Inspection on 19/06/08 for Crossways Residential Home

This inspection was carried out on 19th June 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Crossways Residential Home 20/06/07

Crossways Residential Home 25/04/06

Crossways Residential Home 01/11/05

Crossways Residential Home 08/12/04

Crossways Residential Home 27/05/04

Crossways Residential Home 20/11/03

Crossways Residential Home 24/06/03

Crossways Residential Home 21/08/02

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Crossways Residential Home 66 Highgate Road Highgate Walsall West Midlands WS1 3JE Lead Inspector Amanda Hennessy Unannounced Inspection 19th June 2008 10:15 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Crossways Residential Home DS0000020854.V366177.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Crossways Residential Home DS0000020854.V366177.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Crossways Residential Home Address 66 Highgate Road Highgate Walsall West Midlands WS1 3JE 01922 646168 01922 646168 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Obsan Limited Vacant Care Home 23 Category(ies) of Dementia (12), Old age, not falling within any registration, with number other category (23) of places Crossways Residential Home DS0000020854.V366177.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th June 2007 Brief Description of the Service: Crossways Residential Home provides accommodation for 23 people over the age of 65, 12 of whom may have dementia. The home does provide nursing care. The home is approximately two miles from Walsall town centre. There are nineteen single bedrooms and two double bedrooms. Twelve bedrooms have an en suite toilet. The home has a passenger lift, a staff call system throughout the home and aids and adaptations to assist people. There is a pleasant garden at the back of the home. Car parking is available at the front of the home. The fee range was not clear in the service user guide seen. As the fee information has not been included in this report we advise the reader to contact the service for this information and of any other costs that may charged for, in addition to the fees. The inspection report was not available at the time of the inspection as it should be. Crossways Residential Home DS0000020854.V366177.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. The means the people who use this service experience poor quality outcomes. Two inspectors Mrs Amanda Hennessy and Mrs Tina Smith carried the inspection out in one day, between 10.15 and 19.50. The home did not know we were coming. The Acting Manager was present throughout the inspection. The inspection included a review of information supplied by the Home Manager called “`An annual Quality Assurance Assessment” which provided information about the home, policies and procedures at the home, information about the people living at the home and its staff. We sent out ten survey forms known as “have your say about,” to enable people to tell us about their experiences of life at the home but none were returned. Ten staff surveys were sent to the home but again none were returned. During the inspection the inspectors followed the experiences of living at the home for three people, including looking at their care records, when possible conversations with them, viewing their rooms and if possible talking to their relatives whenever possible and discussing their care with staff. This process is known as case tracking. As part of this process we also looked at peoples medicines, how they are ordered and records of their administration. A Short Observational Framework for Inspection (SOFI) was undertaken. People who live at the home were observed in the lounge for almost two hours to find out the quality of their life in the home, and how they are affected by it. We were able to meet with and talk to other people living at the home and the homes staff, they also told us what it is like to live in the home. We looked around most of the home including peoples’ rooms, bathrooms, toilets and communal rooms. Records about the safety of equipment and the building were also checked. What the service does well: The home provides comfortable and pleasant accommodation for people who live there. The garden at the back of the home is well maintained and a pleasant place to sit when the weather is warm and sunny. Crossways Residential Home DS0000020854.V366177.R01.S.doc Version 5.2 Page 6 People needs are assessed before they come to live at the home so that staff have some awareness of their needs. What has improved since the last inspection? What they could do better: We found that there has been a serious deterioration in the home since the previous inspection as a result of poor and ineffective management. The homes owners have also failed to recognise deterioration in standards. The recruitment of and selection of staff is poor. All required pre-employment checks have not been completed meaning that people have not been adequately protected from the risk of unsuitable people working at the home. We sent the home an urgent action letter after the inspection to highlight concern about recruitment practices at the home. Care records are poor they are incomplete, not available or have not been updated for some time. The poor standard of the care records gives no assurance that staff are aware of all people needs and how they should be met. There is generally insufficient things for people to do, people told us they are bored. What people like to do is not always explored so that staff can plan activities with people that they would enjoy. We also feel that current staff arrangements would also make it difficult for staff to ensure that activities take place and people can go on outing outside the home with staff. We found that other required records and information were not available such as complaints that have been received. Without essential and required information available we do not have confidence that people concerns are responded to and they information to enable them to make informed choice about the home. The home has twelve requirements and nineteen good practice recommendations as a result of this inspection. Crossways Residential Home DS0000020854.V366177.