Inspection on 11/01/07 for Crowtree House

This inspection was carried out on 11th January 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

Crowtree House 09/02/09

Crowtree House 19/09/05

Crowtree House 25/04/05

Crowtree House 04/11/04

Crowtree House 17/05/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Crowtree House 39 Crowtree Lane Louth Lincolnshire LN11 9LL Lead Inspector Mr David Bacon Key Unannounced Inspection 11th January 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 Crowtree House DS0000041717.V323976.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. Crowtree House DS0000041717.V323976.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Crowtree House Address 39 Crowtree Lane Louth Lincolnshire LN11 9LL 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) 01507 602653 01507 600312 www.lincolnshire.gov.uk Lincolnshire County Council Mrs Kathleen Goodacre Care Home 25 Category(ies) of Dementia - over 65 years of age (5), Old age, registration, with number not falling within any other category (18), of places Physical disability (2) Crowtree House DS0000041717.V323976.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service Users within the category of PD are aged between 55 and 64 years inclusive. 19th September 2005 Date of last inspection Brief Description of the Service: Crowtree house is owned by Lincolnshire County Council and is situated in the small market town of Louth. There is public transport, which enables visitors and relatives to visit the care home. The home itself is situated in a residential area close to Hubbards Hills a local beauty spot. Crowtree House is a resource unit, which provides intermediate care, short stay and day care services for male and female service users. The home no longer accepts service users for long-term placements, but continues to offer accommodation for some service users who were placed prior to this change in policy. The home is registered for 25 service users; this includes five service users over 65 with dementia, 18 service users who form the category of old age and 2 service users who are older people with a physical disability. The home is set within its own grounds, there is a car parking at the front and side of property, in addition to on road parking. The home is managed by an experienced manager. Crowtree House DS0000041717.V323976.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This site visit took place over 4.5 hours; it was unannounced and was carried out by one inspector. A tour of the premises was conducted, service users care records and staff records were inspected along with general administrative systems, policies and procedures. The care received by three service users was looked at in detail. This process is called “case tracking” and individual service users care records and other home records were looked at as part of this. The inspector spoke with five staff members and the registered manager. The service users identified in the case tracking exercise were spoken with where possible and three other service users were asked about the standards of care provided. Feedback was also received prior to the visit from fifteen questionnaires completed by service users. Ten of the homes own recently completed satisfaction surveys were also viewed. The range of fees is assessed per individual and charged up to a maximum of £300 per week. What the service does well: Crowtree House is a very well run service that overall receives consistently high levels of satisfaction from those who use the service. Service users comments included: “The staff are wonderful”. “I now have the confidence to get back on my feet”. “I can’t find any faults”. “I definitely received the care I needed there”. “I love staying here because I get wonderful care, the care I need”. “They couldn’t do enough for me”. The staff team are well trained, motivated and supervised and there are particularly good recruitment procedures to protect those who use the service. The environment is well very maintained, safe, warm and clean and is well regarded by service users who feel the home is “comfortable” and “homely”. There are very good systems for seeking the views of service users and their representatives and service users rights are promoted. The quality of food is good, it is enjoyed by service users and there is a choice. Crowtree House DS0000041717.V323976.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. Crowtree House DS0000041717.V323976.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 Crowtree House DS0000041717.V323976.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): 2, 3, 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are satisfied with the homes admission processes although they are not fully involved in the devising of their care plan or aware of information about the home or their rights. EVIDENCE: The service users spoken with were fully satisfied with Crowtree House’s admission process although they were not aware of any written literature regarding the homes provision of services, terms and conditions or if they had been involved in the assessment process to establish their individual care needs. Comments included: “I really can’t remember coming here but they would have been no different to how they are now”. “I have been to the other local authority place, which is good but they are magic here”. “I was too poorly to remember coming here but I do know they have treated me better than I could have ever expected”. “I can’t recall receiving any information, I Crowtree House DS0000041717.V323976.R01.S.doc Version 5.2 Page 9 don’t know much about the place”. “Just tell your readers that the care here will get them back on their feet”. Crowtree House now only accepts referrals for service users requiring shortterm care and those being part of the intermediate care service. This can result in service users being admitted with little notice and therefore create difficulties for staff in obtaining sufficient information prior to admission to thoroughly assess individuals care needs. These difficulties were partially evidenced in the service users care records seen. For example, whilst admission checklists are in place to establish service users care needs these are not fully used. An assessment of each service users care needs is undertaken although records do not fully document where service users are involved in this and some formal risk assessment information is sporadic and not identified within an overall assessment of risk. It is acknowledged that other care records do identify risks but the system would benefit from being reviewed to enable staff to identify service users needs more easily. Service users are provided with a contract of stay, information about the services provided and regarding their individual rights although this is not always signed as received and the service users spoken with were not fully aware of this information. Admission policies and procedures are in place, providing guidance to staff and the information provided to service users about the service provision is clear and jargon free. Crowtree House DS0000041717.V323976.