Inspection on 09/02/09 for Crowtree House

This inspection was carried out on 9th February 2009.

CSCI found this care home to be providing an Good service.

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 11/01/07

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 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Crowtree House 39 Crowtree Lane Louth Lincolnshire LN11 9LL     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Elisabeth Pinder     Date: 0 9 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Crowtree House 39 Crowtree Lane Louth Lincolnshire LN11 9LL 01507602653 01507600312 Crowtreehouse@lincolnshire.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Lincolnshire County Council care home 25 Number of places (if applicable): Under 65 Over 65 5 18 0 dementia old age, not falling within any other category physical disability Additional conditions: 0 0 2 Service Users within the category of PD are aged between 55 and 64 years inclusive. Date of last inspection Brief description of the care home 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 both male and female. The home no longer accepts people for long-term placements, but continues to offer accommodation for one person who was placed prior to this change in policy. The home is registered for 25 people; this includes five people over 65 with dementia and twenty people who form the category of old age, two of whom have a physical disability. The home is set within its own grounds, there is a small area for car parking at the front and side of the property, in addition to on road parking. Care Homes for Older People Page 4 of 27 Brief description of the care home People using this service have a financial assessment carried out to determine the amount of fees (if any) that are payable. Current fees range from nil - 351.50 pounds. Additional charges are made for services such as chiropody and hairdressing and information about these costs, as well as the day-to-day operation of the home including a copy of the last inspection report, is available from the manager. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced visit and it formed part of a key inspection, focusing on key standards which have the potential to affect the health, safety and welfare of people who use the service. Throughout this report the terms we and us refer to The Commission for Social Care Inspection (CSCI). The visit lasted just over five hours and took into account previous information held by us including the previous inspection report, their service history and records of any incidents that we had been notified of since our last visit. Before we made our visit the manager had returned the Annual Quality Assurance Assessment (AQAA). This gave us information about their own assessment of how well they are meeting standards and their plans to improve aspects of the service. The main method used to carry out the inspection is called case tracking, this includes Care Homes for Older People Page 6 of 27 following the care of a sample of people through their care records and assessing their care. We spoke to people who use the service and saw rooms of those who said we could and to two members of staff, one visitor and a team co-ordinator from the Community Mental Health Team. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Older People Page 8 of 27 The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information about this service is available to help people make a decision about moving into the home. People are often admitted in an emergency and it is not always possible for a full needs assessment to be carried out prior to their admission but enough information is obtained to enable staff to support their initial needs. Evidence: Information sent to us prior to the inspection told us that people come into this service for short term care in crisis or planned admissions. People leaving hospital are able to continue with their rehabilitation programme and people spoken to were full of praise for the service telling us its like coming home and I was here last year and although I could have gone somewhere nearer to my home I wanted to come here and I live locally so this place is ideal for me and I simply love it here. A recommendation made during the previous visit had been addressed and people Care Homes for Older People Page 11 of 27 Evidence: currently staying at the home told us they had enough information about the service and facilities available to help them and their families make a decision about coming for a short stay. Since the visit we have received information telling us what action has been taken to address another recommendation made during the previous inspection regarding records being kept to show people are involved in their assessment of care needs and subsequent plan of care. Information about the service is written in the Statement of Purpose and Service User Guide, both documents are currently being reviewed and a discussion was held regarding including details telling people how they can obtain a copy of our inspection report and the manager agreed to do this. Information available tells people how differing needs, such as religion and culture will be met and how each person receives a financial assessment to determine the level of fee, if any is payable. However, documents do not tell people if the Mental Capacity Act will be considered and the manager agreed to include this. Records of two people who had recently been admitted were looked at and these showed limited information had been available to develop a full needs assessment as both people had been referred in an emergency. Staff have had to respond quickly in gathering information to establish whether the persons needs could be met and we were told that on a few occasions further information taken after the persons admission had resulted in the service being unable to meet their needs and an alternative placement had been sought with support from the Intermediate Care Team. Terms and conditions/contracts of residency were held on both records looked at. