Inspection on 23/01/06 for Crowmoor House

This inspection was carried out on 23rd January 2006.

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

Crowmoor House 18/09/07

Crowmoor House 20/04/06

Crowmoor House 23/08/05

Crowmoor House 05/01/05

Crowmoor House 30/07/04

Similar services:

Maple Lodge

Heathlands

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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 Keith Salmon Announced Inspection 23rd January 2006 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.V268216.R01.S.doc Version 5.1 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.V268216.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Crowmoor House Address Frith Close Monkmoor Shrewsbury Shropshire SY2 5XW 01743 235835 01743 340804 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 Mrs Catherine Ann Wallington Care Home 58 Category(ies) of Old age, not falling within any other category registration, with number (58) of places Crowmoor House DS0000032792.V268216.R01.S.doc Version 5.1 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. 23rd August 2005 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 six individual units, five of which provide long-term accommodation, the sixth offering respite care with a maximum of two places allocated for rehabilitation. This latter service is managed in partnership with the local Primary Care Trust. The Inspector was informed this Unit would offer ‘Respite’ only with effect from April 2006. The Registered Manager is Mrs. Catherine Wallington under the auspices of Shropshire Social Services. Crowmoor House DS0000032792.V268216.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Unannounced Inspection, undertaken by one Inspector, commenced at 09.30 and lasted 5.5 hours. This Report is a product of observations made during a tour of the Home, through discussions with 8 Residents, 3 Visitors, the Registered Manager and several members of Staff. In addition, a review was undertaken of care related documentation, staff recruitment/ deployment records, and a range of documents/records reflecting the general operation of the Home. The overall ambience of the Home presents a friendly and open atmosphere with Residents enabled to conduct their ‘day’ as they wish. This was strongly reflected in ‘one to one’ discussions with Residents whose comments included:”I’m really pleased my family found this Home for me...”, “The Staff are always very kind to us and do everything they can for us…”, “I’m very happy with the standard of care my Relative receives at the Home…”, “They do lots of things to keep us entertained, trips out and the food is good…”. During the weeks immediately prior to this Inspection the Home had reported to the CSCI two incidents relating to the administration of medicines. It is alleged these incidents arose from written procedures not being properly followed, and although the two Residents involved were in no way harmed the incidents are being fully investigated through Adult Protection procedures. What the service does well: What has improved since the last inspection? Crowmoor House DS0000032792.V268216.R01.S.doc Version 5.1 Page 6 Six out of eight Requirements specific to the management of medicines, and three out of five other Requirements have been fully met. 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. Crowmoor House DS0000032792.V268216.R01.S.doc Version 5.1 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.V268216.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,6. Pre-admission information is sufficient to enable prospective Residents to make an informed decision regarding entering the Home, and their rights are protected by a written Contract. Processes to ensure appropriate and thorough care needs assessment, prior to admission, are diligently and effectively applied. Residents admitted for the purpose of rehabilitation receive care appropriate to their assessed care needs. EVIDENCE: Review of documentation demonstrated the Home has a Statement of Purpose and User Guide, both of which are concise, easy to read and contain content, which meets the requirements of the Standard. Service Users are provided with a Statement of Terms and Conditions detailing the accommodation to be provided. Evidence from 10 randomly selected Care Plans showed the Registered Manager, or Deputy Manager, assess all prospective Service Users prior to admission, and prospective Residents have the opportunity to visit the Home, or enter the Home on a trial basis, prior to admission. With effect from April 2006 it is planned the Home will cease admitting people for ‘rehabilitation’. In the light of this the Responsible Individual should apply to Crowmoor House DS0000032792.V268216.R01.S.doc Version 5.1 Page 9 the CSCI for a variation of the Homes ‘categories of registration’ to ensure registration is in line with activity. Crowmoor House DS0000032792.V268216.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9. The model of Care Plan utilised by the Home is of an effective design, which is diligently applied in aiding the provision of care, pertinent to Residents’ assessed care needs. The systems for storage, administration, and disposal of medicines have been improved since the previous Inspection. However, incidents related to medicines administration indicate that there are still issues to be addressed. EVIDENCE: Eight Care Plans were examined, and showed care planning documentation is well organised, current, clearly written and comprehensively encompasses the range of ‘care areas’ necessary to ensure the delivery of care appropriate to the needs of each Resident. There was clear evidence of regular monthly review. During the weeks immediately prior to this Inspection the Home had reported to the CSCI two incidents relating to the administration of medicines. These incidents, it is alleged, arose from written procedures not being properly followed, and although the two Residents involved were in no way harmed, the incidents are being fully investigated through Adult Protection procedures. Prior to those incidents the Home underwent an in-depth Inspection of medicine management by the CSCI Pharmacist Inspector. Eight Statutory Requirements were made of which six have been met. The one outstanding Crowmoor House DS0000032792.V268216.R01.S.doc Version 5.1 Page 11 Requirement relates to the re-writing of the Home’s Medicine Management Policies and Procedures – this has been submitted to the CSCI Pharmacy Inspector for comment/approval. It is noteworthy the Home has completed a re-assessment of the capabilities of all Staff approved to administer medicines. However, despite this incidents are still occurring which relate to errors in medicine administration. Crowmoor House DS0000032792.V268216.