Inspection on 23/09/08 for Crossways Nursing Home

This inspection was carried out on 23rd September 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Crossways Nursing Home 26/09/07

Crossways Nursing Home 24/05/07

Crossways Nursing Home 19/09/06

Similar services:

St Vincents

The Cotswold Home

Winton House

Newbeech House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Crossways Nursing Home Greywell Road Up Nately Basingstoke Hampshire RG27 9PJ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Christine Bowman     Date: 2 3 0 9 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 40 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 40 Information about the care home Name of care home: Address: Crossways Nursing Home Greywell Road Up Nately Basingstoke Hampshire RG27 9PJ 01256763405 01256763405 Crosswaysnh@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) S.E.S Care Homes Ltd Type of registration: Number of places registered: care home 18 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home The home is situated in a quiet village near to Basingstoke and provides accommodation, and personal and nursing care, for up to eighteen persons aged 65 and over. The home, which is arranged on two levels, can accommodate persons suffering from dementia type illnesses. Communal space includes a pleasant lounge and dining room for the use of the residents and the home is set in a large garden with an orchard. There are ten single and four shared bedrooms and the majority have en suite facilities. Fees for residency at the home range from £460 to £700 per week. Items not included in the fee include chiropody, hairdressing and newspapers. 0 0 Over 65 18 18 Care Homes for Older People Page 4 of 40 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection report includes information gathered about the service since the previous site visit in September 2007 under the Commissions Inspecting for Better Lives (ILB) process. The appointed manager completed an Annual Quality Assurance Assessment (AQAA) giving some up-to-date factual evidence about the running of the home and informing us of what they think they are doing well, how they have improved the service and of their plans for further improvements. Residents completed six service user surveys, with support from relatives, giving their views on the running of the home. Six staff surveys were also returned, giving their views on the care and support given to the residents, how they are supported by the management to meet the residents needs and on the running of the home. An unannounced site visit was conducted on 23rd September 2008, to assess the outcomes of the key inspection Care Homes for Older People Page 5 of 40 standards for older people with respect to the residents living at the home. The appointed manager was interviewed and provided support for the inspection process by making residents and staff files and other documents available to be sampled. A partial tour of the premises was undertaken and some of the residents’ bedrooms and communal areas were viewed. A number of staff and residents were spoken with throughout the day and observations were made of the residents and of staff as they carried out their duties. Residents’ and staff records, maintenance certificates and complaints and compliments records were sampled and the Statement of Purpose, the Service User Guide and policies and procedures were viewed. What the care home does well: What has improved since the last inspection? Care plans were in place for the residents, whose files were sampled. The care plans reflected their needs and recorded the support, which was to be given by the staff, so that the right support could be given. Fluid and nutritional charts had been completed to ensure people were receiving adequate intake of fluids and food and these were documented in the residents charts. A strategy was in place to ensure that a prompt response would be made should food intake be poor or hydration low to ensure the residents would not be put at risk of dehydration or malnutrition. The moving and handling guidelines in the residents care plans sampled, recorded the equipment needed to support the residents mobility needs so the carers would know how to support them safely. The medication administration records sampled had been completed accurately and the medication was kept in the original containers to reduce the risk of errors. A programme of activities was provided and a record of participation recorded in the residents care plans. The cook confirmed that the fresh fruit and vegetables were included in the foodstuffs purchased and that a local supermarket provided much of the provisions because they Care Homes for Older People Page 7 of 40 deliver the food to the home. The cook stated that she was not restricted to buying the supermarkets own value goods. The heating of the home at the time of the site visit reflected the weather and the two bedrooms situated near the original front door were monitored. A thermometer was placed in the area, readings taken regularly and the heating adjusted to ensure a comfortable temperature for the residents. Damaged flooring in the dining room had been replaced to make it safe and hygienic for people who use the service, some new furniture had been purchased and some of the bedrooms had been fitted with new flooring to enhance the environment for the comfort and enjoyment of the residents. Although the kitchen, which had been condemned as unsafe by Environmental Health in July, had not been replaced at the time of the site visit, a replacement kitchen had been ordered and was due to be fitted in October, to ensure the kitchen equipment and facilities used for the preparation of food would soon be safe. A quality assurance programme, that ensures the residents and their representatives can contribute to the running of the service, had been introduced. Records of staff supervision were sampled, which confirmed that the staff were receiving supervision and appraisal of their skills and competency to ensure that they are able to meet the needs of people who use the service. What they could do better: The Statement of Purpose/Service User Guide should include more information to inform residents and their representatives of how to make a formal complaint and when they can expect a response; how to contact the Commission for Social Care Inspection (CSCI) should they wish to do so and details of the Responsible Individual. A simplified version of the care plan with respect to supporting bedfast residents with their moving and handling and feeding needs should be readily available in their bedroom for new staff to follow including diagrams or photographs