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. Crossways Residential Home DS0000020854.V366177.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Crossways Residential Home DS0000020854.V366177.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1,2,3 and 5 were reviewed. Quality in this outcome area is adequate. People may not have all the information they need to make an informed decision about coming to live at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a service user guide and a statement of purpose. We found that both documents were not accurate or well designed and did not contain enough information about the home. The lack of information and use of confusing information would it make it difficult for people to make an informed choice about living there. Peoples’ needs are assessed before they come to live at Crossways. People are written to following their assessment of need to confirm that the home will be Crossways Residential Home DS0000020854.V366177.R01.S.doc Version 5.2 Page 10 suitable to meet their needs. We spoke to people about coming to live at the home, they told us: “I was in another home first and didn’t like it…I had information about Crossways before moving in and also visited”. “ I am happy here, staff are very good and helpful.” One relative told us: “After our mother died…we were not able to give Dad amount of help he needed to stay at home….my sister found Crossways, which is near enough so we can visit often..”. Crossways Residential Home DS0000020854.V366177.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8. 9 and 10. Quality in this outcome area is poor. Poor care planning gives no assurance that peoples needs will be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care records at the home do not always reflect peoples’ needs, choices and capabilities. We found that one person who had lived at the home for more than three months had no plan of care. There was also no record that other people had not had their care reviewed for several months. The insufficiency of care instructions in care records means that staff may not be are aware of peoples needs and will be able to meet them. We saw one person whose care records identified: “ X is on a diabetic diet although she is not a diabetic”. We asked about the need for a diabetic diet and looked at other care records but could find no information whether this person was diabetic. We also could not ascertain Crossways Residential Home DS0000020854.V366177.R01.S.doc Version 5.2 Page 12 whether the person had received any other care for diabetes such as blood glucose monitoring. Another person was an insulin dependent diabetic this persons care plan stated if x is unwell and unable to attend to her own sugar levels, ………but there were no instructions on what staff should do in this situation. We found that not all people had been weighed or were regularly weighed. One person did have a weight chart commenced on the 4/5/08, when it was recorded: “unable to weigh”, no other weight was seen and yet this person had come to live at the home in March 08. Risk assessments are available for falls, pressure sores, malnutrition and moving and handling. We found that risk assessments were either not completed or had not been updated for several months. One person risk assessment for pressure sores said: “do weekly checks of pressure areas”, but there was no record that it had been updated since 25/7/07. Another person had a pressure risk assessment that was not completed despite this person being admitted to the home with a small pressure sore. The lack of risk assessments (and a care plan) did not provide us with confidence that people would receive care to minimise the risk of pressure sores forming. Another person did not have a completed nutritional risk assessment or care plan identifying that they needed a soft mashed diet. The lack of appropriate care records and risk assessment may mean that they have food that would make them choke and inhale food particles increasing the risk of aspiration pneumonia which is potentially a life threatening condition. We also found that moving and handling risk assessments and plans of care were either not completed or had not been updated for several months. One we looked at had not been updated since 26/6/07 and information available was also not complete. Staff told us that no one required hoisting although we met a very frail person who was unable to move herself. Staff told us that she had been uncomfortable in the hoist sling and so were now lifting her. We found that the hoist slings available were inappropriate for this persons weight and their use would have increased the risk of injury to her. We did see good risk assessments for the use of bedrails that identified potential risk to people who needed them and ways to reduce the risk. We discussed with staff that they needed to specify that bed rail bumpers were needed although it was positive that they were already in place on bed rails. There was a “bath list “ with most of people having a weekly bath. We could not identify from care records that this was people preference or that the “weekly bath” did actually take place. Crossways Residential Home DS0000020854.V366177.R01.S.doc Version 5.2 Page 13 Staff told us people have regular reviews from other health professionals but there was no record of this in peoples care records. Visits from health professionals are recorded separately but we were unable to evidence that all required visits do take place (also see the previous notes in relation to peoples diabetic care). Medication practices at the home were found generally to be satisfactory. There is a record of what medicines are received into the home and usually a record of what medicines are given. Staff do not always record that creams and lotions applied as they are required to do. We were told that only staff that have had training in the administration and safe keeping of medicines give out medicines which is good