Inspection on 20/06/07 for Crossways Residential Home

This inspection was carried out on 20th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 Home 19/06/08

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Crossways Residential Home 66 Highgate Road Highgate Walsall West Midlands WS1 3JE Lead Inspector Mr Keith Jones Key Unannounced Inspection 20 June 2007 09:00 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.V335410.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.V335410.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 post 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.V335410.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25th April 2006 Brief Description of the Service: Crossways Residential Home provides accommodation and personal care for 23 people over the age of 65, 12 of whom may have dementia. Located in Walsall, the home is a two-storey property providing nineteen single bedrooms and two double bedrooms. 12 of the bedrooms have an en suite toilet; all rooms have a wash hand basin. As well as an increase in bedrooms an additional lounge area, 2 assisted bathrooms plus an assisted shower room have been created. First floor accommodation is accessed by a passenger shaft lift and staircases. Externally there is a car park, and the rear garden offers a very attractive enclosed area for residents. The location of this home ensures that there is a wide range of community facilities nearby that can be readily accessed. Crossways Residential Home DS0000020854.V335410.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection of Crossways was undertaken within a day, by one inspector; the Care Manager (designate) and senior care staff, in a professional, frank and open manner. The last inspection report was discussed, and it was noted that requirements and recommendations had been completed or were being addressed satisfactorily. On the day of inspection there were 15 Service Users in residence. A tour of the Home allowed free and open access to all areas for inspection. The opportunity was taken to speak with a number of service users, relatives and members of staff. Service users and staff took an active role in the inspection process and contributed to the subsequent report. A full case tracking of four Service Users yielded a valuable insight of policies in action. Records had been correctly filed and stored, with a sample review of the administrative arrangements confirmed effective management. Weekly fees range from £321 to £346. The Care Manager (designate) and staff were thanked for their cooperation and open willingness to contribute to the inspection process. A full verbal report was offered at the end of the inspection, which included the Registered Provider and Area Manager. The inspector thanked all concerned for their contribution to a pleasing and constructive inspection of an improving service. What the service does well: Crossways offers a good standard of care and service, is well organised, with a committed care management team. Emphasis goes into involving the residents and their families in the process of care, ensuring a highly personal approach to meeting individual needs. Throughout the entire inspection a sense of homeliness and familiar confidence pervaded into all aspects of daily activity expressed by those people met. The standards of personal care were observed to be of a good quality, reinforced by discussion with residents, staff and relatives. The establishment of a professionally accountability towards effective assessment, care planning and review of resident’s needs are meaningful and robust, in formulating an satisfactory standard of care. This highly personable attitude and approach to care is appreciated and welcome by residents and visitors alike. Crossways Residential Home DS0000020854.V335410.R01.S.doc Version 5.2 Page 6 Staff training arrangements are robust and much improved, with a comprehensive support by the whole management team. The overall management style demonstrated an improved professional approach in maintaining an environment conducive to the care of the elderly. There is a continuing appraisal of facilities and services to maintain that environment, by frequent visits by the Registered Provider (Regional Manager) and Area Manager, in support of an enthusiastic Care Manager designate and Deputy. The housekeeping and support services all contribute significantly to the team approach, and are recognised by the management for their efforts. What has improved since the last inspection? What they could do better: The Care Manager designate has been in post, on a three-month probation, for ten weeks. A speedy application for Registration is a requirement. There is a need to demonstrate acknowledgement of Regulation with an openly accessible copy of the Care Standards Act, a higher profile Statement of Purpose, easy to read Service User Guide, and open access to the last CSCI inspection report. Establishing an Internet connection would help considerably in management, communications, information and promotion of the Home to prospective clients. The achievements in meeting a significant compliance in requirements made have been recognised, areas of detail will continue to play a part in the ongoing development and maintenance of an honest, solid and homely service. Crossways Residential Home DS0000020854.V335410.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.V335410.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.V335410.