Inspection on 09/11/06 for Crossways Care Nursing Home

This inspection was carried out on 9th November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 Care Nursing Home 30/10/07

Crossways Care Nursing Home 04/11/05

Crossways Care Nursing Home 22/08/05

Crossways Care Nursing Home 26/10/04

Crossways Care Nursing Home 04/05/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Crossways Care Nursing Home Crossways 17 Overton Road Sutton Surrey SM2 6RH Lead Inspector Deborah Yapicioz Key Unannounced Inspection 08:20 9th November 2006 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.V314338.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 Care Nursing Home DS0000036868.V314338.R01.S.doc Version 5.2 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.V314338.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Intermediate care may be provided for up to five service users. Date of last inspection 4th November 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.V314338.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place on the morning of 9th November 2006. The home was inspected under the National Minimum Standards Care Homes for Older People. The homes manager was away on the day of the inspection, which was undertaken, with the homeowner and the deputy manager. Both were knowledgeable and receptive to the process and they are thanked for their help. A tour of the premises was undertaken and several residents and members of staff were spoken with. A sample of care plans and the medication records were also viewed. Records relating to the health and safety of residents were assessed and recruitment practices and staff training were monitored. 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? The home has recently undergone a period of extensive refurbishment and rebuilding to add a new wing and improve the facilities on offer to the home. The home now provides 36 single bedrooms, 19 of the bedrooms have ensuite facilities. There are also three lounges and one dining room providing ample communal space. A second lift has been added to ensure accessibility As mentioned previously the home also has a separate intermediate care unit. The service users spoken to during the inspection were very happy with the recent changes and liked their bedrooms and ensuites. The inspector is Crossways Care Nursing Home DS0000036868.V314338.R01.S.doc Version 5.2 Page 6 confident that this area will exceed the standard once the homeowners have completed the planned redecoration of some areas. The home is in the process of introducing a new system for the service users care plans. Each floor has a locked “colour coded” cabinet, which hold the service users files. 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.V314338.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 Care Nursing Home DS0000036868.V314338.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3,6 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. 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. A needs assessment is always completed to ensure that service users needs can be met at the home. EVIDENCE: Crossways has a comprehensive statement of purpose and a separate service user guide in place, which contained all the information required under the Care Standards Act. The homeowner confirmed that both documents have recently been rewritten to reflect the recent environmental improvements increase in facilities A copy of the homes most recent inspection report was available in the home on request. A needs assessment is requested from the referring care manager and the home management team also completes the in-house assessment to ensure that the home is suitable and the service users needs can be met. Crossways Care Nursing Home DS0000036868.V314338.R01.S.doc Version 5.2 Page 9 The service users files looked at during the inspection all contained assessments completed before the service users moved into the home. The deputy manager confirmed that any cultural or religious needs are identified at the referral stage and the way the home can meet those needs are built into the care plan. Records seen indicated that residents are invited to view the home and to stay for a trial period before a final decision is made for the placement to be long term. Most residents have involved relatives who also participate in this process. A family member of a service user recently admitted to the home said that they had been very happy with the information provided by the home and felt that the introduction process had gone well. Each of the service users has a personal contract, specifying the terms and conditions of their occupancy that included periods of notice, fees charged, and the cost of ‘extras’ not covered by the basic cost of the placement. The home has recently increased their intermediate care beds as part of their refurbishment and have now got a dedicated intermediate care unit of six beds. The unit has recently been registered with the Commission for Social Care Inspection and consists of six ensuite bedrooms as well as a kitchen/diner and seating area. The unit was not inspected as it is not yet operational and there were no service users in residence. Crossways Care Nursing Home DS0000036868.V314338.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users have individual care plans, which include consultation with service users. Care plans are regularly updated to ensure the service users changing needs are met. Residents’ medication is well managed to ensure good health. EVIDENCE: During the inspection staff were observed to be treating service users in a pleasant, friendly manner. Service users spoken to during the inspection felt that the staff team are nice to them and treated them well. The homes induction process covers treating the service users with dignity and respect and protecting their right to privacy. Details of advocacy services for older people where on display in the home. The home has a system in place for updating care plans. The service user plans carry on from the original plan drawn up by the care manager and other involved professionals. The plans include risk assessments and any medical appointments or visits from other professionals. Details of any cultural or religious beliefs are also included in the plans. A sample of plans was inspected. These indicated that residents’ individual needs were identified, action was taken to meet these and they were reviewed regularly. The staff team at the home make a daily record of significant events Crossways Care Nursing Home DS0000036868.V314338.R01.S.doc Version 5.2 Page 11 and activities for each service users. The home is in the process of introducing a new system for the service users care plans. Each floor has a locked “colour coded” cabinet, which hold the service users files. The home operates a risk management strategy. Service users at the home have individual risk assessments depending on their needs. The service users are all registered with a local General Practitioner The service users preferred term of address is recorded on their file and used by the staff team. The home has a policy on the receipt, recording, storage, handling, administration and disposal of medication. The home manager confirmed that all staff that administered medication has attended an accredited medication course. The records showed that all medication administered had been correctly recorded on Medicine Administration Record Sheets. 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. Crossways Care Nursing Home DS0000036868.V314338.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users at the home are offered the opportunity to engage in various activities that satisfy their social, cultural, religious and recreational interests and needs. 