practice. Staff do record the drugs fridge temperature although it was above the safe temperature for safe storage. We advised staff of a need to record the treatment room temperature to give assurance that medicines stored here are kept safely. We were told that all unused medicines were returned to the pharmacy for destruction at the end of each month. We discussed this practice as a waste of valuable National Health resources with the majority of medicines being reordered each month despite some never being used. We advised that balances were checked at the end of each month and when appropriate medicines are not reordered and a record of the amount of medicine “carried forward” is recorded. Staff do regular medicine audits and it was positive that the balance for all medicines checked during the inspection was correct. Staff do usually treat people with respect although we did see occasions when people were ignored by staff. The home does have some double rooms but have confirmed that appropriate screens are now available in all double rooms. People are asked whether they have any preference of the gender of care staff providing personal care to them and this is respected. Crossways Residential Home DS0000020854.V366177.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12 – 15 were reviewed. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Daily life at the home does not meet peoples needs, preferences and choices. EVIDENCE: People personalise their rooms, get up, go to bed and generally have meals when and where they prefer. Visitors can stay for a meal and visit when they wish to. Birthdays, religious and other holidays are celebrated and families are invited. We discussed activities that place. One person said: “…sometimes we play with a ball, which I like…no, activities are not every day…a couple of times a week”. Someone else told us: “ I like quiet to read, sometimes the TV is too loud” and “we need more types of entertainers.” A relative told us: “There is only one thing they can improve...activities and entertainment…there are not enough…the entertainer is good, dad enjoys this.” Management told us that they are aware that a daily choice of activities is wanted, and more variety including outings, and have recently begun to address this. There are posters in the reception area about the activities Crossways Residential Home DS0000020854.V366177.R01.S.doc Version 5.2 Page 15 taking place but was found to be inaccurate. Posters also were found to be confusing as people may think there is a fee for entertainment which is not the situation. People are able to choose where they spend their day. One person whose care records identified that they were depressed and suicidal had been left for several hours in her room with a used lunch tray with dirty crockery, cutlery and food remnants. We were concerned that staff may not been in to see this person since bringing in their lunch. We found that mealtimes were unhurried and a few people were helped, discreetly. Food we sampled was tasty and nutritious, A person told us they liked the food but said : “…the portions are too big…often the two choices are similar, like breaded fish and breaded fish cakes…I don’t like breaded fish and they don’t serve plain fish. Today’s menu is gammon or sausages, both from a pig.” We found other examples of lack of suitable food choices on the handwritten menu examined. We were told menus were chosen by the cook to meet needs, such as diabetes, and that the cook asked people their likes and dislikes. We saw that skills people came into the home with, were not being respected and used, such as helping themselves to vegetables, laying tables, etc. and that continence was not being prompted and promoted. We saw growing dependency on staff and loss of self esteem, rather than their individuality and dignity being maintained. People who needed personal attention to express themselves appeared to be affected negatively by living at the home. We observed that the majority of time staff interaction was purely based on the routine. One person who showed signs of hallucinating had the least contact with staff. We did see though that when any contact was made it appeared to improve their state of mind for a few minutes. We saw a person who had only come into the home to live that day become distressed. We had already noticed that this person had had very little staff support. Staff did try to reassure them but they were not assisted to use the phone as they had asked. There were good episodes of staff interaction, for example giving reassurance to someone wandering, asking people how they felt and giving them time to answer. We noticed that staff mainly spoke to the men and people who were able to start a conversation. We feel that the home is not meeting its own equality and diversity policy displayed in reception in this matter. Crossways Residential Home DS0000020854.V366177.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 - 18 were reviewed. Quality in this outcome area is poor. Concerns may not be dealt with appropriately and people are not protected from harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints procedure. There is no reference to timescales that complaints will be responded to within the complaints procedure seen during the visit. The policy also need to be updated with CSCI new contact details so the public do have accurate information on how we can be contacted if they have any concerns. The home also has a suggestion box for people to use if they wish to. Crossway’s complaints procedure says that “complaints should be recorded…no matter how minor …or trivial…verbal…for the Manager and Deputy to deal with.” The AQAA states “a few complaints about staff…dealt with promptly”. We were not given any recorded complaints since 2004 despite this being queried twice. Crossways Residential Home DS0000020854.V366177.R01.S.doc Version 5.2 Page 17 There were reports for 2007 and 2008, one identified an alleged serious crime, and another that no pain relief was given the day someone died. No records were provided to indicate these matters were investigated