to show correct positioning and to enable staff with a limited knowledge of the English language to provide care appropriately. Suitable arrangements should be in place to ensure residents privacy and dignity is respected. When residents share rooms it is essential that sufficient screens be provided to ensure their privacy and dignity and a private space should be available for meeting with visitors and healthcare professionals to enable confidential conversations to take place. Residents should never be given clothes which are not their own to wear because this does not preserve their dignity. Safe access to the garden must be provided to enable residents to enjoy this facility for fresh air, excercise and the enjoyment of being in the garden. Suitable storage facilities must be provided for the residents. Having old and broken furniture in bedrooms is not good for the self-esteem of the residents. Good quality, suitable domestic furnishings should be available to the residents in their bedrooms for Care Homes for Older People Page 8 of 40 their convenience and enjoyment. Domestic and administrative staff must be employed in sufficient numbers so that nurses and carers may concentrate on ensuring the health and personal care needs of the residents are met and not be involved in administrative issues, supporting with the preparation of food and in maintaining the general cleanliness of the home in addition to their own duties. When employing workers from abroad, whose first language is not English, the registered person must ensure that their understanding of, and ability to communicate in the English language is sufficient to enable them to read, understand and follow the residents care plans and to give and receive information with respect to the residents to ensure they receive their care, appropriately and safely. The provider must take responsibility to ensure that the bank of Registered nurses, who work at the home, receive clinical training in accordance with their training and developmental needs and with respect to the assessed needs of the residents, and not assume that this is provided by other organisations. When the manager carries out in-house training, she should be suitably trained to do so to ensure the staff learn appropriate methods of moving and handling, food hygiene, infection control, safeguarding adults, fire safety, health and safety for the safety and protection of the residents. The Responsible Individual, as representative of the provider company and the only person registered on behalf of the home, must ensure he carries on the care home with sufficient care, competence and skill with respect to the needs of the residents, and from time to time undertake such training as is appropriate to ensure he has the experience and skills necessary for carrying on the care home. All the information required in the AQAA to describe how the care home provides good quality services for the residents and the manner in which such services are provided, should be completed to clarify the situation and enable accurate judgements about the home to be made. All parts of the home the residents have access to should be as far as reasonably practical free from hazards to their safety, and unnecessary risks should be identified and as far as possible eliminated, to ensure a safe environment for the residents. Advice should be sought from the Health and Safety Executive with respect to the illfitting French windows in the lounge and dining room, means of access to the garden for people with mobility needs and the security of the external door access with respect to residents with dementia. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Older People Page 9 of 40 The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 40 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 40 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is available to prospective clients to help them to make a decision about the suitability of the home to meet their needs and expectations, but this does not cover all the information the home is legally required to make available. Prospective residents individual needs are assessed prior to the offer of a placement to enable the home to put measures in place to meet them. The home does not provide intermediate care, so Standard 6 does not apply. Evidence: Since the previous site visit, the appointed manager had compiled a combined Service User Guide and Statement of Purpose to inform prospective new residents about the home and to help them to decide if the home was right for them. The six residents who completed surveys, with support from relatives, thought they had sufficient information to help them to decide about staying at the home. One resident commented, we viewed before deciding it was the right home, and we received Care Homes for Older People Page 12 of 40 Evidence: enough information and all our questions were answered satisfactorily. Important information, however, was missing from these documents including details of the Responsible Individual and their qualifications and experience, a full complaints procedure with timescales informing the residents and their representatives how to make a formal complaint and to whom it should be made, and the contact details of the Commission for Social Care Inspection. A reference was made in the Service User Guide that the principles of equality and diversity followed by the home prevent discrimination on the grounds of sex, race, and age etc. Completed pre-admission assessments of residents who had been admitted since the previous site visit, showed that physical, sensory, dependency, mobility, nuitrition and personal care needs had been looked at in detail and risk assessed. The manager wrote in the AQAA that, these more detailed assessment forms had been introduced recently, allowing the home to have a clear picture of the prospective residents needs before admission. Other improvements made over the previous twelve months and recorded in the AQAA were that communication with the local authority had improved allowing care management assessments to be received by the home and that a named nurse and named carer system had been implemented to give residents continuity of support. Care Homes for Older People Page 13 of 40 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents’ health and personal care needs are planned and mostly carried out appropriately, and medication is handled safely. Residents’ right to be treated with respect and have their privacy upheld is generally promoted but improvements could be made. Evidence: Care plans were in place for the residents, whose files were sampled. The care plans reflected their needs and