Inspection on 18/09/07 for Crowmoor House

This inspection was carried out on 18th September 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 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

Crowmoor House 20/04/06

Crowmoor House 23/01/06

Crowmoor House 23/08/05

Crowmoor House 05/01/05

Crowmoor House 30/07/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Crowmoor House Frith Close Monkmoor Shrewsbury Shropshire SY2 5XW Lead Inspector Pat Scott Key Unannounced Inspection 18th September 2007 09:30 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 Crowmoor House DS0000032792.V344796.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. Crowmoor House DS0000032792.V344796.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Crowmoor House Address Frith Close Monkmoor Shrewsbury Shropshire SY2 5XW 01743 235835 01743 340804 jan.patterson@shropshire-cc.gov.uk 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) Shropshire County Council vacant post Care Home 58 Category(ies) of Old age, not falling within any other category registration, with number (58) of places Crowmoor House DS0000032792.V344796.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home may admit from time to time two (2) service users between the ages of 60 to 65 years for the purpose of rehabilitation. 8th January 2007 Date of last inspection Brief Description of the Service: Crowmoor House is a large Care Home situated in the Monkmoor area of Shrewsbury and owned by Shropshire County Council. Built about twenty years ago it is single storey and comprises three units which provide long-term and respite accommodation. Fees for Crowmoor House are £345.07 and are reviewed on an annual basis. The statement of purpose and service user guide are available in the home. Up to date inspection reports are also available to view. Crowmoor House DS0000032792.V344796.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A range of evidence was used to make judgements about this service. This includes: information from the provider, staff records kept in the home, medication records, discussion with people who use the service, discussions with the staff team, discussion with the manager, tour of the premises, previous inspection reports, quality assurance process, Fire Authority reports, Environmental Health Office reports. What the service does well: What has improved since the last inspection? Refurbishment has occurred in bedrooms and communal areas with a commitment to maintain the improved décor of the home. The manager has ensured that the physical environment of the home provides for the individual requirements of the people who live there. The living environment is appropriate for the particular lifestyle and needs of the residents and is more homely, clean, safe, comfortable and well maintained. Service users spoken to feel that the home looks fresher and is more pleasant to live in. Crowmoor House DS0000032792.V344796.R01.S.doc Version 5.2 Page 6 Medication systems have been reviewed and implemented. The improved approach for storage of in-use medicines and administration in service user’s own bedrooms allows for private one to one contact where any concerns or anxieties can be addressed. 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. The summary of this inspection report can be made available in other formats on request. Crowmoor House DS0000032792.V344796.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Crowmoor House DS0000032792.V344796.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Key Standard 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Written records for the admission of new people to the service demonstrate that the process is personalised and that consideration has been given to all aspects of care. EVIDENCE: Discussion with the manager established that the service maintains preadmission and admission records. The Single Assessment paperwork is provided through the care management process. The assessment information forms the care plan based on the individuals needs. The manager keeps copies of the assessment summary and care plans of those carried out through care management arrangements. The service has identified that it could improve the timescales in which it receives assessment paperwork Crowmoor House DS0000032792.V344796.R01.S.doc Version 5.2 Page 9 from the care management team. A service user spoken with stated that he had provided information to the manager prior to coming to live at the home. Crowmoor House DS0000032792.V344796.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Key Standards 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service aims to address and meet assessed need through the continued development of plans of care, so that service users are provided with more person centre care. The manager understands the need to comply with safe medication systems and staff practice ensures that the home’s procedures are complied with and that service users health matters are always safely addressed. The actions of staff and their approach to care ensures that service users are treated with respect and their right to privacy is upheld. EVIDENCE: The care plans have a standard tick box format which allows for planning information to be recorded on the back. Of the four seen the detail was not Crowmoor House DS0000032792.V344796.R01.S.doc Version 5.2 Page 11 enough to provide clear direction to staff on how they are to deliver care. The recording was not written in a way that demonstrates personal preferences and wishes are taken into account. A pressure relief care plan did not state the type of equipment used. Tick boxes of need are not always updated to reflect change in circumstances, for example