or reported to authorities. There was one safeguarding matter recently ended, where the management participated in full, but the records were not on site. Staff have not all been trained in abuse but we were told that additional training was being arranged There were several policies and procedures sampled and found to need updating to ensure the legal rights of people are respected. Restraint is used as a last resort, but the procedure does not include consent, consultation and audit for the use of restraint. There have been 58 reports of incidents in the home in the past 6 months, affecting 22 people, CSCI were not informed of all incidents that have affected peoples health, safety and wellbeing. Most incidents involve falls and minor injuries which have been managed by first aid; three identified minor aggression between people living in the home. Two people had multiple falls before other Health services were contacted. Management agreed they have not been auditing incidents as required. Effective auditing of incidents may identify a pattern and possibly reduce the risk of further incidents occurring. Failures to undertake required checks before staff commence employment increase the risk of unsuitable people working at the home. Crossways Residential Home DS0000020854.V366177.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is clean and provides comfortable and safe accommodation for people who live there. EVIDENCE: The home is clean, generally homely and warm. We were told that there has been an ongoing refurbishment programme of decoration and new furniture to bring original rooms up to the same standard as the new extension. The new extension has been completed since the previous inspection and has pleasant modern rooms and facilities. The home has a large lounge with dining area and also another separate lounge that people told us that they sit in the “quiet” lounge with their relatives. The Dining room was found to lack natural light, and the lounge next door was used throughout the inspection as a thoroughfare. The home has vinyl floor covering Crossways Residential Home DS0000020854.V366177.R01.S.doc Version 5.2 Page 19 throughout the majority of the home with the exception of a small area of the lounge and one bedroom. The Proprietor told us that bedroom carpets will be provided if it is requested. The previous manager had indicated that there was a concern about the security of the home. The front door is kept locked and there are signs indicating that visitors should ask staff to let them out when they are ready to leave. We discussed new guidance from CSCI which identifies a need for over-ride risk in services for people with dementia, which does not appear to have been considered. There is a pleasant enclosed garden planted with mature shrubs and trees and lawns. There is raised area directly outside the dining room which has garden furniture for people to use and which has sloped access to the remainder of the garden. The car park has been re surfaced which staff told us has been a great improvement. The home has a variety of aids and adaptations throughout which are suitable for dependent people and a staff call system throughout the home. Toilets are situated throughout the home, are accessible and have grab rails. There is an assisted shower room and assisted baths suitable for dependent people to use. We did highlight a need for additional hoist slings and belt so people of differing weights can be hoisted when needed- the Proprietor informed us that an additional sling had already been ordered. All bedrooms were found to be pleasant, clean and in most cases personalised with peoples’ treasured possessions such as photographs, pictures and ornaments. The home has a policy that as bedrooms become vacant they are redecorated for the next person and whenever possible they are consulted about their choice of colour for the room. There is a lockable facility in each bedroom where people can keep their treasured items safely. The home also has a safe where valuable items can also be stored. There are two double ensuite bedrooms the remaining nineteen bedrooms are single with all but two having ensuite facilities. Equipment such as gloves, aprons and liquid hand gel is provided throughout the home to minimise the risk of cross infection. Laundry and kitchen facilities are appropriate to reduce the risk of cross infection. Crossways Residential Home DS0000020854.V366177.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27-30. Quality in this outcome area is poor. Staffing levels are not sufficient to meet the needs of people living at the home. Poor recruitment practices put people at risk from people who are unsuitable to work with vulnerable people. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staffing levels have been unchanged since the previous inspection despite the home having an additional eight people living there and one person in hospital. We highlighted that there is a lack of activities, but the activities are dependent on staff having the time to undertake them. We found that there been a high number of falls which may also suggest that staff are unable to provide appropriate supervision and support to minimise the risk of falling. We also found that care records have not been completed for some time, suggesting that staff have insufficient time to update and complete essential records. We observed one person become distressed when she was stuck in the hall, unable to get through the door with her frame and poor eyesight. Staff who had assisted her to the toilet did not return and were busy serving lunch. Her cries and knocks could not be heard by staff in the dining room and Crossways Residential Home DS0000020854.V366177.R01.S.doc Version 5.2 Page 21 without our intervention would have continued to be distressed. There is a need to review staffing levels to ensure that people receive the required support and attention. We were told that staff training is supported. We found that training is generally not up to date and staff have not had all required training. A training plan for 2008/2009 was