recorded the support, which was to be given by the staff, so that the right support could be given. Fluid and nutritional charts had been completed to ensure people were receiving adequate intake of fluids and food and these were documented in the residents charts. A strategy was in place to ensure that a prompt response would be made should food intake be poor or hydration low to ensure the residents would not be put at risk of dehydration or malnutrition. A resident, who had been losing weight had been referred to the General Practitioner, and a dietician had been involved in assessing their dietary needs. The manager wrote in the AQAA that, service users and relatives are fully involved in the care planning process, allowing a Care Homes for Older People Page 14 of 40 Evidence: person-centred care plan to be developed. A visiting relative confirmed this and their description of the individual requirements of their relative was clearly recorded in the care plan. This relative did, however, state that they had, observed newly appointed staff not following the care plan and that this information should be available in the residents bedrooms perhaps with diagrams of the correct feeding position and moving and handling instructions, especially as some of the new staff did not speak good English, and some of the residents also could not communicate their needs. The moving and handling guidelines in the residents care plans sampled, recorded the equipment needed to support the residents mobility needs so the carers would know how to support them safely. The medication administration records sampled had been completed accurately and the medication was kept in the original containers to reduce the risk of errors. One resident, whose records were sampled, had consistently refused the oral pain relief prescribed for them, so a referral had been made to the General Practitioner, who had sent the resident for a hospital assessment where external patches had been prescribed. The manager confirmed that a pharmacist had been consulted with respect to the medication policy and that only trained nurses, who had received external training, administered medication. Medication was appropriately stored including controlled drugs, which were stored in a metal cabinet secured to the wall to prevent misappropriation and recorded in a controlled drugs register, which accurately recorded all controlled drugs currently stored in the home. Mental Capacity Act assessments confirmed that residents, whose records were sampled, did not have the capacity for safe self-medication. Observations of the interactions between the staff and the residents throughout the site visit, showed respect and promoted the privacy and dignity of the residents. The staff knocked on the residents’ bedroom doors and screens were provided in shared bedrooms sampled, to allow some privacy for medical examinations and the carrying out of personal care tasks. The training and development files of two staff enployed since the previous site visit recorded that the Skills for Care Common Induction Standards had been completed, providing new staff with an introduction to the caring role, which promotes the residents rights to be treated as an individual and to have their equality and diversity needs respected. However a staff member stated, there are not enough screens to use in all the double bedrooms to ensure the residents privacy and dignity is respected, and no private space was available to ensure that those residents occupying shared bedrooms could entertain guests or health care professionals and be assured of confidentiality. Staff also recorded in comment cards that, there are no staff have direct responsibility for the laundry, which results in residents not always wearing their own clothes. Care Homes for Older People Page 15 of 40 Care Homes for Older People Page 16 of 40 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements had been made with respect to the opportunities for social and recreational activities offered to the residents to provide them with stimulating and meaningful engagement. Contact with relatives and representatives was promoted and community access had improved. A balanced diet was offered, but a suitably trained cook and sufficient dining-room space for all the residents would improve the dining experience for the residents. Evidence: The activities co-ordinator was observed working with a group of residents in the sitting room during the site visit and tea and biscuits were being served for elevenses. Crossways Newsletter and Activity Programme, produced by the activities co-ordinator, was very nicely set out with a picture of September asters on the front and included the activity programme for the month. Each day had an illustration of the activities available in the morning and afternoon and a cheerful and encouraging description inviting the residents to join in. Activities advertised included reminiscence board game, painting and drawing, getting out in the bus for a bit of fresh air and a change of scenery, skittles - exercise and a little healthy competition, gentle exercise to music - stretch and listen, relaxing in the lounge with the oil burner going and getting Care Homes for Older People Page 17 of 40 Evidence: creative, general knowledge quiz, bingo with big playing cards, pamper time for feet either in the lounge or in your own personal rooms to make you feel relaxed and fresh, baking - making fairy cakes, knitting, puzzles, reading, word games in the lounge - flash cards and word search, one–to-one visit in own rooms for a chat and a look at the newspaper - to have a cuppa and put the world to rights and do your nails if you fancy. The newsletter also included introduction news from the activities coordinator, as she had recently been taking a summer holiday with her children and home news of any changes at the home such as, staff members moving to pastures new was included to inform the residents. Since the previous site visit, the activities organiser had arranged for the Hoppa bus to call at the home to take people out. Until recently, an individual record had been kept in each residents care plan of their daily participation in leisure and social activities, to show to what extent their individual wishes and aspirations had been met, but the manager stated that another recording tool had been introduced because of the time taken to complete this exercise. The new recording tool included the names of all the residents and required only a tick to confirm participation. On the day of the site visit the record showed that nine resident had enjoyed one to one time, one had received a foot soak and pamper, one had been given nail