CARE HOME ADULTS 18-65
Crossways Community Crossways Community 8 Culverden Park Road Tunbridge Wells Kent TN4 9QX Lead Inspector
Maria Tucker Announced Inspection 30th January 2006 09:30 Crossways Community DS0000023917.V270183.R01.S.doc Version 5.0 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 Community DS0000023917.V270183.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 Adults 18-65. 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 Community DS0000023917.V270183.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Crossways Community Address Crossways Community 8 Culverden Park Road Tunbridge Wells Kent TN4 9QX 01892 529321 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) jooley.taylor@crosswayscommunity.org.uk Crossways Community Mr Martin Granger Care Home 16 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (16) of places Crossways Community DS0000023917.V270183.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 11th May 2005 Brief Description of the Service: Crossways Community provides care, support and accommodation for 16 adults aged between 18-65 who have or are recovering from a mental health problem. Crossways was first registered on 12th February 1971. It consists of a detached property and gardens with car parking facilities to the side of the building. The home is located in a residential area of Tunbridge Wells, close to shops and public transport with other usual town amenities being a few minutes walk away. Accommodation is over three-storeys. There is no shaft lift. The home has sixteen single rooms, all having en-suite or designated facilities and television points. Crossways senior staffing team comprises of the registered manager, two deputy managers and an administrator. The home employs staff, working a roster, which gives 24-hour cover. Service users and staff share the domestic duties as part of their programme towards more independent living. The staff who work at Crossways are Christians and their faith forms the basis of the philosophy of care offered within the home. Crossways Community DS0000023917.V270183.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was an Announced inspection conducted on 30th January 2006 from 09.15 am to 14.30 pm and 1st February from 10:20 am to 13:30pm. It was the second inspection for the year April 2005 to April 2006. Some judgements about quality of life and choices were taken from direct conversation with residents individually and collectively, as well as direct observation followed by discussion with staff. Information was gained through conducting a case tracking exercise. Discussions were held with the Manager and management team and staff. Residents were spoken with individually and collectively. A partial tour of the premises was undertaken. The pre inspection documentation was received by the CSCI. 21 comment cards were received, from service users, relatives, and health and social care professionals. Comments included: • “This is a well run home with high standards” • “When ever we visit the Crossways there is always a good atmosphere” • “Crossways has made a terrific help” • “Seems like a pleasant home” • “My is very happy at Crossway. I’m very pleased with progress” It is recommended that this report be read in conjunction with the last inspection report to enable the reader to gain a full picture of the home, as some of the standards that were inspected and met during the last inspection were not inspected during this inspection. What the service does well:
Crossways Community is a progressive service that is evolving and developing to meet the current and future needs of the residents. Future plans and changes are made following consideration of the service aims and objectives and based upon good practice. As expressed by the management this is to enable resident’s to ‘feel safe with the organisation”. The resident’s benefit from a clear management structure identifying staffs roll and responsibilities. This includes comprehensive systems in place for monitoring and reviewing the service from an organisational operational perspective. This is informed through seeking the views of the residents and other interested parties or representatives. Crossways Community is supportive for those residents living at the home and the wider community of ex residents. Meeting its objective in the Christian values and community spirit. Crossways Community DS0000023917.V270183.R01.S.doc Version 5.0 Page 6 Residents receive an individual service aimed at supporting them to attain their full potential and/or maintain stability in where they are in life. The home provides a comfortable homely environment and has a calm welcoming atmosphere. The manager and staff at Crossways community are proactive in working with the CSCI in meeting the Care Standards Act 2000 Regulations and good practice recommendations. They are open to suggestions and welcome ideas on how they operate and how they may improve the service provided. What has improved since the last inspection? 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