not available. The home have fourteen care staff who have National Vocational Qualification (NVQ) level 2. The home number of care staff with a care qualification and has exceeded a requirement of more than half the staff with a minimum of NVQ level 2 or above. Recruitment and selection is not safe and does not protect people living at the home. We sent the home an urgent action letter after the inspection to highlight concern about recruitment practices at the home. We found that staff do not have all required checks in place before they commence employment. Staff are usually employed following the receipt of a Protection of Vulnerable Adults (POVA) check but this should also depend on an appropriate risk assessment being in place but this was not the situation. We found one member of staff had stated on their application form that they had no criminal conviction. When the criminal record check was returned it did include a previous conviction. The Proprietor told us that she had met with the employee and discussed this matter but records of the meeting were kept off the premises. We discussed how a similar instance could be avoided in the future with the Proprietor and she told us that she needed to discuss it with the company employed to give them advice on all employment law. Another member of staff had a criminal record check for another home but there was no criminal record check of POVA first check available for Crossways, again this is inappropriate and unsafe practice. References received were on ordinary paper and were sometimes addressed “To whom it may concern” ( it is good practice for the home to send out their own reference forms or request references on headed paper of the previous employer). References gained did not reflect the member of staffs employment and two member of staff had no references at all. Staff application forms did not give dates of employment and we also found that employment history was not always complete. There is a record of staff interviews although there was not always a record of employment history or the reason for any gaps in employment history. We discussed staff supervision with the Acting Manager and Acting Deputy Manager, both agreed that supervision was not up to date. They told us that it was only when they started in their new roles that it had been recommenced. Crossways Residential Home DS0000020854.V366177.R01.S.doc Version 5.2 Page 22 We were also told that all new staff receive formal induction training. We were shown the staff induction which the Area Manager was able to confirm meets the “Skills for Care” standards. Crossways Residential Home DS0000020854.V366177.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. Quality in this outcome area is poor. The home has poor and ineffective leadership and management systems that put people living at the home at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s Manager has been off work and has since resigned. The Deputy Manager has recently been asked to become the Acting Home Manager we were told that she is additional to care staff numbers for three days a week. We found numerous concerns about the poor management of the home and advised the proprietor that there is a need for additional hours for the manager away from care duties to enable her to address the outstanding concerns. Crossways Residential Home DS0000020854.V366177.R01.S.doc Version 5.2 Page 24 We found that there has been a serious deterioration in the home since the previous inspection as a result of poor and ineffective management. Care planning was weak, incomplete, not available or had not been updated for some time, staffing levels are not meeting people needs, recruitment of staff has been poor and required pre-employment checks have not been completed. This means that people have not been adequately protected from the risk of unsuitable people living at the home. Records of complaints made about the home were not available so we are unable to assess whether the home have appropriately investigated all concerns; incidents that should have required notified to CSCI and an Adult Protection referral have not been done giving no assurances that the home followed required procedures to safeguard people living there. There has also been insufficient staff training and staff supervision for some time. The manager did submit the Annual Quality Assessment (AQAA) when required but it contained confusing information referring to the “Acting Manager” and a need for additional experience and support. We were not certain whether the AQAA had not been updated since the previous AQAA was sent to us. The manager has completed information saying that she has completed numerous audits including care plan audits. We feel that not all the information was factual as we found the majority of care plans were incomplete and had not been updated. There is a requirement that providers undertake formal visits to the home and complete a report of their findings. These visits should provide them with confidence how their home is managed. We were very surprised to find that records of these visits had been signed as completed by the manager. If the homes owner had undertaken these visits concerns about the home highlighted by CSCI would have been highlighted first by the owner and could have been addressed earlier and people living at the home would have been protected from poor practices that we highlighted. We were told that service user surveys are undertaken but none could be found. Surveys sent to the home by CSCI to provide us with information about the home remained in a pile in the office, although the Deputy Manager did say that she had given out a couple to relatives. It is positive though that there are “resident” and “relatives” meetings to find out how the service can improve. Arrangements at the home are appropriate for the safe keeping of peoples money. Balances that we checked were found to be correct and there were receipts of transactions with two signatures confirming the transaction. Maintenance contracts were spot checked and were found to be up to date. Hot water temperature records were also checked and we found that hot water is delivered within safe temperatures. Mandatory staff training is not up to date. The homes own records for March highlight that eleven staff need Crossways Residential Home DS0000020854.V366177.R01.S.doc Version 5.2 Page 25 moving and handling training, twelve staff need first aid, eighteen staff need food hygiene training and adult protection training is needed by eleven staff. As previously identified CSCI have not been informed of incidents that have adversely affected peoples health and well being. Crossways Residential Home DS0000020854.V366177.