care, two beauty therapy, four enjoyed a quiz, seven had joined in a music and singing session and one was not very well. An interesting overview of all the residents involvement and one-to-one support could be obtained from this method of gathering information, but it is not appropriate to include information concerning other residents in individual files as residents, their relatives and representative may view them. The original method of recording individuals daily participation should be reinstated to protect residents privacy. Of the six residents who completed surveys with support from their relatives, one thought activities were always arranged, three that they usually were and two that they sometimes were. One relative commented, if mum wishes to take part, activities are available. Throughout the day, a number of visitors called to see their relatives and those spoken with expressed satisfaction with the service. The AQAA recorded that, the hairdresser visits weekly, the chiropodist six-weekly and local ministers of different religious denominations visit regularly. The manager also stated that she would like to increase trips out for residents and to support those wishing to attend church in the community. The four-weekly menu appeared to be balanced and nutritious. Breakfast included orange juice and prunes; lunch consisted of a main course and an alternative choice with seasonable vegetables and variety of puddings and fresh fruit. Tea was varied and included such items as scrambled egg, fish fingers and tomatoes, ham and pickle, jacket potatoes with various fillings, sausages and spaghetti hoops, quiche and salad and cauliflower cheese. Supper included cheese or pate and crackers, scones, oatcakes Care Homes for Older People Page 18 of 40 Evidence: and sausage rolls. Hot and cold drinks were offered throughout the day. Sandwiches were included only for tea at the weekends, following a substantial roast, casserole, braised steak or steak and kidney pie for lunch. The cook confirmed that fresh fruit and vegetables were included in the foodstuffs purchased and that a local supermarket provided much of the provisions because they deliver the food to the home. The cook stated that she was not restricted to buying the supermarkets own value goods. Lunch was observed on the day of the site visit and much positive engagement between staff and residents took place. Some residents required active feeding or supervision and the staff supported them with patience and kindness, allowing residents to take their time and enjoy their food. Unfortunately the sausage casserole was over-cooked when presented to the residents and did not look appetising. Records showed that much effort had been exerted and training offered to improve the quality and presentation of the meals. Three of the residents, who returned surveys, recorded that they always liked the meals and two that they usually did. Improvements had been made to the décor of the dining room in that new tables and chairs had been purchased and the carpet had been renewed, however, there were not sufficient spaces around the tables should all the residents wish to eat there at the same time. One staff member commented under what they thought the service does well, the dining room has been refurbished and patients are encouraged to eat together in pleasant surroundings. Menus have been improved greatly, as has meal choice for patients. Care Homes for Older People Page 19 of 40 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are satisfied that their concerns and complaints will be listened to and acted upon and the homes practise was satisfactory, but more details are needed in the complaints procedure to ensure that stakeholders have sufficient information about the process and the staff do not feel that their concerns are taken seriously. Systems are in place to protect the residents from the possibility of abuse, neglect and self-harm, but the staff highlighted shortfalls in the moving and handling training, which could be potentially harmful to residents. Evidence: As previously mentioned, under the Choice of Home section of the report, the complaints procedure does not inform residents and their representatives of, to whom a complaint may be addressed and the contact details of those responsible for carrying out the investigation, when they can expect to receive an official response to their complaint or how to contact the Commission for Social Care Inspection (CSCI), should they wish to do so. The AQAA recorded that ten complaints had been received by the home since the previous site visit, that they had all been resolved within twenty-eight days and that none of them had been upheld. The record of complaints and compliments received by the home was sampled, showing that a full and detailed written response had been made to complaints received, within an acceptable timescale. The CSCI had received two complaints on behalf of this home with respect Care Homes for Older People Page 20 of 40 Evidence: to the lack of moving and handling equipment and training, and staff ratios to residents with respect to the ability to provide sufficient support for feeding, mobilising and incontinence. One of these complaints had been sent to the provider to investigate, concerns had been addressed appropriately and a response provided. Four of the six residents who completed surveys with support from their relatives recorded that they always know who to speak to if they are not happy and two that they usually did. 100 knew how to make a complaint and one commented, if we have needed to speak to someone, we have always had satisfactory answers. The manager wrote in the AQAA, the home has an open door policy, which promotes working in an inclusive way, allowing all stakeholders to air their concerns, however small, and know that someone will listen and that action will be taken. Staff surveys confirmed that the staff knew what to do if a resident or their representative had concerns about the home, but commented, staff have concerns about this home, but nothing is being done. The home held a copy of the local authority Safeguarding Adults policy and procedure to inform the staff of the referral process should they need to use it and the staff training matrix confirmed that the Protection of Vulnerable Adults training had been accessed by all the staff within the previous twelve months to keep them up-to-date. The manager stated that, having recently attended the Mental Capacity Act Training provided by the local authority, she would now book a place on the train the trainer Safeguarding Adults training to enable her to pass the information on to the staff team. She was also in the