Inspection on 17/05/05 for Crossways Residential Care Home

This inspection was carried out on 17th May 2005.

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

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

Other inspections for this house

Crossways Residential Care Home 19/07/06

Crossways Residential Care Home 12/10/05

Crossways Residential Care Home 10/11/04

Crossways Residential Care Home 05/05/04

Crossways Residential Care Home 26/01/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton 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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE CROSSWAYS 306 Yorktown Road Sandhurst Berkshire GU47 0PZ Lead Inspector Debbie Willcox Unannounced 17 May 2005 @ 09:15 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 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 H51-H01 11116 Crossways V217106 170505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Crossways Address 306 Yorktown Road Sandhurst Berkshire GU47 0PZ 01276 34691 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Tom Neehaul & Mrs Neehaul Care Home 10 Category(ies) of Older Person (OP) registration, with number of places CROSSWAYS H51-H01 11116 Crossways V217106 170505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 10/11/04 Brief Description of the Service: Crossways is a residential care home providing 24 hour care to 10 older people over the age of 65. The home is an extended domestic dwelling over two floors with a passenger lift in situ. The home is within close proximity to local amenities and is well served by public transport and is close to the M3 and M4 motorways. CROSSWAYS H51-H01 11116 Crossways V217106 170505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out on a weekday by one inspector and lasted approximately 6 hours. A tour of the home was undertaken. The majority of time was spent talking with people who live in the home as well as some time spent with the owner/manager and one staff member. This inspection was restricted by the fact that the inspector was unable to view records relating to the recruitment of staff, the pre-admission assessment, reviews and contracts for people living within the home. The manager did not have a key to the filing cabinet where staff records and some service user records are stored. The only key available was with the joint owner/provider who has this key with him at all times. Since this inspection a second key has been cut and is now available to the manager. Some care records and health and monitoring records were viewed. Feedback was given to the manager. There are 5 outstanding requirements made by the CSCI from previous inspection visits to the home, which have not to date, been complied with. What the service does well: What has improved since the last inspection? Since the last inspection a medication checklist for assessing staff competency has been implemented within the home. CROSSWAYS H51-H01 11116 Crossways V217106 170505 Stage 4.doc Version 1.30 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. CROSSWAYS H51-H01 11116 Crossways V217106 170505 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection CROSSWAYS H51-H01 11116 Crossways V217106 170505 Stage 4.doc Version 1.30 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 standard(s) 1,2,3,4,5, The homes statement of purpose and contracts/statement of terms and conditions do not detail all information required by regulation to enable prospective service users to have the information they need to make an informed choice prior to moving into the home. Written assessment documentation is not made available prior to a service user moving into the home so the home cannot be sure that individuals needs will be met and staff do not have the guidance to know how to meet health and personal care needs. Without this service users can potentially be put and risk EVIDENCE: The home has a statement of purpose. This document does not detail the number of rooms and their sizes including communal areas as is required by regulation. CROSSWAYS H51-H01 11116 Crossways V217106 170505 Stage 4.doc Version 1.30 Page 9 Contracts/statement of terms and conditions were not made available for inspection, as the manager did not have the key to open the filing cabinet where these are stored. None of the service users spoken with had experienced a trial visit before entering the home. However the majority of people spoken to said they had come to the home straight from hospital. On the day of this inspection a prospective service user was expected to move into the home. No pre-admission assessment documentation was made available for inspection. No care plan had been compiled. The manager informed the inspector that she had planned to write the care plan upon this person’s arrival into the home. A pre-admission assessment had been carried out by social services. The manager informed the inspector that the care manager pre-admission assessment documentation was not available to view. CROSSWAYS H51-H01 11116 Crossways V217106 170505 Stage 4.doc Version 1.30 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 standard(s) 7,8,9,10,11 Further work is needed to ensure that a comprehensive care plan of