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples personal care and health care needs are being met by staff who understand their needs and deliver care in a respectful manner. However, care plans do not record enough detail to show that individual needs and preferences are always taken into consideration. Medication policies are detailed and safe procedures are being followed for the administration, recording and storage of medicines. Evidence: We looked at the care plans of four people living at the home and they did not give staff clear guidance on the action they should take to meet the persons needs. One person is receiving permanent care and staff are supported by the district nursing team to meet her needs. Records did not show us that care plans were reviewed and evaluated regularly and did not make reference to peoples capacity to make decisions. However, staff had a good knowledge of the needs of people who were using the service and how to meet them and they were observed to be responsive to people, respectful and kind. Since our visit we have received information from the manager Care Homes for Older People Page 13 of 27 Evidence: telling us what she has done to ensure care plans are kept up to date, this has included discussions with team leaders and implementing a training programme. Staff are supported by physiotherapists and occupational therapist from the primary care trust and the community mental health team (CMHT). During our visit we spoke to a team co-ordinator from CMHT who told us the service works well with them and staff are knowledgeable about peoples needs and will always seek their advice when necessary. She confirmed that CMHT carry out mental capacity assessments for people they support and agreed to ensure the service receives a copy to keep on individual files. People spoken to all told us they felt their needs were being met and said that staff know how they like things to be done, they help them undertake daily living tasks and encourage them to be as independent as possible. Specific comments were staff know how to treat me and meet my needs and they are helping me to remain independent so I can return home in a couple of weeks. Each person has their own file in their room containing their plan of care, life history and personal preferences including their preference for male or female carer. Daily notes were written showing that people were receiving the correct level of care and support towards returning home. The service has a team of professionals including, nurses, physiotherapists and occupational therapists who assess and develop the persons rehabilitation programme. Moving and handling assessments are carried out identifying any specialist equipment needed and access to other health care services such as chiropodist, opticians and hearing are made if required. Information taken from the AQAA told us that policies and procedures concerning the receipt, storage, administration and disposal of medications were available. During our visit the homes pharmacist was undertaking their inspection and the report given read no problems. Individual medication is stored in a secure cabinet on the wall in each persons room, we looked at medication records of the people whose care was being followed and these showed they were receiving their medications correctly. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to choose how they spend their time and maintain contact with family and friends. Meals provided are well balanced and take into account personal preferences and special dietary requirements. Evidence: People told us they were able to spend their time as they liked and felt their rights and independence was always respected. They told us they were quite satisfied with the activities available, staff discuss their social interests and daily routines at home and try to match their life style where possible. The majority of activities focus on daily living skills such as making a hot drink, cooking a meal and carrying out exercises set by the physiotherapist. One person told us she was able to continue practising her religion by attending the monthly communion service. Another person said they had many friends living nearby who frequently visit and are always made welcome. A visitor told us she always receives a good welcome and is offered a drink when she arrives. A recommendation was made during the previous inspection for the provision of activities to be reviewed to provide more regular and appropriate activities for people Care Homes for Older People Page 15 of 27 Evidence: and the manager told us that this has been addressed. There is a day unit within the home and although this is not currently regulated by us people are able to access this facility and join in the activities arranged. Activities are advertised on the notice board and the activity co-ordinator keeps individual records. Recent activities have included making valentine cards, painting, crossword puzzles and orientation for people with dementia care needs. People can choose where to have their meal, these can be in the dining room or other smaller dining areas or peoples own rooms. Since the last visit flexi breakfast has been introduced and people can now choose what time they have breakfast. During our visit the meal of the day was pigs fry, or grilled bacon, with mash potato, roast parsnips and Brussels sprouts, or cheese and potato bake, followed by lemon sponge and custard or trifle. People were very complimentary about the food, they told us that kitchen staff attend resident meetings and discuss menus and choices and the food is always lovely. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are protected by the procedures in place for handling complaints and allegations of abuse. Staff have received training in these subjects to help them protect the people they support. Evidence: Information taken from the AQAA tells us that a clear complaints procedure is available and is included in the Service User Guide. Leaflets and information about Lincolnshire County Council complaints procedure were available in the reception areas of the home. People told us they feel able to raise issues with staff and felt these would be taken seriously. Comments included I would talk to the boss, I have no need to complain about anything and everything is so good here, I have no complaints. Within the last twelve months two referrals had been made to Lincolnshires Safeguarding Adults team who made the decision to investigate one and not to take further action on the other. During our visit a complaint was received and the manager immediately took appropriate action to deal with it. No other complaints had been received within the last twelve months. Training records looked at verified dates staff had undertaken training relating to adult abuse, however, for some people this was undertaken in 2004 and the manager told us that staff are currently doing safeguarding adults training with the County Council. Care Homes for Older People Page 17 of 27 Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a well-maintained, clean, comfortable and homely environment. Evidence: We took a partial tour of the home which included looking at the bedrooms of the people whose care was being followed and some communal areas. Communal areas were bright and nicely decorated and