process of updating all the homes policies and procedures, including a local version of the local authority Safeguarding Adults policy and procedure and the whistle blowing policy. The AQAA confirmed that there had been no safeguarding referrals over the previous twelve months. Staff personel files sampled confirmed that enhanced Criminal Record Bureau checks had been carrried out prior to employment to safeguard the residents and the staff training matrix indicated that mandatory training was up-to-date. However, observations and comments made by staff, indicated that new staff may not be sufficiently well prepared with respect to the moving and handling of residents to ensure their safety. Care Homes for Older People Page 21 of 40 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some improvements have been made to enhance the environment for the comfort of the residents but much more investment is needed to bring the facilities up to an acceptable standard and to ensure sufficient specialist equipment and aids are available for all the residents. The home was clean and odour-free. Evidence: The home was located in a pleasant rural setting in a small Hampshire village. There were other large detached houses in the area. A drive led from the road to a car parking area at the rear of the building and a mature area of garden with trees and shrubs, extended to the side and front of the home. There was a friendly and welcoming ambiance to the entrance of the home and the managers office was situated close to the entrance. A partial tour of the premises was completed and the communal living areas were viewed. The lounge was situated at the end of the hall and some of the residents were enjoying a mid-morning hot drink and biscuits with the activities co-ordinator, who was cheerfully chatting to them. The lounge was pleasant enough, receiving plenty of light from the French windows looking out over the garden. However, the French windows, despite looking nice, were not secure and a more detailed account of the situation can be found under the management and administration section of the Care Homes for Older People Page 22 of 40 Evidence: report. Some of the easy chairs in the sitting room were new. Adjacent to the lounge was the dining room, which also had French windows over-looking the garden. This room had been re-furbished with good quality solid but domestic tables and chairs and the room had also been re-carpeted to make the flooring safe and hygienic for the residents. However, there were not sufficient spaces around the tables, should all the residents wish to eat in dining room or sufficient wheelchairs for the residents who might wish to use them and some of the wheelchairs were old and in need of replacement. Staff members commented in their surveys under what the service could do better, more equipment is needed for moving and handling, some wheelchairs do not have footplates or brakes, when requests have been made to fix curtain poles/curtains/replace light bulbs/buy brushes or necessary toiletries/give more blankets or pillows, these requests are hardly ever met for months, if ever, all patients should have their own reclining chairs in their bedrooms so they can choose to be in the lounge or alone as preferred, utilise the garden (service users dont go out there), more commodes are needed to promote continence, and it would be nice not to run out of sheets and towels and to have proper blankets on the beds. Some of the residents bedrooms were viewed. The two double bedrooms situated near the original front door were a comfortable temperature for the residents on this visit. A thermometer had been placed in the area and regular readings had been recorded to confirm this. The bedrooms were personalised with pictures, photographs and other personal items, but the furnishings, bedding and general décor was of poor quality. A door front was missing from one chest of drawers and wardrobe doors and drawer fronts were labelled with a list of contents (not with a colourful picture to aid the resident with dementia). Some of the bedrooms had been re-carpeted and some new wardrobes had been purchased to improve the accommodation for the residents. A staff member stated, there are not enough screens to use in all the double bedrooms to ensure the residents privacy and dignity is respected. There remains much work to be completed to bring all the accommodation up to a good standard, to provide sufficient sitting and dining space for all the residents, sufficient equipment for the assessed needs of the residents and to ensure that those residents occupying shared bedrooms have access to a private space in which to entertain guests or health care professionals and that bedrooms are provided with comfortable seating. There continued to be only one hoist of the type used by at least eight of the residents, another type of hoist was specifically for one resident and remained in their bedroom. The manager wrote in the AQAA that, plans are in place to provide an electric bath. Care Homes for Older People Page 23 of 40 Evidence: A new tumble dryer had been purchased to improve the laundry facilities and the bed linen continued to be sent to an external laundry. With no staff having a special responsibility for the laundry, staff commented that, there should be a housekeeper to make sure every resident is wearing their own clothes, rather than like now, all the clothes are mixed up because new staff either cannot read or do not know who the clothes belong to, and carers are spending a lot of time washing seventeen patients clothing. The staff training matrix confirmed that the majority of the staff had received infection control training and the home was clean and odour-free on the day of the site visit. A staff member commented that, the service provides a clean and homely environment, five residents who completed surveys thought the home was always fresh and clean, and one that it usually was. A relative commented, Yes, in particular mums bedroom always looks fresh and clean. Care Homes for Older People Page 24 of 40 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are mostly supported by sufficient staff, who have received adequate training, but some shortfalls in appropriate moving and handling training, the lack of domestic and administrative staff and communication barriers result in residents not receiving the full benefit of the specialist support staff. The homes recruitment processes protect the residents. Evidence: On the day of the site visit there was a registered nurse on duty in addition to the manager, an activities organiser, three carers and a cook. There were no other domestic or administrative staff and the cook