service users health and personal care needs are recorded to enable staff to have the up to date written guidance they need to understand and meet the needs of service users. Service users enjoy the benefits of weekly support from a visiting GP. Service users are not currently provided with the support of other NHS services such as continence assessments, eye tests and hearing tests. Service users can be assured that staff have the written guidance as to their wishes in the event of death. EVIDENCE: All service users currently residing in the home have a care plan. The manager has implemented a new system for care planning and is reviewing the effectiveness of this system. Staff are recording on a daily basis care provided and commenting on individuals well being. Some personal care needs and actions are detailed with plans. However not all aspects of health and personal CROSSWAYS H51-H01 11116 Crossways V217106 170505 Stage 4.doc Version 1.30 Page 11 care needs are detailed. One service users diagnosed with Parkinsons disease did not have a written plan as to how needs specific to this condition will be met. A keyworker system is in operation. Service users are paying for incontinent pads directly from the home. Only one person has been assessed by a district nurse and is now receiving these free. The home must ensure that all service users have access to continence assessments and access to professional advice about the promotion of continence and be provided with their entitlements to aids. Specialist equipment for prevention of pressure sores, where required was seen to be provided. There was no evidence of care planning for hearing and sight tests and no evidence that service users have access to these services to maintain their visual and hearing needs. Service users spoke highly of the GP support provided to the home as the GP visits the home weekly. The storage and recording of medication was viewed at this inspection. The home does not currently have any controlled drugs prescribed. The home operates using the NOMAD monitored dosage system. There is currently no recording of stock into the home apart from the receipt of PRN medication. There is a record of all medication returned to the pharmacy for disposal. The home has a policy instructing staff how to deal with dying and death. Information relating to service users wishes in event of death was attached to care plans. CROSSWAYS H51-H01 11116 Crossways V217106 170505 Stage 4.doc Version 1.30 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 standard(s) 12,13,14 Service users are supported to maintain contact with family and friends. There are no planned opportunities to enable service users to maintain links with the local community. This has the potential for service users to become institutionalised. EVIDENCE: The homes statement of purpose states that; ‘The home will do it’s best to provide opportunities for service users to maintain and develop outside contacts as desired’ and that service users will have access to a range of social activities within and outside of the home should they wish to participate. There was evidence that visitors are welcomed into the home. However the home does not currently have any organised plan of activities or entertainment. Care plans viewed did not evidence the planning for meeting the social, leisure and community contact needs of service users living within this home. Some of the residents spoken with said they would like to see regular planned activities and have opportunities to go outside of the home. Some people have not been outside of the home for a significant period of time. One resident said; ‘the only entertainment is the television. I miss going out shopping, I do not remember the last time I went out of here’. CROSSWAYS H51-H01 11116 Crossways V217106 170505 Stage 4.doc Version 1.30 Page 13 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 standard(s) 16,18, The home has a system in place for the recording of complaints. There has been no progress in providing staff with training in responding to abuse of vulnerable adults. This has the potential to put service users at risk. EVIDENCE: There have been no complaints since the last inspection. Complaints are recorded including actions taken to investigate and outcomes are recorded. All service users spoken with said that if they had a problem they would have confidence to speak to the owners of the home or their relatives. There is an outstanding requirement for all staff to be provided with training in Responding the Abuse of Vulnerable adults. CROSSWAYS H51-H01 11116 Crossways V217106 170505 Stage 4.doc Version 1.30 Page 14 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 standard(s) 19,20,21,22,23,24,25,26, Service users are provided with a domestic style environment, which is comfortable. The home does not adequately protect service users from cross infection. EVIDENCE: A tour of the home was undertaken during this inspection. The home is domestic environment with comfortable, homely touches. One service user said how much she enjoyed the garden and has a patch of her own to potter in having brought some plants from her previous home to enjoy. One service user had some handles