Crossways Community DS0000023917.V270183.R01.S.doc Version 5.0 Page 7 contacting your local CSCI office. Crossways Community DS0000023917.V270183.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Crossways Community DS0000023917.V270183.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5 Residents have comprehensive information on which to base the decision to move into the home. They can feel confident that their needs will be fully assessed and met. EVIDENCE: An updated version of the Statement of Purpose and service users guide was inspected and found to be comprehensive detailed documents, which contained all items as required. The contracts for residents are ‘care licence agreements’ within the residents’ guide, introduction to Crossways. Perspective new residents visit the home and stay initially for 5 days then return to their normal residence, before the final decision is made that the home is right for them. This provides a ‘flavour’ of what it may be like to live at Crossways and gives other residents and staff an opportunity to welcome newcomers in. Residents are admitted following needs assessments from health and social care professionals. Information gathering by staff as part of the assessment process is made through meetings and discussions held with current carers. Crossways admit residents once they are confident that they can meet their needs. Negotiations on care needs and extra support required are made on an individual basis if required. Crossways Community DS0000023917.V270183.R01.S.doc Version 5.0 Page 10 It was discussed that it would be of benefit to review the current procedure for obtaining information relating to any cultural or religious wishes. Crossways Community DS0000023917.V270183.R01.S.doc Version 5.0 Page 11 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): All of these standards were met during the last inspection. Residents can continue to feel confident that their personal goals and aspirations will be developed and supported with them from comprehensive care planning systems. EVIDENCE: All of these standards were inspected and met during the last inspection. From discussions and some document reading at this inspection Crossways continue to meet these standards. Crossways Community DS0000023917.V270183.R01.S.doc Version 5.0 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 13, 14, 15, 16, 17 standard 12 was met during the last inspection. Residents are supported and offered opportunities to have a good quality of life and lifestyle choices. EVIDENCE: The menu offers a range of variety and choice. Residents have their main meal in the evening. Residents expressed that the food was generally good. They had choice and were offered seconds. The inspector shared a lunchtime buffet meal with residents and staff. It was a pleasant relaxed shared experience that provided an opportunity for casual discussions and quiet moments. Crossways support residents with their independence and daily life skills through individual support and training. Designated life skills staff work alongside residents, key workers and staff in encouraging and developing skills at a pace that considers the overall aims as well as the daily functioning. The development of local services and community-based activities in line with normal living has led to more activities being undertaken outside of Crossways. In house activities are planned and enjoyed. Residents spoken with detailed
Crossways Community DS0000023917.V270183.R01.S.doc Version 5.0 Page 13 places that they visit with staff or independently and activities that they enjoyed together such as the mutual interest in sport. Visitors are made welcome and encouraged as part of the overall ethos of the home as a community. The visitors’ room currently available tends not to be used as residents’ preferences are to use the chapel room. It was discussed that a review could be made as to the use of the visitors’ room to maximise the space for residents and staff at the home. The current system for resident’s mail could be improved upon so that collection is not in an open area. Crossways Community DS0000023917.V270183.R01.S.doc Version 5.0 Page 14 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Resident’s medication support and needs are supported thorough robust policies and procedures. EVIDENCE: There is a designated member of staff who takes responsibility for medication. Each shift has an identified staff member who holds the key and dispenses. There are good systems in place for the overall management of medication. The practice of re potting one medication continues. The pharmacy inspector from the CSCI has visited and discussed this practice. It is recognised that this situation is out of the control of the home to change. Although it is not ideal measures have been put in place to ensure that this is as safe as it can possibly be. The risk posed to residents of changing this practice in this situation is considered to outweigh the risk of re potting. Residents are supported individually with medication. One resident spoke of how the combination of medication and spiritual well-being was part of their healing process. Crossways Community DS0000023917.V270183.