was working her notice. The rota showed that the shifts were long, mostly 8.00am to 9.00 pm, and two of the carers on duty had been recently recruited from abroad. One of the carers spoken with could not understand when asked about the work they were carrying out and answered that they did not speak any English. The activities organiser was included in providing care over lunchtime when the residents needed help with eating. The manager stated that since the maintenance support worker had resigned, a self-employed maintenance worker was now completing 14 hours per week over the weekends and evenings, and that recruitment checks had been carried out to safeguard the residents. The manager explained the current situation with respect to staffing, which is described in more detail in the management section of the report. Care Homes for Older People Page 25 of 40 Evidence: Service user surveys confirmed 100 that the staff always listened and acted upon what the residents say and two of the four residents, who completed surveys with support from their relatives, recorded that the staff were always available when they needed them and the other four that they usually were. Of the six staff, who completed surveys, one thought there were always enough staff to meet the needs of the residents, three thought there sometimes were and two that there never were. Comments included, However, this is variable and has improved recently, but considering the client group, these inconsistencies should be rectified and maintained. One of the staff who thought there were never enough staff to meet the needs of the residents qualified this by adding, there are three carers and one registered nurse on the early shift, but two of the carers dont speak good English, which leads to communication problems. Time with each resident is very limited so we can only provide basic care –there is no time to sit and chat. Another carer explained, Over the last few months, most of our permanent carers have left, pay rises have not been honoured as promised, staff are working too many hours and Crossways is deliberately advertising work at a very low hourly rate and that is why no local people are applying. We have three carers from abroad, who cannot speak a word of English, and another recorded that, now that an inspection is due, more staff have been taken on. Staff ratios have been low because staff have been doing the laundry, cleaning and kitchen work as well as caring. The cleaner left some time ago and has not been replaced and the handyman has also left. The ratio of staff having gained National Vocational Qualifications (NVQ) at level 2 or 3 was difficult to assess because this information was not included in the AQAA and the four new carers from abroad had not been included in the staff training matrix. The staff training matrix recorded that three of the eight carers, which included the activities organiser, had achieved a National Vocational Qualification at level 2 or 3 and that one of the registered nurses had trained as an assessor. The manager stated that, the contract with the agency, which supplied the workers from abroad, included the provision of training in the English culture, the Skills for Care Common Induction Standards and National Vocational Qualifications. The manager had recorded in the Service User Guide that, the home operates on an average of 50 carers with NVQ 2 and that commencing employment, the carers are enrolled for NVQ. The manager stated that since most of the permanent staff had left the employment of Crossroads, recruitment had been difficult and two newly recruited staff had also moved on. To alleviate this problem, the provider had applied for a license to employ staff from abroad. Staff personnel files sampled confirmed that recruitment checks had been carried out prior to the offer of a post and full employment histories, with gaps explained and reasons for leaving had been completed, to ensure that only those Care Homes for Older People Page 26 of 40 Evidence: suitable to work with vulnerable people would be considered for employment to safeguard the residents. Police checks had also been carried out in the country of origin and translations had been provided of original references. Recruitment was in line with equal opportunities. 100 of the staff, who completed surveys, confirmed they had checks carried out before they started work such as Criminal Record Bureau checks and references. The manager also stated that English lessons were available for new staff, whose first language was not English, and that, new staff from abroad, always work alongside staff with a good knowledge of the English language. Two of the six staff, who completed surveys, wrote that their induction covered everything they needed to know to do the job when they started, very well. Three staff thought it mostly did, but one stated that they did not receive moving and handling training, and one recorded, not at all, but this staff member had worked at the home for many years. The personnel file of a staff member recruited since the previous site visit contained the Skills for Care Common Induction Standards signed of as completed, confirming a good introduction to the caring role. Five of the six staff, who completed surveys, confirmed they were given training which is relevant to their role and one that they were not. Again this was a staff member, who had been employed before the current owner bought the home in 2006. Staff personnel files sampled, contained certificates for mandatory training including fire training, food hygiene, the protection of vulnerable adults and infection control. Nurses training and development logs sampled included training in venepuncture (the taking of blood), tissue viability (the skins ability to renew itself and the care of pressure sores), Diabetes, moving and handling (NHS Trust), Basic Life Support and Anaphylaxis. The staff-training matrix confirmed that most of the staff were up-to-date with mandatory training, that they had received Dementia, and the Mental Capacity Act training, and that most of the nurses had received updated training in the administration of medication. The manager pointed out that information with respect training, provided free of charge by government, was displayed on the staff notice board and that she tried to ensure the staff were as well informed as possible about residents medical conditions. Three of the six staff, who completed surveys, thought they were given training which keeps them up-to-date with new ways of working and three thought they were not. One staff member stated that they also worked part-time for another employer, who provided most of their training needs, and