bedrooms had been personalised with photographs and ornaments. There were no unpleasant odours in the home. People told us they liked their rooms and felt very safe in the home. One visitor told us she often has difficulty in parking as the number of spaces is very limited. This was discussed with the manager who told us the Council know about this problem but is not aware of any action being taken. Information taken from the AQAA told us that the manager is supported by the handyperson, team leaders and business support officer who help to ensure health and safety procedures are carried out. Within the last twelve months new carpet tiles have been fitted to ground floor corridors and first floor dining area and safety flooring has been fitted to the first floor kitchen. New cleaning schedules have been written to meet with infection control guidance and a number of bedrooms have been redecorated and an ensuite bathroom has been fitted in one of the rooms. Risk assessments are undertaken for the premises, hot water temperatures throughout the home were being Care Homes for Older People Page 19 of 27 Evidence: monitored regularly and protective covers have been fitted to radiators. Various pieces of equipment were in use during the visit including hoists, specialist mattresses, raised toilet seats and grab rails. The service has received an excellent for food safety from their district council Environmental Health Officer in 2008. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is enough staff on duty to meet the needs of the people currently living at the home. People are protected by robust staff recruitment procedures and staff have the skills and experience necessary to carry out their roles. Evidence: On the day of the visit 22 people were living at the home. Duty rotas looked at for the past two weeks showed that there were generally four care staff in the morning, three in the afternoon and two throughout the night. In addition to this there is a team leader, senior care, activity co-ordinator, registered manager, administrator and handyman on duty. A number of relief staff are employed to cover sickness and annual leave and during our visit one person was on duty and they confirmed they regularly work shifts and access the same training and support as staff with contracted hours. During our visit only positive comments were received from people, these included, theres the same staff here as last time so I feel at home and I couldnt fault the staff, they are brilliant and the staff are lovely. Robust recruitment procedures are in place, these include equal opportunities monitoring, application and interviewing systems. The records of two staff recently employed were looked at and these showed that essential checks such as written Care Homes for Older People Page 21 of 27 Evidence: references and C.R.B. (Criminal Records Bureau) checks were being undertaken. All staff undertake induction training and complete a probationary period. Lincolnshire County Council have a good training programme covering a variety of topics. Training records confirmed that staff had received essential training to meet the needs of the people they support. Training undertaken included, manual handling, first-aid, fire awareness, dementia awareness and medication. To date staff have not had training relating to the Mental Capacity Act and the manager told us she is hoping that all staff will be able to access this training shortly. Information received told us that 75 of care staff have achieved a nationally recognised vocational award, level II or above, in care. Observation of care practises during the visit showed staff caring for people in an appropriate manner. They were visible in communal areas and responded well to peoples needs. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This service is well managed and the staff are supported and supervised in carrying out their roles. Substantial quality monitoring systems are in place ensuring that peoples views are listened to and acted upon. Evidence: The registered manager is suitably qualified and experienced to run this home. She has been in post since 1999 and has completed a nationally recognised vocational award, level IV, the Registered Managers Award and holds additional certificates in Social Care. People told us the manager was supportive, always available and very supportive. Discussion and records showed that there are various systems in place to monitor the quality of the service being provided. This includes seeking the views of people through meetings and questionnaires. Records of those undertaken for the periods between July and December 2008 were looked at and these all gave positive comments. Recent quality assurance questionnaires focused on quality and diversity and these are currently being collated by Head of Service. A report will then be made Care Homes for Older People Page 23 of 27 Evidence: available in the home. Records of the last staff meeting and the last resident meeting were looked at and these showed us that many topics had been discussed including, new appointments, activities and supervision. The service does not keep any monies on behalf of the people living there, people are encouraged to look after their own finances and if they are unable to do this their carer or advocate will take on this responsibility. Information provided in the AQAA told us that there are a range of policies and procedures in place and the majority of these had been reviewed and updated in 2007 and 2008. We were also told of equipment maintenance and service dates. Building risk assessments are in place and regular health and safety audits are completed. The Department of Health Essential Steps is used to assess infection control and records showed staff receive health and safety training. Generally records required by law to be kept about the operation of the service were up-to-date and well maintained. A representative from Lincolnshire Count Council had visited the home at least once a month, the last being on January 26th 2009 and completed a report on their findings. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 It is recommended that care plans contain more information about how people want their care providing, as well as their abilities. It is recommended that care plans include reference to the Mental Capacity Act 2007 and the effects it has on peoples lives. It is recommended that staff have a working knowledge of the Mental Capacity Act and how the Act impacts on the way they support people using the service 2 7 3 30 Care Homes for Older People Page 26 of 27 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - 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!