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Residents can feel secure that the home will be proactive in ensuring their safety. EVIDENCE: The pre inspection document received lists 1 complaint made that was responded to within 28 days and substantiated. The complaints form was completed corresponding to the complaints policy and procedure. Crossways are pro active in seeking the views of the residents’ and appropriate others. They strive to take action before complaints arise. It was discussed that some issues which may be considered as a possible complaint are made as suggestions, as this is the preferred informal open way the residents feel comfortable with. During the inspection no complaints were made or did any resident raise any concerns. The staff receive adult protection training. There are policies and procedures in place to promote and protect residents. No adult protection alerts have been raised. Crossways Community DS0000023917.V270183.R01.S.doc Version 5.0 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 30 Standards 27, 28 exceeded during the last inspection Residents live in a comfortable homely environment where improvements continue to be made to ensure that the home is safe and well maintained. EVIDENCE: Ongoing improvements have been made to ensure that the residents have a comfortable well-maintained environment. These include fitting of showers and bathroom fittings; redecorating areas and replacement of a washing machine & dryer. Residents spoken with expressed that the home was very clean and this was a good thing. Overall the premises were comfortable, bright and airy with good quality furniture, fixtures and fittings. A resident kindly invited the inspector to view their room. It was very individual, comfortable and homely. It was noted that the downstairs disabled toilet did not have an indicator. Crossways Community DS0000023917.V270183.R01.S.doc Version 5.0 Page 17 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 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, 32, 33, 34, 35, 36, 37 Resident’s benefit from a well-supported staff team, who work closely together in ensuring that the residents needs, and aims of the service, are met. EVIDENCE: Staff have designated roles and responsibilities in accordance to their position. There is a cross over of tasks as staff support each other in absences or when things arise that it is appropriate to do so. Staff were seen to interact well with each other and had a mutual respect and understanding of their duties and tasks. There is a very low staff turnover with most staff having worked at Crossways for a considerable period of time. The staff rota listed staff with their designated responsibilities during the shift. Volunteers complement the staff team. Regular training is undertaken with records kept of out of house and in house training. There is a high level of commitment towards supporting staff with specialist training this is identified through supervision and appraisals. Future planning for training is made. Over 50 of staff have attained the NVQ level 2 or above. Six staff have successfully completed the NVQ level 3 award. A selection of staff and volunteers files were inspected and contained all items required evidencing the homes robust policy and procedures for staff recruitment.
Crossways Community DS0000023917.V270183.R01.S.doc Version 5.0 Page 18 Staff spoken with commented that Crossways is “Very supportive, staff support each other’ and there is ‘a genuine concern for each other’. Staff confirmed that regular supervision takes place. Supervision notes were seen (not read) in staff files. Specialist support for staff includes visiting professions for training techniques, guidance and specific support for staff in meeting the residents needs. Crossways Community DS0000023917.V270183.R01.S.doc Version 5.0 Page 19 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39, 40, 42, 43 standards 37, 38, 41 were met during the last inspection. Residents can feel confident that the home is managed and run in their best interest and that systems are in place to ensure that they are regularly consulted. EVIDENCE: The pre inspection documentation lists maintenance and associated records. These were spot checked during the inspection. A fire alarm test was made during the second visit. Residents spoken with were asked if they had any thoughts on how the service could be improved. Without exception those asked could not think of anything. Policies and procedures are reviewed at least annually or when applicable. The policies viewed were very precise and comprehensive. The manger has successfully completed the BTEC professional development certificate management studies. Crossways Community DS0000023917.V270183.R01.S.doc Version 5.0 Page 20 Regular meetings are held to seek the views of the residents. Residents and stakeholder surveys are conducted as part of the homes quality assurance procedure. The PQASSO quality assurance system is in place. Regular Regulation 26 visits take place with reports sent to the CSCS. A valid insurance certificate was on display. Crossways Community DS0000023917.V270183.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 4 3 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X X X X X Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 X X X X 3 LIFESTYLES Standard No Score 11 3 12 X 13 4 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score 3 3 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Crossways Community Score X X 3 X Standard No 37 38 39 40 41 42 43 Score X X 3 3 X 3 3 DS0000023917.V270183.R01.S.doc Version 5.0 Page 22 No Are there any outstanding requirements from the last inspection? 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 2 3 Refer to Standard YA3 YA16 YA27 Good Practice Recommendations It is recommended that the current procedure for obtaining information for cultural and religious wishes be reviewed. It is recommended that the current system of mail collection for residents be reviewed. It is recommended that an indicator be fitted to the downstairs toilet. Crossways Community DS0000023917.V270183.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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