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): 1,2,3,4 and 5 The quality in this outcome area is good. The resources and services set aside by the Home are of a much improved standard in considering the needs of residents and families, and the ability of the Home to meet those needs. It is acknowledged that the Statement of Purpose represents the foundation on which the home operates upon, offering service users and their relatives the opportunity to make an informed choice about where to live. Residents are admitted to Crossways following a pre-admission needs assessment, always carried out by a senior member of staff. This assessment initiates the process of care, each individual having a plan of care. The assessor also makes a judgement as to the suitability of each prospective service user, using the same criteria. This is confirmed in writing before admission. Prospective residents and their relatives are able to visit and assess the quality, facilities and suitability of the Home at any reasonable time, to meet with staff and management Crossways Residential Home DS0000020854.V335410.R01.S.doc Version 5.2 Page 10 EVIDENCE: The Statement of Purpose and service user’s guide represent a good description of the Home’s aims and objectives, philosophy of care and terms and conditions, offering residents and their relatives the opportunity to make an informed choice about where to live. All the requirements prescribed in Schedule 1 are addressed. The document is presently under review by the Care Manager (designate) to reflect changing circumstances, and offer a more ‘user-friendly’ Service User Guide that would be given to all residents. It is stated in the Statement of Purpose that independence, privacy and dignity are encouraged, with the full involvement of family in all matters concerning the well being of service users. The Statement of Purpose also indicates the terms and conditions, which are discussed with service users and relatives prior to admission. A confirmation in writing is sent to the prospective resident before admission. Examination of four care files presented a solid foundation in securing a working care plan. It was acknowledged that the Care Manager (designate) has invested a substantial effort in reinforcing pre-admission, risk-based assessment, always carried out by a senior member of staff. The assessment in appreciated any special needs of the individual, includes cultural, social or personal needs, which are fully discussed and documented. This assessment initiates the process of care, each individual having a plan of care based on a daily living process. The Provider demonstrated through case tracking, that the assessor explained this information in respect of each individual to ensure a clear understanding is established. The Registered person also makes a judgement as to the suitability of each prospective service user using the same criteria. At all times the family is kept fully informed of the situation, offering service users and their relatives the opportunity to make an informed choice about where to live. Relatives spoken to were positive and appreciative of the communication with care staff and management. Crossways Residential Home DS0000020854.V335410.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): 7,8,9,10 and 11 The quality in this outcome area is good. This judgement is based on the examination of four care plans, discussions with service users, staff, managers, general observations and the Home’s medication system. The care assessment and planning system is an organised, yet personalised process offering meaningful and valid documentation of care administered. A broad vision of needs is addressed through the care planning process, meeting personal and health needs. It is recognised that this reflects an individual profile of needs, discussed fully with the family. The provision of a secure and safe medicines administration is managed efficiently. The Inspector was impressed with the confidence and closeness within the Home of staff, residents and visitors, and the mutual respect that prevailed. Staff were seen to demonstrate a personal empathy with residents through a respectful, yet friendly discourse. Crossways Residential Home DS0000020854.V335410.R01.S.doc Version 5.2 Page 12 EVIDENCE: Care records and case tracking demonstrated that this standard is well met, maintaining a good quality process of assessment. The pre-admission assessment represented the foundation for a well-considered care planning process. A profile of the service user’s social, physical and psychological status offered an individual plan of care, based upon activities of personal daily living, to be implemented and frequently reviewed. Each service user’s health, personal and social care needs are assessed in an individual plan of care that is reviewed monthly, including service users and relatives views, to reflect their changing needs. That review is more frequent, dependant upon the individual’s needs and clinical condition. The strength of purposeful planned care lies within the frequency of the review process in monitoring and adapting care profiles with family involvement. Risk assessments were carried out on an individual basis and frequently reviewed. Included in the care records were applications of established monitoring systems following a process of aims, care and evaluation models of monthly assessment. Case tracking confirmed the extent that the wellprepared care plans were appreciated by service users and relatives alike. Tissue viability, continence, psychological and special needs are assessed and documented, along with nutritional and pressure care screening, as appropriate. The GP service is supportive; through this service, arrangements are made to provide professional support. A District Nurse had been seen for those residents, whose records were examined, one on a twice-daily diabetic monitoring regime. A very ill resident requiring nursing care was seen to be comfortable, with an effective regime of care and attention