the home. The service users commented on how much they enjoyed have a glass of wine or a sherry with their meal. Crossways Care Nursing Home DS0000036868.V262932.R01.S.doc Version 5.0 Page 6 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 Care Nursing Home DS0000036868.V262932.R01.S.doc Version 5.0 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 Care Nursing Home DS0000036868.V262932.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,4,6, The home provides good information and introduction opportunities for prospective service users and their families to make an informed choice about moving to the home. Service users referred for intermediate care are provided with an occupational therapy programme, which enables them to maximise their independence. EVIDENCE: Crossways has a statement of purpose and a Service users guide in place. Service users are only admitted to the home once a full assessment of their needs; compiled by their care manager or other relevant person has been received. A care manager’s assessment was seen on the service users files sampled during the inspection. Families are encouraged to visit and “test drive” the home before making a decision to move there permanently. The home provides intermediate Care to a small group of service users. These service users are provided with a rehabilitation programme and assessment and assessment by an Occupational Therapist. The home manager explained that the home hopes to develop the intermediate care provision as part of the building extension. Crossways Care Nursing Home DS0000036868.V262932.R01.S.doc Version 5.0 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): 7,9,11 Personal care is carried out in a way that residents prefer so that dignity and choice are maintained. Residents’ medication is well managed to ensure good health. Service users have been consulted on their personal and cultural preferences in relation to illness, death and dying, thus ensuring their individual wishes are respected. EVIDENCE: The home has a policy on the receipt, recording, storage, handling, administration and disposal of medication. Records examined showed that all medicines administered are recorded on Medicine Administration Record Sheets. The service users are registered with a local General Practitioner Service users who are prone to pressure sores had the necessary equipment for the promotion of tissue viability and prevention or treatment such as airbeds, soft cushions and heavy-duty foam cushions. Pressure sore risk assessments (Waterlow) are carried out and districts nurses routinely visit the home. The home has care plans in place that carries on from the original care plan and assessment. Residents’ individual needs were identified and the actions to be taken to meet the requirements. Crossways Care Nursing Home DS0000036868.V262932.R01.S.doc Version 5.0 Page 10 The care plans are reviewed regularly and the staff team at the home monitor the plans and make regular entries to record daily activities and any areas of concern. Service users are asked about issues around death and dying before admission to the home, this includes any cultural or religious wishes. Crossways Care Nursing Home DS0000036868.V262932.R01.S.doc Version 5.0 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): 13,14,15 The daily routines and house rules promote residents’ rights and encourage independence. The home has an open visitors policy to ensure family links are maintained. Dietary needs are catered for with meals that are nutritionally well balanced, nicely presented, and clearly based on the service users food and drink preferences, providing them with daily variation and healthy eating options. EVIDENCE: There is an open visitors policy and families are welcome to visit at any time, although the service users can choose who they wish to see. Visitors can be seen in any part of the home including bedrooms. The home invites relatives and families to any social events. Service users can bring in their own possessions and furniture if they wish. Service users are on the electoral register and have postal votes. The service users are offered three meals a day as well as morning and afternoon tea’s. Any dietary needs are recorded in the service users care plan. The home keeps a detailed record of all food consumed by the service users. The following is evidence of exceeding this standard: The home offers the service users offers a wide range of alternative meals to the service users if they do not wish to have the main choice on offer i.e. not just an omelette. The cook at the home is happy to cater for individual tastes and has prepared dishes such as curry for small groups of service users. Wine and Sherry is available to service users (if their health and medication permits.) Crossways Care Nursing Home DS0000036868.V262932.R01.S.doc Version 5.0 Page 12 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): 16,18 There is complaints policy and procedure, which facilitates good access to the complaints system for the residents, their family or their representatives. The home has the appropriate policies in place to ensure the protection of vulnerable service users. EVIDENCE: Crossways have a complaints procedure, which outlines how a complaint is dealt with and timescales for action. The complaints procedure is included in the service uses guide. The home keeps a record of any comments or complaints made about the service. The home has an Abuse policy and any concerns would be referred in line with the Vulnerable Adults Procedure. The home has a copy of the local authority Adult Protection Policy on site. The majority of staff have access to training on Adult Abuse. Crossways Care Nursing Home DS0000036868.V262932.R01.S.doc Version 5.0 Page 13 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): 