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 2 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 1 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 2 18 1 3 x x x x x x 3 STAFFING Standard No Score 27 1 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x 1 x 3 1 x 2 Crossways Residential Home DS0000020854.V366177.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No 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 OP7 Regulation 15 Requirement Timescale for action 31/07/08 2 OP8 13(5) 3. OP16 22 4 OP16 22 (3 & 8) People should all have a plan of care that includes all their needs, choices and capabilities that is regularly updated. People should be consulted about their care needs and a record of this should also be recorded. An accurate and up to date plan of care will provide instructions for staff on peoples needs and how they should be met. Hoisting equipment and 31/07/08 appropriate slings should be available for people who need them. An accurate written complaints 31/07/08 procedure that includes the name, address and telephone number of the Commission, and timescale for investigation within 28 days should be available. This will enable people to be confident how to raise any concerns and feel confident that they will be addressed The registered person shall 31/07/08 ensure that any complaint made under the complaints procedure is fully investigated, and supply DS0000020854.V366177.R01.S.doc Version 5.2 Crossways Residential Home Page 28 5. OP18 13 (4)(c) 6 OP27 18(1)(a) 7 OP29 19 Schedule 2 9 26(2) 26(3), 26(4) 8 9 OP31 OP33 10 OP38 37 to the Commission at its request a statement containing a summary of the complaints made during the preceding twelve months and the action that was taken in response. This will enable people to be confident that any concerns that they have will be appropriately addressed. The registered person must ensure that systems are in place to ensure that there are no unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. This will include risks from falls and depression from lack of social stimulation. The availability of staff at the home and their skills should be sufficient and appropriate to meet people’s needs. The home must ensure that all required checks are undertaken before people commence employment. The home must have a suitably experienced and registered manager The registered provider must ensure that a written report of monthly visits to the home is undertaken by a person who is not directly concerned with the conduct of the home. The home must inform CSCI of all incidents that affect the health and wellbeing of people living at the home. 31/07/08 31/07/08 31/07/08 31/10/08 31/07/08 31/07/08 Crossways Residential Home DS0000020854.V366177.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2. 3 4 5 6 7 8 9 10 11 Refer to Standard OP1 OP1 OP3 OP7 OP12 OP13 OP15 OP15 OP27 OP29 OP33 Good Practice Recommendations The Statement of Purpose should be updated and provide all required information that is easy to understand. The Service User Guide should be updated and provide all required information in a format that people understand. Pre-assessments record likes, dislikes, preferred routines and choices to plan support during admission to reduce anxiety and confusion of people with dementia People should be regularly weighed and when there is concern about their weight/ diet this should be included in their plan of care Social care plans identify people’s preferred leisure activities.- this would also identify if they would like to go for outings outside the home. There should be private telephone facilities which are suitable for the needs of people living at the home. People should be consulted on the home’s menu, and always have an appropriate food choice available including variety of meal choice and snacks. Nutritional needs and preferences should match care plans and weight/diet monitoring, and this should be audited. Permanent arrangements should be made for a dedicated member of staff to organise and plan activities that match the needs of people using the service. There should be a comprehensive record of employment history of new staff. Manager audits on a regular basis menu variety, and effect of activity levels and types on emotional and psychological wellbeing of people who use the service, and take appropriate action The complaints procedure references the Funding authorities rather than the Parliamentary Ombudsman. The “Staff Suspected of Abuse” procedure and “Safeguarding Adults” Procedure should include and comply with the locally agreed Walsall Council Safeguarding Adults Policy and Procedure There should be a review of security and fire risk assessment to include the risk of people with dementia over-riding the door security system DS0000020854.V366177.R01.S.doc Version 5.2 Page 30 12 13 OP16 OP18 14 OP19 Crossways Residential Home (http:/www.communities.gov.uk/publications/fire/firesafe tyrisk5) 15 16 17 18 OP30 OP33 OP36 OP38 All staff should have safeguarding training annually. The home should have an effective quality assurance system Staff should have bimonthly supervision that is recorded Accident sheets should be filed following inspection and a 3-monthly analysis log created for auditing purposes. Systems should be in place to ensure that staff receive all required statutory training 19 OP38 Crossways Residential Home DS0000020854.V366177.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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