in place, overseen by District Nurses. Continence is assessed on admission and promoted within the plan of care, and there was evidence that service users nutritional needs, and weights were frequently reviewed. There was evidence of a ‘Key worker’ carer, with whom staff maintain all aspects of service users personal care, overseen by the care management on a daily basis. The administration of medicines adheres to procedures to maximise protection to service users. The storage was secure with satisfactory added security for controlled drugs. A monthly audit of stocks, storage and administration has been introduced. A controlled drug register was available and found to be in order. Each service user has their own lockable facility in their bedrooms, for which certain creams and ointments can be stored. There is no prevailing Crossways Residential Home DS0000020854.V335410.R01.S.doc Version 5.2 Page 13 Homely Remedy policy, and no resident was self-medicating at the time. Staff training is appropriate and up to date. The Statement of Purpose, admission assessment and care plans are geared to engender a sense of individuality and privacy. These policies are reinforced with a staff induction programme and supervised practice. Case tracking confirmed that the policies were implemented, with all service users spoken with being complimentary of the degree of respect given, by each and every member of staff. The inspector observed the free, courteous interaction between service users and staff based on a level of confidence of mutual trust and respect. Relatives have freedom of visiting, emphasising on the importance of maintaining social contact. Adequate privacy policies exist for all toilet/bathroom areas and bedrooms. The routine of using information notices on furniture and doors is to be reviewed, to offer a more discrete environment. The policy and procedure on care of the dying and death were in place with the full knowledge of both service users and relatives. Individual spiritual persuasions were documented and individual diversity respected at all times. A monthly non-denominational holy communion is offered. Relatives are welcome to stay as long as they liked in times of stress, including overnight stay. Crossways Residential Home DS0000020854.V335410.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): 12,13,14 and 14 The quality in this outcome area is good. Routine is seen as flexible to acknowledge individuality, yet maintain a focal point for service users to latch on to without dictating events. Service users’ life-styles and interests are recorded in their care plan, discussed with their relatives prior to admission, and documented as far as possible to enhance a position of supported independence. Personal choice and relative selfdetermination are respected in policy and action. Those who wish to bring in personal possessions are encouraged to do so. Service users were offered a varied and nutritious choice of meals from a 4week rotating menu. Special diets were accommodated with the cook making every effort to engage with service users to discuss personal preferences. Staff were seen to offer discreet assistance to those who required it. EVIDENCE: Discussions with residents and staff clearly identified a relaxed atmosphere in which the service user’s needs were respected. A routine exists to establish a framework for managing the home, not as a yardstick for service users to Crossways Residential Home DS0000020854.V335410.R01.S.doc Version 5.2 Page 15 comply with. Several residents expressed their appreciation for the freedom they enjoyed, with the security that there are familiar events to the day they could relate to. Those service users’ rooms inspected showed a significant influence of personalisation in the inclusion of belongings, some furniture and general décor. A varied and useful in-house activities programme is provided by staff on a daily basis, and there is a visiting entertainer each month. Music and Movement sessions are held every two weeks. Examination of records show that such events as memory music, I-Spy, DVD music sessions and personal care items like nail care, hairdressing, movement sessions are popular. An individual record is kept as an integral part of care planning. The good standards of catering at Crossways offered an excellent service, to which service users spoken to were complimentary of all aspects of quality. A menu on a four weekly cycle offered a wholesome, varied and excellent choice. An excellent lunch was served during inspection, with choices available served in a well-furnished, and clean dining room. The cook indicated her ability to offer a suitable diet to meet diverse needs, although she had requested, and will be shortly attending a study day on the subject. Staff were seen to offer discreet assistance to those who required it. The choice of dining room, lounge or bedroom was at the discretion of residents. The kitchen was inspected with the cook and found to present a well equipped and organised area. All fridges and freezers were well maintained and checked daily by the kitchen staff. A cleaning schedule was in place recorded on a daily basis to evidence the high quality observed. It was acknowledged that a new floor and refitting of the kitchen was imminent. Crossways Residential Home DS0000020854.V335410.