19,26 The general décor of the home is good providing a comfortable, clean and safe environment for service users to live in. EVIDENCE: The home is situated in a residential area of south Sutton and is within reasonable walking distance of shops and public transport. On the morning of the unannounced inspection the home was warm, comfortable, bright, well ventilated and free from offensive odours. There were many “homely” touches such plants and flower arrangements. There is ample communal space through out the home. The communal areas appeared comfortable, bright and furnished appropriately with areas for service users and their visitors to meet in private. During the inspection many of the service users said that they liked their rooms. The home is currently undergoing a refurbishment and part of the building is being extended and improved. The home manager has written to service users or their family’s to inform them of the planned changes to the home. As yet the building programme has not had much of an impact as the area currently being worked on has been cordoned off and has a separate entrance from the rest of the home. Crossways Care Nursing Home DS0000036868.V262932.R01.S.doc Version 5.0 Page 14 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): 27,30 The staff team at the home have a range of skills and abilities, which enable them to meet the needs of the service users living at the home, ongoing training to build on staff skills is provided. EVIDENCE: “The Crossways” arranges for two Registered General Nurses to be on duty during the day as well as four care staff. The home employs laundry staff as well as domestic and kitchen staff to support the nursing and care staff. The home arranges for additional staff to be on duty if the need arises, such as escorting a service user to a hospital appointment. The staff members spoken to during the inspection made positive comments on their experience of working at the home and two people felt that “it is like a family”. The management team provides the staff team with a uniform of polo shirts. The Staff team have access to a range of training courses including National Vocational Qualifications, manual handling, food hygiene and first aid. The home manager explained that she is planning refresher courses in manual handling in the near future. Attendance certificates are kept on staff files The home holds regular staff team meetings, which are recorded. Crossways Care Nursing Home DS0000036868.V262932.R01.S.doc Version 5.0 Page 15 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): 31,36,38 The management style is open and the home appears to be well run. There are clear lines of accountability, which is aimed at ensuring that the interests of the service users, are safeguarded and their safety and welfare are protected, however this would be further enhanced when a fire risk assessment is in place. EVIDENCE: Alison Churchill is registered with the Commission for Social Care Inspection as the home manager of Crossways. Ms Churchill has been in post two years and is a Registered General Nurse and has substantial experience in a care setting. Mrs Yu, the homeowner is available to support Ms Churchill although there are clear lines of accountability within the home and staff members spoken to were clear about the roles of the management team. The manager stated she endeavours to create an ‘open’, positive and inclusive atmosphere. Crossways Care Nursing Home DS0000036868.V262932.R01.S.doc Version 5.0 Page 16 Members of the staff team spoken to during the inspection felt supported by the home manager and were kept informed of the changes regarding the planned environmental changes to the home. Several members of the team said that they would be happy to speak to the manager if they had a concern. The home has staff meetings, which are recorded. Although there has been an improvement in the number of supervisions sessions occurring they are still not happening as frequently as they should. This requirement is therefore carried over to the next inspection. Copies of the homes policies and procedures are kept in the office and the staff members spoken to were aware of where to locate them. The home manager demonstrated a good awareness of health and safety issues. The home has a health and safety policy in place. A first aid box and a fire blanket are situated in the kitchen. There are fire extinguishers throughout the house. Coloured chopping boards were seen in the kitchen. Fridge and freezer temperatures are taken and recorded. The local fire safety officer has recently visited and highlighted the need for a fire risk assessment at the home. Since the previous inspection the home has replaced three exit doors with alarmed push bar types, which should help to ensure a safe exit in an emergency situation. Crossways Care Nursing Home DS0000036868.V262932.R01.S.doc Version 5.0 Page 17 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 3 X X 3 X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 3 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X 2 X 2 Crossways Care Nursing Home DS0000036868.V262932.R01.S.doc Version 5.0 Page 18 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 OP36 Regulation 18(1) Requirement The home manager must ensure that all members of the staff team receive regular supervisions. The home manager must complete a fire risk assessment for the home. Timescale for action 21/03/06 2 OP38 12(1) 31/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Crossways Care Nursing Home DS0000036868.V262932.R01.S.doc Version 5.0 Page 19 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Crossways Care Nursing Home DS0000036868.V262932.R01.S.doc Version 5.0 Page 20 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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