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13,14,15. The Home facilitates achievement of desired lifestyle through Residents conducting the pattern of their day as they wish. This includes contact with family and friends and continuation of religious practices. Meals are of a good, homely type, offering both choice and variety, with catering for special dietary needs. The Home is well integrated into the Community and its’ activities. EVIDENCE: Visitors spoken with confirmed they are always welcome at the Home and are kept well informed regarding the wellbeing of their Relative/friend. The Home holds monthly Residents’ meetings the discussion and decisions of which form the basis of a weekly newsletter. The Home provides a printed menu, the contents of which appeared well-balanced, nutritious, and varied. Residents spoken with all commented the food was plentiful and to their liking. Crowmoor House DS0000032792.V268216.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18. The interests of Residents are protected through ready access to the Home’s Complaints Procedure and information relating to advocacy services. Staff are clearly aware of their role in protecting Residents from abuse. EVIDENCE: There are policies and procedures in place to facilitate protection of vulnerable people which meet the requirements of this Standard. Evidence was observed in Staff files confirming this topic is covered, both at induction, and through on-going staff training. Crowmoor House DS0000032792.V268216.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 21,22,23,24,26. The Home provides a safe and pleasant environment. Well decorated, clean, and maintained to an acceptable standard, it possesses a homely and congenial atmosphere. Residents have access to lavatory and washing facilities, together with specialist equipment consistent with their needs. EVIDENCE: A tour of the building demonstrated issues cited as ‘Requirements’ at the previous Inspection had been partly remedied. Communal wash-hand basins (e.g. located in bathrooms and toilets) now have provision of liquid soap and paper towels. The programme to remove vanity units from bedrooms in order to give Residents more usable space is on-going with completion expected to take in excess of 12 months. Crowmoor House DS0000032792.V268216.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29, 30. On the surface it appears Residents’ needs are being met. However, there are indications that Staff, particularly Management and Senior Care Staff, are being subjected to excessive levels of stress in working to ensure this aim. Recruitment and employment practices are consistent with the safeguarding of Residents. The Home has a strong and effective commitment to staff training, which is exemplary. EVIDENCE: Discussions with members of management indicated that for some time they have found the management task over-stressful and believe their numbers are insufficient. On a more objective front, the Home has undergone an in-depth Inspection of medicines management by the CSCI Pharmacy Inspector. A number of Statutory Requirements were issued and most have been met, including re-assessment of the capabilities of all Staff approved to administer medicines. However, despite this there are still incidents occurring which relate to medicine administration. The previous Inspection Report adjudged the Home occasionally fell short of having sufficient support staff (housekeeping/domestic) and a Requirement relating to this was cited. Although the Home has now recruited to full establishment for support staff, there are indicators which suggest the problem may not rest solely with the numbers of Staff, but be generalised – particularly the numbers of Senior Care Staff. It is possible the numbers of Senior Care Staff is insufficient to achieve effective day to day management cover – a factor which, in turn, may be exacerbated by managing the Home as six discrete Units. Crowmoor House DS0000032792.V268216.R01.S.doc Version 5.1 Page 16 In the light of the Inspector’s concerns relating to staffing, the background of recurring medicine administration errors and the related Adult Protection investigation, it is a Requirement of this Report the levels and skill-mix of staffing, and the model used to manage the six units must be reviewed and issues arising resolved. Staff Personal Files demonstrated evidence of full compliance with the Standard and Schedule 2 of the Regulations. In excess of 90 of Care Staff have attained NVQ Level 2 and the Home’s commitment to training is to be commended. Crowmoor House DS0000032792.V268216.R01.S.doc Version 5.1 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,36,38. The Home has excellent leadership from the Manager who is very well supported by longstanding and experienced Staff. The ambience of the Home is warm, friendly and inclusive. Operationally, the Home is very well organised, with the central purpose being ‘the best interests of Residents’. Lines of accountability are clearly set out and observed. Staff are subject to effective support, with regular supervision, and appeared involved and happy in their work. EVIDENCE: The Registered Manager has many years experience as a Care Manager and is clearly closely involved in the day-to-day ‘hands-on’ management, as well as strategically. The Inspector observed Residents and Staff were able to approach the Registered Manager, and her Deputy, with a range of issues, all of which were received in an interested and involved manner. Crowmoor House DS0000032792.V268216.R01.S.doc Version 5.1 Page 18 The tour of the Home showed that ‘COSHH’ materials are appropriately stored and documentation confirmed equipment is regularly serviced and maintained. Crowmoor House DS0000032792.V268216.R01.S.doc Version 5.1 Page 19 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 3 3 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 X X 3 3 3 2 X 3 STAFFING Standard No Score 27 2 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X 3 X 3 Crowmoor House DS0000032792.V268216.R01.S.doc Version 5.1 Page 20 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. Standard OP9 Regulation 13.-(2) Requirement The policy and procedures document for the safe handling of medicines within the Home must be amended and up-dated to include the comments made by the Pharmacist Inspector. The remaining vanity units in bedrooms must be removed. The levels and skill-mix of staffing covering shifts throughout 24 hours, and the model used to manage the six units, must be reviewed and issues arising resolved. Timescale for action 28/02/06 2. 3. OP24 OP27 12.18.(1)(9)(a) 31/03/07 31/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Crowmoor House DS0000032792.V268216.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Crowmoor House DS0000032792.V268216.R01.S.doc Version 5.1 Page 22 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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