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): 16, 17 and 18 The quality in this outcome area is adequate The home had a meaningful complaints policy in place to ensure the protection of resident’s legal rights, identifying the CSCI as a resource to approach with a complaint or grievance. On discussions it was evident that any small matters were handled immediately, discretely and to the satisfaction of all concerned. The home has systems and procedures and to protect residents from abuse. EVIDENCE: Residents’ legal rights are protected by the systems in place in the home to safeguard them, including their contract, the continual assessment of care planning and policies in place i.e. the complaints procedure. The complaints policy was seen and records examined. There were few verbal complaints, which would be better dealt with through a formal ‘record of concerns’, to provide evidence in a meaningful and effective manner. On discussions it was evident that any small matters were handled immediately, discretely and to the satisfaction of all concerned. The overall policy of openness and transparency was acknowledged. On discussion with a resident, who felt uneasy with the manner of a member of staff, it was apparent that the manager was prepared to address the problem directly. Crossways Residential Home DS0000020854.V335410.R01.S.doc Version 5.2 Page 17 Discussion confirmed that there is a protocol and response procedure to anyone reporting any form of abuse, to ensure effective handling of such an incident. Evidence of a recent case identified a meaningful intent, and willingness to action protection to a vulnerable adult. The case had been handled by referral to a Social Services’ strategy group. Staff induction and in-house training programmes clarified and reinforce the responsibilities of all staff in their daily contact with service users, especially their privileged position in protecting service users from abuse, of all natures. The practical training requires a formal annual approach for all staff. Crossways Residential Home DS0000020854.V335410.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): 19,20,21,23,24,25,26 The quality in this outcome area is good. This judgement was based on discussions with residents, staff and a tour of the premises. The home is well appointed to meet the needs of an elderly population of service users in providing a safe and comfortable environment. On inspection bedrooms were personalised, with most displaying service user’s own furniture, and with personal belongings. All communal areas are of a good standard, offering social as well as private reflection, as the mood takes. The overall environment was found to be safe for service user’s comfort within risk assessed limits. The domestic services in the home were seen to be of a high standard, with no evidence of unpleasant smells or unsightly debris anywhere throughout the inspection. EVIDENCE: Crossways Residential Home DS0000020854.V335410.R01.S.doc Version 5.2 Page 19 There is adequate, newly surfaced parking space at the front of the building. Visitors and residents are able to take advantage of attractive patios, gardens and grounds; pathways were safe and recently attended to. It is planned to have a sensory garden section to benefit all residents. On admission the provider or care manager assesses each individual service users’ needs for equipment and necessary adaptations. Internal access was facilitated with ample fittings of hand and grab rails, in adequate, well-lit and airy corridors. Wheelchair access was satisfactory throughout all areas of the home. Bedrooms were well maintained to meet resident’s personal preferences. On inspection most bedrooms were personalised, with most displaying service user’s own furniture, and most with personal belongings. It is the policy that on bedrooms becoming vacant that each room is reappraised for redecoration, as confirmed during the Inspection. There is throughout a good standard of furnishing complimented with a variety of personal belongings. A decision to put down vinyl floor covering is presently under review. A resident who has requested a carpet will be fitted with one within the month. There were no other resident at the time complaining of the flooring. Double bedrooms have no provisions for privacy, requiring overhead curtain screening, and the removal of portable screens. Some windows of the old style have inadequate restrictors in place. Recent rain damage to a vacant double room needs urgent attention. It was advised that a valance on each bed would improve the presentation value of a more ‘homely’ appearance. Communal space including the welcoming entrance hall is furnished in domestic style and presents as having a homely atmosphere. All communal areas are of a high standard, offering social as well as private reflection, as the mood takes. The two lounge spaces allow activities to be presented in very pleasant areas of the home with furniture and fittings of good quality. The dining area is very well furnished and presented, to provide a conducive environment to enjoy a good meal. Corridors are wide enough for wheelchair access, well lit and with sufficient handrails. Fire equipment was inspected and seen to be serviced and up to date. One bedroom door magnetic firelock was not engaged, which was attended to immediately. The external and internal environment was generally well maintained and secure. Front windows have been repaired or replaced, and work on the rotting window frames at the rear is being tendered for. Heating and ventilation were found to be satisfactory and lighting was domestic in style. Aids, adaptations and equipment were available throughout the Home. The home presented a clean and pleasant, odour-free atmosphere, much to the credit of staff. To complement the presentation there were numerous floral and decorative displays. Crossways Residential Home DS0000020854.V335410.R01.S.doc Version 5.2 Page 20 Toilets are accessible to all, and within close proximity to all communal areas, the standard and presentation of all the toilets and bathrooms were of a good quality, clean, uncluttered and odour-free. Policies for handling soiled and