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 and clearly based on the service users food and drink preferences, providing them with daily variation and healthy eating options. EVIDENCE: The home has a basic activity programme in place although the homeowner informed the inspector that this is an area that she hopes to increase and improve upon in the future, now that the building works has been completed and the number of service users is increasing. The activities currently in place include an “exercise lady”. One service users was approaching her onehundredth birthday on the day of the inspection and informed the inspector that she was having a tea party to celebrate. She had invited some friends to the celebration and the home was organising a cake and food. The homeowner confirmed that all service users have the choice of a birthday celebration. Crossways Care Nursing Home DS0000036868.V314338.R01.S.doc Version 5.2 Page 13 Visitors can be seen in any part of the home including bedrooms. Personal items including furniture can be brought into the home if service users wish (if it is appropriate). This is recorded on the service users property file. Service users spoken to during the inspection had personalised their rooms and said that it had helped then settle in and feel more at home. 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. Having examined a random sample of menus, it was clear that a wide variety of well-balanced, nutritional food was available. The service users can also have seasonal choices such as salads. 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.V314338.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 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 has 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 in place procedures for responding to suspicion or evidence of abuse, including whistle blowing, and passing on concerns to the Commission for Social Care Inspection The London Borough of Sutton’s adult protection procedures were available in the office on request. The manager assured the inspector that any allegations or incidents of abuse would be reported to the appropriate authorities, including the Commission, and appropriate records maintained, including any action taken. The home provides staff training on issues of elder abuse. Crossways Care Nursing Home DS0000036868.V314338.R01.S.doc Version 5.2 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): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 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. The home has recently undergone a period of extensive refurbishment and rebuilding to add a new wing and improve the facilities on offer to the home. The home now provides 36 single bedrooms, 19 of the bedrooms have ensuite facilities. There are also three lounges and one dining room providing ample communal space. A second lift has been added to ensure accessibility As mentioned previously the home also has a separate intermediate care unit. The service users spoken to during the inspection were very happy with the recent changes and liked their bedrooms and ensites. Crossways Care Nursing Home DS0000036868.V314338.R01.S.doc Version 5.2 Page 16 The home has been judged as “Good” in this outcome area. The inspector is confident that this area will exceed the standard once the homeowners have completed the planned redecoration of some areas. Crossways Care Nursing Home DS0000036868.V314338.R01.S.doc Version 5.2 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): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 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 staff team receive an induction when they begin at the home relevant to the post that they are holding and a record is kept on the staff file. The homes duty roster demonstrated that staffing levels were maintained appropriately and included a sufficient skill mix of qualified nurses and care workers to meet the needs of elderly service users. Staff files hold copies of the staff contracts, copies of passports/birth certificates, and copies of Criminal Records Checks, however two staff files did not contain two references. The home manager must ensure that in future two references are held on staff files. The job descriptions for staff at the home staff clearly states what is expected of its employees in terms of their roles and responsibilities and the values that should underpin their conduct. Staff spoken to during the inspection demonstrated a sound knowledge of the care needs of older service users Evidence of training is kept on staff files. The home has held some staff meetings although records held at the home demonstrate that they are not happening as regularly as recommended by the national minimum standards. The staff members spoken to during the inspection made positive comments on their experience of working at the home. Crossways Care Nursing Home DS0000036868.V314338.R01.S.doc Version 5.2 Page 18 The service users spoken to during the inspection said that the staff team treated them well. Observations of the contact between the staff team and service users confirmed this. Crossways Care Nursing Home DS0000036868.V314338.R01.S.doc Version 5.2 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): 31,33,35,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management style appears to be transparent with clear lines of accountability. In the main health and safety arrangements are adequate to ensure potential risks to service users health and safety are so far as reasonably possible identified and minimised. EVIDENCE: Crossways Care Nursing Home DS0000036868.V314338.R01.S.doc Version 5.2 Page 20 Alison Churchill is registered with the Commission for Social Care Inspection as the home manager of Crossways. Ms Churchill has been in post three years and is a Registered General Nurse. She 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 homeowner informed the inspector that the management team are considering applying for an “Investors in People” award in the near future. The home has also applied to be involved with the “End of Life Initiative” Members of the staff team spoken to during the inspection felt supported by the home manager and were happy with the 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. 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 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. A fire risk assessment has been completed for the home. Crossways Care Nursing Home DS0000036868.V314338.R01.S.doc Version 5.2 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 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 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 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Crossways Care Nursing Home DS0000036868.V314338.R01.S.doc Version 5.2 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 OP36 Regulation 18(1) Requirement The home manager must ensure that all members of the staff team receive regular supervisions. The home manager must ensure that in future two references are held on staff files. The home manager must ensure that staff meetings are held at regular intervals (at least six per year) Timescale for action 31/03/07 2 OP29 19.-(4)( b) 21.-(1)(2) 31/03/07 3 OP29 31/03/07 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 It is recommended that the home manager reviews the activity programme at the home Crossways Care Nursing Home DS0000036868.V314338.R01.S.doc Version 5.2 Page 23 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.V314338.R01.S.doc Version 5.2 Page 24 - 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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