one service user had it recorded that they are on oxygen therapy which in fact is now discontinued. The manager stated that the new care plan format has been introduced and is being trialled for its effectiveness as a working tool for staff. Risk assessments are in place. The service has introduced a nutritional risk assessment process which is identifying problems at an early stage so appropriate intervention can take place. There is evidence that service users are involved in their care as signatures were seen on the care plans. Service users all appeared well groomed with their hair, nails and clothes looking clean. No issues were identified in discussions regarding approach of staff or being assisted with intimate tasks. Significant improvement has been made in the management of medication following consultation with service users. Service users have their personal inuse supply stored in a locked cabinet in their bedrooms. Staff procedures direct them to administer medication individually within their rooms which is dignified and respectful practice. Times of administering medication have been reviewed on an individual basis with their GP to facilitate this approach. Medication audits within the home have evidenced that less mistakes are made using this method. A main storage cupboard is provided for stock items and controlled medication within the home. Crowmoor House DS0000032792.V344796.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Key Standards 12,13,14,15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users are provided with social activity and can keep in contact with family and friends. Social, cultural and recreational activities meet service user’s expectations through assessment, consultation and choice. Residents receive a healthy diet according to their assessed requirement and preference. EVIDENCE: The assessment process demonstrates that social/leisure pursuits are addressed prior to admission in a personalised way for the individual. Once living at the home, social activities are provided and the service shows that this is based on service user consultation through regular service user meetings regarding all aspects of living at Crowmoor House. Planned activities are displayed around the home. An activity group is in place with the involvement of three service users. Leisure pursuits and hobbies are organised for regular dates in the home and for days out/trips etc. Service users helped organise stalls for the summer fayre held at the home. Many external events have recently taken place and Crowmoor House DS0000032792.V344796.R01.S.doc Version 5.2 Page 13 include: shopping trips to Telford, trips into Shrewsbury. Extend classes are held. Yoga class was taking place during the inspection. All service users spoken with said they liked the food and it is always nicely cooked. One service user said she is very, very happy in the home and enjoyed going out. Quality surveys conducted by the service identified service users are very satisfied with the meal provision and that the chef cooks ‘lovely soups’. Relevant staff have had food hygiene training. Menus are displayed around the home and staff assist service users with their choice each morning. Crowmoor House DS0000032792.V344796.R01.S.doc Version 5.2 Page 14 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): Key Standards 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service has a complaint procedure which is accessible so that people who use the service have information of how to make complaints about the home. Training is provided so that service users are protected from abuse and have their legal rights protected. EVIDENCE: Service users spoken to say that they would go to the manager or one of the staff if they had a problem. All expressed confidence that issues would be dealt with. Records show that concerns spoken about by service users had been promptly dealt with and a satisfied outcome reached. An anonymous complaint regarding staff practice had been appropriately responded to with full information having been provided to the CSCI. This was within the home’s timescales for dealing with complaints. A suggestion box is in the foyer for all to use. The manager keeps records of action taken to respond to suggestions made. Feedback is written into the newsletter. Staff files examined had details of attendance at adult protection training. Crowmoor House DS0000032792.V344796.R01.S.doc Version 5.2 Page 15 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): Key Standards 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home has improved, through service user choice, so that they live in a safer, better-maintained and comfortable environment, which encourages independence. EVIDENCE: The manager spoke of the refurbishment improvement plan which has been achieved and of the further work in progress. All areas seen around the home are clean and rooms personalised and decorated according to the wishes of those service users occupying them. This has been welcomed by those living at the home and many favourable comments were made about the decoration. The choice and style of furnishings respects the diversity of service user groups regarding preference; for example not all elderly service users wanted ‘older style’ bedding and lampshades and wanted a fresh modern feel to their private space. The service has respected this viewpoint. Crowmoor House DS0000032792.V344796.R01.S.doc Version 5.2 Page 16 Staff do not currently wear uniforms but procedures to minimise infection are in place and used by staff such as gloves, aprons etc. Management are reviewing the non-uniform policy. However, bedrooms do not have en-suite toilet facilities and many commodes are