infected linen were satisfactory. Each bathroom is to be supplied with a bath thermometer. Water temperatures were satisfactory. It was advised that items should not be stored on toilet cistern lids. Infection control figures highly within the staff induction and supervisory training programmes. Domestic staff were approached and were fully aware of the importance of infection control. An effective call system is installed; care staff reacted speedily to tests. The care manager expressed a willingness to meet any reasonable demand for special needs. A locked facility and lockable bedroom doors are in place. The evidence seen on inspection of service user’s rooms, and on discussion with the individual service users and family, assured that this standard was well met. Sluice facilities have suitable arrangements to assist in control of infection. Displaying appropriate COSHH posters, and information charts would enhance notices regarding chemical handling in the areas that store chemicals. Kitchen presentation showed good standards of cleanliness and evidence of sound food hygiene practices. The laundry was well organised and equipped to a good standard. A surplus stack of clothing is to be removed from store. Crossways Residential Home DS0000020854.V335410.R01.S.doc Version 5.2 Page 21 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): 27,28,29 and 30 The quality in this outcome area is good. Staffing levels were seen to be adequate to meet an expected demand for caring for 15 residents, the daily care staffing rota showed adequate balance between skills and qualifications, although there are lower levels at weekends, due to vacancy and sickness factors. The Provider and Care Management have established an improved procedure for interview, selection and appointment of staff, which requires continual reinforcement in ensuring the protection of service users. Staff training records complement the effort placed into staff training. EVIDENCE: There were 15 service users in the home on the day of the inspection, 6 of who receive care for dementia. Off-duties for weeks commencing 11/06/07, through to 24/06/07, were provided and examined; staffing levels were seen to be satisfactory. The daily care staffing rota showed adequate balance between skills, experience and numbers to provide a good standard of care. There is active attention to ensure consistent levels of staff at all times in anticipation of an increase in admissions, and in meeting the CSCI staffing notice. Crossways Residential Home DS0000020854.V335410.R01.S.doc Version 5.2 Page 22 An average coverage was seen to be: a.m - 1 senior 2 carers p.m - 1 senior 2 carers N.D - 1 senior 1 carer Shortfalls are usually made up with flexible rostering and overtime; agency staff are not used. The Care Manager (designate) is supported by a deputy, who each contribute to the rota. There are sufficient laundry and domestic staff over a seven-day period. There is a very experienced head cook, assistant, and 4 kitchen assistants established. There is a handymen/gardeners available for 16 hours a week. The staffing compliment on the day of the inspection was found to be satisfactory. The home reported that 14 care staff had obtained at least NVQ level 2, and several staff were reported to be enrolled on NVQ training. Most of the care, and support staff have a NVQ status, exceeding minimum expectations. 16 staff hold a valid first aid qualification. Documentary evidence confirmed an improvement in the quality of staff selection, recruitment effort and practice. Three staff files were sampled and found to be generally well organised. Each staff file would be more informative with a copy of job description, interview record to support the letter of appointment, and a suitable photograph of each staff member. Two members of staff were spoken with, each being pleased and satisfied with the foundation offered to them through effective management. All staff have a statement of terms and conditions. Service users are supported and protected by these practises and all new staff goes through an induction process that will ensure that they are going to be the right person for the home. The Registered Provider and Care Manager (designate) are committed to a learning environment. Staff induction programmes are meaningful and well established, forming the base upon which in-service supervision and training are planned. Overall the evidence shows a satisfactory account of a training programme and record that offers a full understanding of training needs. This would be enhanced with a more focussed, date specific planning element to the schedule to evidence mandatory and supportive training cycles. Evidence showed a diligent attention to on-the-job practical supervised training, involving a shared aspect of responsibility between staff and trainer. There is a continuing need to extend this process by involving general working arrangements to offer a substantial commitment to the supervision and appraisal process through delegated responsibilities to encompass all staff in the process. Crossways Residential Home DS0000020854.V335410.R01.S.doc Version 5.2 Page 23 Crossways Residential Home DS0000020854.V335410.R01.S.doc Version 5.2 Page 24 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): 31,32,33,34,35,36,37 and 38 The quality in this outcome area is good. The influence of positive leadership in support for the Care Manager (designate) has been significantly enhanced over the past 3 months, and from the last inspection. This accountability has resulted in a much-improved level of performance through a broad avenue of issues, especially in improvement of involving families and residents in the process of care, staff appointments and management, and the supporting