missing from her wardrobe and chest of drawers; this was brought to the attention of the owner/manager. Service users are encouraged to bring in their own personal furniture and possessions. Some service users told the inspector that they have within their rooms having brought with them personal furniture and pictures. The home does not CROSSWAYS H51-H01 11116 Crossways V217106 170505 Stage 4.doc Version 1.30 Page 15 currently have an inventory system for the recording of service users furniture and valuables being brought into the home as required by regulation. The home must provide a recorded inventory of these items. There is an outstanding requirement for the bathrooms to be updated suited to the needs of this service user group. There was a lack of adequate hand washing facilities for staff and service users in bathrooms and toilets. The manager was advised of the need to provide liquid soap and paper towels to prevent cross contamination. The manager was also provided with the telephone number of the Health Public Protection Nurse who can be approached for advice and training for staff. The home was found to be generally clean and free from offensive odours. However attention is needed in the cleaning of the conservatory area, which is accessed by service users. CROSSWAYS H51-H01 11116 Crossways V217106 170505 Stage 4.doc Version 1.30 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29,30 No evidence was provided that this home protects service users through its recruitment procedures. Staff have not been provided with mandatory training as required. This has the potential to put service users and staff at risk. EVIDENCE: It was not possible to assess these standards in full, as records relating to the recruitment of staff were not made available to the inspector as they were locked in a cabinet to which the manager did not have a key. An immediate requirement was made for another key to be cut. Evidence has been provided since this inspection that this requirement has been met. There have been requirements made at the last 2 inspections for staffing checks to be carried out prior to the employment of staff as required by regulation. This requirement will remain outstanding. A record of staff training attendance was provided. However no certificates were available to evidence staff attendance and qualifications. There is an outstanding requirement for all staff to attend manual handling training. The manager and one other staff member have been on first aid training. It is necessary for all staff to be trained in first aid. The manager informed the inspector that several staff have now completed NVQ level 2. CROSSWAYS H51-H01 11116 Crossways V217106 170505 Stage 4.doc Version 1.30 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,34,35,36,37,38 Service users benefit from staff who are supported with formal 1-1 supervision where the care needs of service users are discussed. Without the provision of receipts for items purchased via the home and adequate auditing systems in place, service users cannot be assured that their financial interests are safeguarded. This home does not provide a formal quality assurance system where the views of service users or their representatives are sought. Thermostatic water valves must be serviced to protect service users from the risks of scalding. EVIDENCE: CROSSWAYS H51-H01 11116 Crossways V217106 170505 Stage 4.doc Version 1.30 Page 18 The manager informed the inspector that she has now completed the NVQ level 4 in management. It was not possible to view evidence of this, as the certificate of completion was not made available. The staffing rota detailed the hours worked by staff and management. There was evidence that staff are provided with the support of formal 1-1 recorded supervision. The records for the safekeeping of service users monies were viewed. It would assist if receipts were numbered to assist in the audit of service users accounts. A high percentage of service users are paying the home for the provision of incontinence pads with no receipts provided and money taken directly from monies held for safekeeping. Receipts evidence that one service user is paying from her personal monies for food such as fruit. It was not possible for the inspector to view the homes contract/statement of terms and conditions, as these were not made available for inspection. It has been identified at previous inspections that contracts are not clear as to what is provided in the fee paid. The manager said she was not aware that any changes had been made to contracts to facilitate this. The provider must be clear within service users contracts what is provided and to be clear as to what extras will need to be paid for. The homes statement of purpose states that ‘effective quality assurance and quality monitoring systems would be provided’. It was evident that there is currently no formal quality assurance system in operation. However service users said they were asked regularly their views and asked for their suggestions about the provision of food. One service user said that she had made suggestions for changes in the menu but had not seen this provided as yet. The home does not have formal residents