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): 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 users spoken with are satisfied with standards of care, they feel they are treated with respect and the homes care records provide staff with sufficient information to meet service users care needs. Procedures for the administration of medication are appropriate. EVIDENCE: Information gathered from the service users spoken with and from within the completed quality satisfaction surveys seen identified high levels of satisfaction about the standards of care provided and that service users felt they were treated respectfully. Service users confirmed that they were encouraged and supported to maintain their independence and any skills to return back to their own homes. Comments included: “The service is very good and the staff wonderful”. “It’s brilliant, like the Ritz”. “It has enabled me to gain confidence”. “The staff are very kind and helpful”. “I’ve been before and I look forward to coming back and that is saying something”. “Any and every need is met by the wonderful staff here but they help you to get better”. “If Crowtree House DS0000041717.V323976.R01.S.doc Version 5.2 Page 11 anyone tells you they could do better elsewhere then I would like to speak with them”. “Yes, of course they respect your dignity”. A formal risk assessment is undertaken of each service user although some of this information mainly focuses on mobility needs. Other relevant risk information is detailed in the main care plan. Records do not clearly document where service users are consulted with about their care plan or about life within the home. Care records were generally updated daily and following any changing care needs and they were regularly reviewed to provide staff with clear indicators as to service users wellbeing and their progression towards returning home, where relevant. Records clearly identified any specific health care needs and how these were being met by supporting agencies. The homes medication system was well maintained and documented medicines as receipted into the building, where administered and as disposed. Medicines are securely stored and staff whom administer medication receive awareness training regarding this and policies and procedures provide guidance to staff. Improved facilities have now been created to safely store service users own medicines in their private accommodation to further assist them in maintaining independence. Crowtree House DS0000041717.V323976.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): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The services users enjoy the food provided by the home, they can choose how they spend their time and their visitors are made welcome. The homes provision of activities do not consistently provide sufficient stimulation for service users. EVIDENCE: Policies and procedures are in place clearly detailing how service users rights, independence and choices are to be promoted and met. This information is provided to service users and maintained in each bedroom although the service users spoken with were not fully aware of this. The service users spoken with confirmed that they were able to spend their time as they liked, that their individual rights were promoted and that any visitors were made welcome. Comments included: “If I can say that if you are feeling poorly or need a pick me up then this is truly the place to be”. “I can’t remember receiving information about the place but it hasn’t stopped me receiving the best care there is”. “You can tell everyone from me that you couldn’t wish for better care or treatment to get you better again”. Crowtree House DS0000041717.V323976.R01.S.doc Version 5.2 Page 13 Staff initially receive information regarding promoting service users rights during induction to the home and policies and procedures are included within the homes staff handbook. A menu is produced, which is regularly updated to meet the preferences of service users and a choice of foods is available at each mealtime. The home cook was aware of individual service users dietary needs and said that the majority of meals are home produced. A kitchen staff member will meet with every service users each day to establish individual choices and preferences regarding meals. A record of all meals provided is maintained along with equipment temperature records and a cleaning schedule. The service users spoken with expressed high levels of satisfaction regarding the homes meal provisions. Comments included: “Very good meals”. “Lovely”. “I generally enjoy the meals”. “If you don’t like something then they will offer you something else”. “Imagine a hotel, the food is lovely, plenty of it and the quality is nice”. The home has recently been awarded three stars for its food hygiene. The manager said that a variety of activities are made available to service users by the homes care staff although the service users spoken with were not fully aware of these and there are insufficient activities provided overall to meet service users recreational needs. The manager said that activities were regular but not fully recorded and agreed to address this. Crowtree House DS0000041717.V323976.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): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users feel that they can voice any concerns about the service should they wish to. There are clear procedures in place to protect service users from abuse and staff are made aware of the homes whistle blowing and safeguarding adults policies and procedures. EVIDENCE: There have been no formal complaints or safeguarding adult referrals made since the last inspection visit. The manager said that one complaint had recently been received but that this was currently being investigated. The homes complaints procedure is displayed in the home and included within information provided to each service user, a copy of which is kept in each bedroom. The service users spoken with said they felt comfortable discussing any views with staff. Comments included: “I would have absolutely no need to complain about anything”. “Complain about what, they can’t do enough for you”. “I may have received some information but I’m not sure, it doesn’t really matter because they are all approachable”. A rolling awareness training programme regarding abuse is in place for staff and the staff members spoken with were aware of abuse and whistle blowing Crowtree House DS0000041717.V323976.R01.S.doc Version 5.2 Page 15 policies and procedures and the correct action to be taken should an issue be identified. Crowtree House DS0000041717.V323976.R01.S.doc Version 5.2 Page 16 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, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment is very well maintained, safe and comfortable and it meets the individual needs and expectations of service users whose health and safety is protected. EVIDENCE: The