infrastructure of services within the environment. EVIDENCE: Crossways Residential Home DS0000020854.V335410.R01.S.doc Version 5.2 Page 25 The Care Manager (designate) of the Home accompanied the inspector for the day. Lisa Allsopp has demonstrated her capacity as suitably qualified and experienced to manage the day-to-day care needs of service users. She has a NVQ levels 3 and 4, and has enrolled to undertake the Registered Managers Award programme. There is a recognised need to ensure that a full working knowledge of the Care Standards Act with Regulations is achieved prior to a speedy application for Registered Manager. The inspector was impressed by the openness and confidence in the observed interactions of staff, relatives and service users. The relationships were seen to be of mutual trust and respect. The Registered Provider, Area Manager and Care Manager (designate) have developed a formal approach to monitoring quality across a broad range of activities. This includes a care plan review process that is recorded at least once a month focussed on family and resident involvement, a staff training programme and a risk assessment programme. It is expected that a full risk appraisal would generate the setting of objectives, effective budgeting of plans and target dates to aim for. Evidence was secured to acknowledge achievements from the last inspection, and ongoing, planned objectives. Involved within this process are the views of residents and relatives, confirmed at case tracking and informal discussion. Social Workers’ review meetings are often a vehicle for assessing quality. Files inspected evidenced a satisfactory standard of maintenance and security, with ongoing attention to upgrading and refurbishment. The Provider was asked to draw up and provide CSCI with a development plan for 2007/08/09. Care plans were drawn up, implemented and reviewed on a monthly basis. This process has been enhanced with the inclusion of service users and relatives whenever possible. Case tracking and informal discussion provided evidence that participation is encouraged on an informal level. A sample of administrative, maintenance and care records were examined and found to offer an accurate reflection of a service committed to providing a safe and comfortable environment for elderly service users. These included procedures for a code of conduct, first aid, and Movement and Handling. Service records for water supplies, gas, disposal of sharps, and maintenance of fire equipment were examined. Routine maintenance ensures that essential services linked to utilities and safety, are monitored and serviced on a regular basis. The monies of two service users and records were checked at the inspection and there were no discrepancies. The home does not act as agent for any of the current service users. A annual, independent audit was recommended. Fire safety remains high priority for all staff evidenced in routine maintenance checks, regular fire drills and frequent staff training sessions are organised on a mandatory basis. Crossways Residential Home DS0000020854.V335410.R01.S.doc Version 5.2 Page 26 Accidents were seen to be addressed, risk assessed, actioned in an effective way, with access to Riddor if needed. Maintenance of the accident record is required to facilitate a 3-monthly analysis of cause and effect. The administration and management of the home is effective, uncomplicated, and very sensitive to the needs of service users. Crossways Residential Home DS0000020854.V335410.R01.S.doc Version 5.2 Page 27 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 3 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 2 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 3 3 3 3 3 Crossways Residential Home DS0000020854.V335410.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard OP32OP32 OP1 Regulation 8 1 Requirement The Care manager is registered with the CSCI. A copy of the Care Standards Act be made available Timescale for action 01/08/07 01/07/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 Refer to Standard OP19 OP19 OP19 OP1 OP24 Good Practice Recommendations The kitchen floor be replaced and units replaced . Exterior (rear) window frames must be repaired. Windows be restricted effectively Service users Guide will need to be updated. A re-furbishment plan be drawn up to address DS0000020854.V335410.R01.S.doc Version 5.2 Page 29 Crossways Residential Home improvements for 2007/08/09. 6 7 8 9 10 11 12 13 14 15 16 17 OP30 OP38 OP38 OP38 OP30 As a course of good practice COSHH posters should be located in areas where chemicals are stored Establish abuse training for all staff on an annual basis. Replace portable curtain screens with overhead tracked rails Bath thermometers be sited in each bathroom. Accident sheets should be filed following inspection and a 3-monthly analysis log created for auditing purposes. A photograph would enhance all staff file records The practice of storing items on toilet pedestal lids cease That an internet connection be established. That each divan bed be provided with a valance. An external annual audit of cash flow management be conducted. Discourage the use of (paper) instructions on furniture, doors and corridors. That the stack of surplus clothing be discarded. Crossways Residential Home DS0000020854.V335410.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Birmingham Local Office 1st Floor, Ladywood House 45-56 Stephenson Street Birmingham B2 4UZ 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. Extracts may not be used or reproduced without the express permission of CSCI Crossways Residential Home DS0000020854.V335410.R01.S.doc Version 5.2 Page 31 - 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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