they commented, but I still need update training and Crossways does not wish to spend any resources. The manager recorded in the AQAA in response to the barriers to improvement that staff training materials were not easily accessible and expensive, but that a set of DVDs had been purchased to meet mandatory training needs and government supported training had been Care Homes for Older People Page 27 of 40 Evidence: accessed through a local college. Care Homes for Older People Page 28 of 40 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Lack of consistent leadership and investment, prior to the appointment of the current manager had led to a deterioration in staff/management relationships and in the quality of the environment and care at the home. However, commitment from the provider and plans already in progress for improvement, mean that residents will be assured of better outcomes in the future. Evidence: The current appointed manager, who is a Registered General Nurse, had been in post since January 2008. The Statement of Purpose recorded that the manager had completed a National Vocational Qualification at level 4 in Care and the Registered Managers Award. She also held certificates in Palliative care, Dementia, Healthy Eating and Nutrition and stated that she undertakes regular mandatory training up-dates. She has had experience of hospital work specialising in general medicine and in the care of the elderly for past seven years. She has also had six years experience in management roles in small and large companies. No application has yet been made for Care Homes for Older People Page 29 of 40 Evidence: registration with the CSCI and the home has been without a registered manager since July 2007. The previous site visit in September 2007 had carried forward seven repeat requirements and left the home with an additional five new requirements. A number of areas highlighted previously had remained an issue, which reflected upon the effectiveness of the management of the home and the appointed manager had resigned. A response had been made to the improvement plan sent to the home with the final report, by another appointed manager, which showed how the home had already put measures in place or had plans to complete this within a specified timescale. The current appointed manager had drawn up a development plan with monthly reviews from January 2008, showing improvements made with respect to the delivery of the service and for improved outcomes for the residents. Safeguarding issues prior to the previous site visit had prevented the home from taking new clients and the home had been running with a full staffing complement and only eight residents for a period of time. Discontent amongst some of the original staff team with the new provider had left the new manager with a challenging situation, whilst attempting to instigate change in the culture of the home and investment from the provider, and make the necessary improvements to upgrade the home environment and the quality of the service. Currently, many of the original staff have taken other employment and the manager is in the process of building a new and cohesive staff team. The manager wrote in the AQAA, the rural location of the home with on public transport service and expensive local accommodation has made recruitment difficult, but salary increases have been instigated to attract staff with their own transport and some accommodation has been provided in a nearby town at a reasonable rental charge to reduce the impact of these barriers. A quality assurance programme had been introduced, which ensures the residents and their representatives can contribute to the running of the service. The AQAA, which had been completed by the appointed manager, was incomplete. A number of pages were missing including the staffing and management sections and the staffing information. Records of staff supervision were sampled, which confirmed that the staff were receiving supervision and appraisal of their skills and competency to enable them to meet the needs of people who use the service. The AQAA did not include the information with respect to the servicing or testing of Care Homes for Older People Page 30 of 40 Evidence: equipment or the most recent reviews of policies and procedures with respect to health and safety to confirm that these measures were in place to protect the residents and staff. However, maintenance certificates sampled for the fire alarm system, the hoists and for the servicing of the boiler, were dated within the previous twelve months and confirmed as in good working order. The staff training matrix included fire safety, food hygiene, infection control, first aid and moving and handling for the majority of the staff, but only a small minority had accessed health and safety training. The manager stated that most of the mandatory training was in-house and that she delivered it herself with videos and set questionnaires, but her own training and development file was not available to confirm training qualifications. Accidents had been recorded and forms stored appropriately. Environmental Health had condemned the kitchen on the grounds of safety, in their report of July 2008, and had required that it be refurbished or replaced to ensure the units were capable of being adequately cleaned and where necessary disinfected to ensure the safety of food preparation for the vulnerable residents. The manager confirmed that the new kitchen had been ordered and was due to be delivered early in October to ensure the kitchen equipment and facilities used for the preparation of food would soon be safer. Other safety issues with respect to the environment were observed including the ill-fitting French windows in the lounge and dining room, which had a tendency to fly open if the fire door bar was touched lightly, and the fact the glass was not shatter-proof. A staff member commented that the security doors had been insecure for years. Means of access to the garden for people with mobility needs and the security of the external door access with respect to residents with dementia, who may be inclined to wander, were also issues in need of consideration. Advice should be sought from the Health and Safety Executive with respect to these matters and thorough risk assessments, with actions to reduce risks completed. Since the previous site visit, door guards had been fitted to fire doors, which had been previously wedged open, to enable them to be left open safely. Care Homes for Older People Page 31 of 40 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 32 of 40 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 4 The Statement of Purpose and the Service User Guide must include all the information listed in Schedule 1. To ensure prospective residents are fully informed about the service prior to making a decision to live there. 