physical environment was clean, tidy and well maintained throughout and there were no unpleasant odours. The service users spoken with said that the environment was comfortable and kept clean and tidy. Comments included: “It’s very clean”. “The toilets are very clean and bedrooms, very good”. “It’s all four star here, I don’t want to go back home”. “I’m tidying my room before I go home, they don’t want me to but they keep it all so clean”. There is plenty of shared space available to enable service users to receive guests privately if they so wish. Crowtree House DS0000041717.V323976.R01.S.doc Version 5.2 Page 17 Sufficient numbers of domestic are deployed each day to keep all areas clean and odour free. Health and safety policies and procedures are in place for staff, who receive awareness training regarding this and cleaning equipment and products are safely stored. Specialist equipment is provided as per the needs of service users, which was clearly detailed within the care records seen. A risk assessment has been undertaken of the premises and of individual service users and health and safety policies and procedures are in place providing guidance to staff. Clinical waste is properly managed and stored. Fire safety systems were being tested and maintained as per fire safety regulations and staff attend regular awareness training. Call bells are portable and kept within reach of service users whom confirmed that staff respond to calls promptly. Hot water temperatures within the home are monitored regularly and regulating valves are fitted to water outlets. Systems are in place to prevent risks from legionella. Protective covers are fitted to radiators. Crowtree House DS0000041717.V323976.R01.S.doc Version 5.2 Page 18 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, 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. There are sufficient numbers of staff and significant recruitment and induction procedures are in place to safeguard and to meet the needs of the service users. Staff overall have the skills and experience necessary to carry out their roles. EVIDENCE: The service users spoken with expressed high levels of satisfaction regarding the homes staff and confirmed that their care needs were consistently met. This was further documented within the completed quality satisfaction surveys seen. Service users comments included: “The staff are wonderful, they know what to do to get you feeling better and to get you on your feet again”. “The support I’ve had is fabulous, I would rather be at home of course but the quality of support and care is wonderful”. “Some more staff would be nice on occasion”. “They are there almost immediately unless they are very busy but they get my recommendation”. “There’s nothing to complain about the staff here”. Comprehensive recruitment policies and procedures are in place. These include equal opportunities monitoring, application and interviewing systems and records. Staff also undertake a probationary period and newly recruited staff initially “shadow” existing staff. The staff members spoken with were Crowtree House DS0000041717.V323976.R01.S.doc Version 5.2 Page 19 satisfied with the homes induction and training programmes, of which highly developed systems are in place, which was further evidenced in the staff records viewed. Comments included: “You may have to wait to get on some training but your turn does come around”. “We are fortunate really, there is the right training for the work we do”. “We have regular training, if you wanted to do any you can ask to be put forward and they are happy to support you”. Newly recruited staff are supervised and a comprehensive training plan is in place for all staff relevant to meet the care needs of service users. Crowtree House DS0000041717.V323976.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Substantial quality assurance systems are in place and staff are provided with sufficient information and support to provide a quality service. Systems are in place to protect service users finances. The home is well managed and systems are in place to ensure that care is provided in a safe and appropriate manner. EVIDENCE: The service users spoken with were fully satisfied with the manager’s approach to the role and standards of care. Comments included: “Yes, the manager and all the team are approachable”. “It is well run, from the top”. “I can talk with the manager, or the staff for that matter, very good”. The views expressed by those spoken with during the site visit were further confirmed in the completed Crowtree House DS0000041717.V323976.R01.S.doc Version 5.2 Page 21 quality satisfaction surveys seen, which are undertaken upon each service user returning home. The staff members spoken with commented about the individual support and supervision they received and said that they were satisfied with the manager’s approach to the role. Comments included: “I really don’t have any problems, we are well managed”. “The atmosphere here is very good, you can talk to the manager and be listened to”. Staff handbooks are readily available to provide guidance for staff in addition to staff meetings and regular training sessions. The registered manager has considerable experience in managing and working within residential care settings, has attained nationally recognised management qualifications and maintains awareness of service user care needs through a continuous training programme. Crowtree House refrain from any involvement in service users finances where possible and information regarding this is provided to service users. Also, policies and procedure information is provided to staff although these were not regularly updated. A risk assessment of the premises had been undertaken, which is reviewed as necessary and the staff members spoken with were satisfied with the homes management of health and safety of which designated training is provided. Crowtree House DS0000041717.V323976.R01.S.doc Version 5.2 Page 22 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 2 2 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 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 4 X 4 X 3 3 X 3 Crowtree House DS0000041717.V323976.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? N/a 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 OP2 Good Practice Recommendations It is recommended that the recording of the admission process is reviewed to ensure that service users are aware of the provision of facilities and services and terms and conditions. Care records should clearly document where service users are involved in their assessment of care needs and devising of their individual care plan. It is recommended that the homes provision of activities is reviewed to provide more regular and appropriate activities for and service users. 2. 3. OP3 OP12 Crowtree House DS0000041717.V323976.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN 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 Crowtree House DS0000041717.V323976.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!