used. Commode pots are emptied in the sluice rooms. They are also cleaned within these rooms and are disinfected by hand which is not good infection control practice Crowmoor House DS0000032792.V344796.R01.S.doc Version 5.2 Page 17 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): Key Standards 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff in the home are being trained and are in sufficient numbers to fill the aims of the home and meet the changing needs of service users. EVIDENCE: Staffing rotas are in place and a board displays the daily staffing compliment in the office. Numbers and skill mix have been reviewed with the outcome that less agency staff are used and more staff deployed at the times of day that service users require care. NVQ training is provided and the minimum ratio of 50 trained staff being at level 2 has been exceeded. Staff files kept in the home evidence the induction process provided for new starters. Initial training such as infection control, manual handling, first aid and medication are provided. Other recent training provided includes; infection control and medication. After induction, candidates are assessed for suitability to move onto NVQ training. Staff turnover in the home is low so that continuity of care is provided. The service users know the staff very well and observation showed that they provide a personal but professional service. Crowmoor House DS0000032792.V344796.R01.S.doc Version 5.2 Page 18 Service users commented that staff are ‘very kind’, ‘excellent’ and ‘wonderful staff, I love coming here”. The service does not keep recruitment files on site. Two staff files were viewed at Shropshire County Council human resources office on 25/9/07. These records showed that all required checks had been completed before the employees started at the home. However, lack of recruitment information held on site at the home, does not allow any potential manager to have access to information about staff experience and skills. Crowmoor House DS0000032792.V344796.R01.S.doc Version 5.2 Page 19 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): Key Standards 31,33,35,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management and administration of the home is based on openness and respect and with effective quality assurance systems and audits in place, service users are assured that the overall conduct of the home is being well managed. EVIDENCE: The manager’s practice is service user focussed and customer satisfaction is high on the agenda. This is evidenced by the commitment to conducting service user surveys twice yearly, regular service user meetings that are minuted and held on each unit and a whole home meeting every six months. Surveys results seen are collated and an action plan developed to address any points raised. Changes are then made in the daily management of the home to Crowmoor House DS0000032792.V344796.R01.S.doc Version 5.2 Page 20 reflect the outcomes of the surveys. For example, service users were consulted about the kind of type size and colour they preferred to read in the service user guide. The result was that they would like bold typing on capitols which has been carried out. Medication systems have been altered in accordance with service user wishes. Quality surveys are also carried out for short term respite care and service user are asked to compete these two days before discharge. People who use the service say that they trust the staff and feel safe in the home. One stated that the management “consistently offers good care” and a returned survey stated “I would recommend Crowmoor to the Queen”. The annual quality assurance assessment by the home identified where the provider suggests they could do better. The manager has an action plan to address these areas, such as, improving security for entry into the home. Record keeping systems have improved. All records seen are written in a way that shows the service listens to the people who use it. What people say is heard, acted upon and reviewed and elements of the annual quality self assessment were seen to be in place. e.g. redecoration and quality assurance processes. Fire and hot water testing records were seen to be in order. Risk assessments for the management and safe working practices in the home are in place. The manager intends to review and improved these. Crowmoor House DS0000032792.V344796.R01.S.doc Version 5.2 Page 21 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 4 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 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 3 X 3 X 3 X X 3 Crowmoor House DS0000032792.V344796.R01.S.doc Version 5.2 Page 22 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP26 Good Practice Recommendations The provider should consider installing thermostatic sluice disinfectors in addition to the existing facilities due to the large amount of commodes used. This would reduce the possibility of cross-contamination through disinfecting by hand. Care plans should be written in a person centred way providing clear information for staff. Staff recruitment files are held at the personnel office in County Hall. The service should maintain copies of relevant documents such as criminal record check outcomes, references, skills and experiences of staff within the home. The manager needs to have access to this information so that she/he can deploy staff appropriately DS0000032792.V344796.R01.S.doc Version 5.2 Page 23 2 3 OP7 OP29 Crowmoor House to care for service users. Crowmoor House DS0000032792.V344796.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate Shrewsbury SY2 5DE 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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