20/11/2008 2 10 12 Suitable arrangements should be in place to ensure residents privacy and dignity is respected. When residents share rooms it is essential that sufficient screens be provided to ensure their privacy and dignity and a private space should be available for meeting with visitors and healthcare professionals to enable confidential conversations to take place. Residents should never be given clothes which are not 21/11/2008 Care Homes for Older People Page 33 of 40 their own to wear because this does not preserve their dignity. 3 16 22 The Statement of Purpose and the Service User Guide must include the full complaints procedure and contact details of the Commission for Social Care Inspection. To inform residents and their representative of how to make a formal complaint and to let them know when they can expect to receive a response. The contact details of the Commission for Social Care Inspection should be included to enable residents and their representatives to make contact should they wish to do so. 4 18 13 Initial training with respect to the safe moving and handling of residents must be sufficient to protect them from harm. Practical training in the use of hoists and safe moving and handling techniques from an acredited trainer would be sufficient to ensure satisfactory initial training and protect the residents from potential harm. 5 19 23 Safe access to the garden must be provided to enable residents to enjoy this facility. 21/12/2008 21/11/2008 20/11/2008 Care Homes for Older People Page 34 of 40 To enable residents to enjoy fresh air, excercise and the enjoyment of being in the garden. 6 20 23 Suitable storage facilities must be provided for the residents. Having old and broken furniture in bedrooms is not good for the self-esteem of the residents. Good quality, suitable domestic furnishings should be available to the residents in their bedrooms for their convenience and enjoyment. 7 22 23 Suitable adaptations and 21/12/2008 sufficient support equipment must be available as required to meet the assessed needs of the residents. To enable the staff to provide appropriate care to the residents and to assist them with their mobility needs. 8 27 18 Domestic and administrative 21/11/2008 staff must be employed in sufficient numbers so that nurses and carers may concentrate on ensuring the health and personal care needs of the residents are met and not be involved in administrative issues, supporting with the preparation of food and in maintaining the general 21/12/2008 Care Homes for Older People Page 35 of 40 cleanliness of the home in addition to their own duties. If the nurses and carers are spending time on domestic duties they will not be making sure the residents health and personal care needs are being met and the staff ratios will need to be adjusted accordingly. 9 29 19 When employing workers 21/11/2008 from abroad, whose first language is not English, the registered person must ensure that their understanding of, and ability to communicate in the English language is sufficient to enable them to read, understand and follow the residents care plans and to give and receive information with respect to the residents to ensure they receive their care, appropriately and safely. It is essential for all staff to be able to communicate verbally and read and understand the English language for the residents to receive the care they need safely. 10 30 18 The provider must take responsibility to ensure that the bank of Registered nurses, who work at the home, receive clinical training in accordance with their training and developmental needs and 21/11/2008 Care Homes for Older People Page 36 of 40 with respect to the assessed needs of the residents, and not assume that this is provided by other organisations. To ensure that the nursing staff, who take responsibility for the nursing care of the residents are appropriately trained to meet all their needs. 11 31 10 The Responsible Individual, 21/11/2008 as representative of the provider company and the only person registered on behalf of the home, must ensure he carries on the care home with sufficient care, competence and skill with respect to the needs of the residents, and from time to time undertake such training as is appropriate to ensure he has the experience and skills necessary for carrying on the care home. This home has not had a registered manager for more than a year and the responsible individual has allowed the service to deteriorate. To ensure sufficient resources are made available to meet the nursing and personal care needs of the residents the responsible individual must have knowledge of these needs. Care Homes for Older People Page 37 of 40 12 33 24 All the information required 21/11/2008 in the AQAA to describe how the care home provides good quality services for the residents and the manner in which such services are provided, must be completed to clarify the situation and enable accurate judgements about the home to be made. This information is used to assess the standards of care at the home and provide evidence from which judgements are made. 13 38 13 All parts of the home the 21/11/2008 residents have access to must be as far as reasonably practical free from hazards to their safety and unnecessary risks must be identified and as far as possible eliminated. To ensure a safe environment for the residents. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 A simplified version of the care plan with respect to supporting bedfast residents with their moving and handling and feeding needs should be readily available in their bedroom for new staff to follow including diagrams or photographs to show correct positioning and to enable staff with a limited knowledge of the English language to provide care appropriately. When the manager carries out in-house training, she should be suitably trained to do so to ensure the staff learn Page 38 of 40 2 30 Care Homes for Older People appropriate methods of moving and handling, food hygiene, infection control, safeguarding adults, fire safety, health and safety for the safety and protection of the residents. 3 38 Advice should be sought from the Health and Safety Executive with respect to the ill-fitting French windows in the lounge and dining room, means of access to the garden for people with mobility needs and the security of the external door access with respect to residents with dementia. Care Homes for Older People Page 39 of 40 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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