meetings. Everyone spoken with said the staff and proprietors are approachable, kind and helpful. It was evident from discussions with the manager that the CSCI has not previously been notified of every death that has occurred as is required by regulation 37. The manager was given guidance as to how to obtain forms already produced by the CSCI for providers to assist them in this process. The homes policies and procedures are provided through an external company. It was evident from the viewing of records that water temperature testing is carried out. The home does not have a contract for the regular Service users contracts/statements of terms and conditions do not clearly state what is included in fees paid by service users and what is not included. Inventories have not been implemented within the home to record furniture brought into CROSSWAYS H51-H01 11116 Crossways V217106 170505 Stage 4.doc Version 1.30 Page 19 the home by service users. This does not ensure that the financial interests of service users are safeguarded. CROSSWAYS H51-H01 11116 Crossways V217106 170505 Stage 4.doc Version 1.30 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 1 1 1 2 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 2 15 x COMPLAINTS AND PROTECTION 3 2 2 2 3 3 3 2 STAFFING Standard No Score 27 3 28 x 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 3 3 2 2 2 3 1 2 CROSSWAYS H51-H01 11116 Crossways V217106 170505 Stage 4.doc Version 1.30 Page 21 yes 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. 1. Standard 30 Regulation 18 Requirement Develop an induction and training programme for staff which meets National Training Organisation standards. THIS REQUIREMENT HAS BEEN OUTSTANDING FROM THE PREVIOUS 3 INSPECTION VISITS Ensure staff records required by regulation are in place prior to employment within the home. THIS REQUIREMENT HAS BEEN OUTSTANDING FROM THE PREVIOUS 3 INSPECTIONS. Carry out refurbishment of the downstairs bathroom seeking advice from a qualified Occupational Therapist as to the most suitable layout to improve access for this service user group. ORIGINAL TIMESCALE FOR COMPLIANCE 31/03/05. All staff to have up to date manual handling training. ORIGINAL TIMESCALE FOR COMPLIANCE 10/02/05 Provide all staff with Responding to Abuse of Vulnerable Adults training by ORIGINAL TIMESCALE WAS 31/01/05 The upstairs bathroom to be refurbished suitable for the Timescale for action 17/07/05 2. 29 17(2) Schedule 4.6 17/07/05 3. 21 23(2)B 30/09/05 4. 8 13(5) 17/08/05 5. 18 13.6 17/08/05 6. 21 23(20)b 30/09/05 Page 22 CROSSWAYS H51-H01 11116 Crossways V217106 170505 Stage 4.doc Version 1.30 7. 8. 1 37 4 Schedule 1 17 (3)(b) 9. 3 14 (1)(a) 10. 2 5 11. 8 13 (1)(b) 12. 26 13(4) 16(2)(j) 13. 23, 35 Schedule 4 (10) 18 14. 15. 30 35 needs of this service user group. (this timescale was confirmed as realistic in achieving by the provider in previous action plan sent to the CSCI) The homes statement of purpose to include all criteria listed within schedule 1 of the NMS. The proprietor/manager to have access to a key so that records are at all times made available for inspection in the care home when the manager is on duty. The registered person shall not provide accomodation to a service user unless they have obtained a copy of the care managers pre-admission assessment for service users placed via social services. Service users contracts/statement of terms and conditions to clearly state what is included in the fee paid and what extras service users are expected to pay for. The registered person to ensure that service users have access to NHS continence assessments and supported in accessing entitlements to continence aids. The registered person to provide appropriate handwashing facilities for staff and service users such as liquid soap and paper towels. A recorded inventory to be maintained of all furniture brought into the home by a service user. All staff to receive first aid training. Receipts to be obtained for all purchases made from service users money including incontinence pads rpvoided by the home. 17/07/05 Immediate and ongoing Immediate and ongoing 17/07/05 17/07/05 17/07/05 17/07/05 17/07/05 17/07/05 CROSSWAYS H51-H01 11116 Crossways V217106 170505 Stage 4.doc Version 1.30 Page 23 16. 31 37 17. 38 13(4)(a)( b) 16(2)(m)( n) 18. 12,13 The commission to be notified of all deaths, illness and other events as detailed within this regulation. Thermostatic water valves to be fitted to baths and serviced regularly as required to prevent scalding to service users. The registered person to consult with service users about their social interests and provide a programme of activities to enable them to engage in social and community activities both within and outside of the home. Immediate and ongoing 17/07/05 17/07/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations CROSSWAYS H51-H01 11116 Crossways V217106 170505 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection 2nd Floor 1015 Arlington Business Park Theale Reading RG7 4SA 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 H51-H01 11116 Crossways V217106 170505 Stage 4.doc Version 1.30 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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