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Inspection on 12/06/07 for Croxley House

Also see our care home review for Croxley House for more information

This inspection was carried out on 12th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The standard of care provided to people who live in the home is good; "They are really very kind and helpful" was one typical comment received. There is a well established and committed staff team who work consistently strive to meet the aims and objectives of the home. The original building dates back to the 1700`s and continues to need updating and maintaining regularly. However the home presents as homely and comfortable with various areas of the home having been decorated since the last inspection was carried out. The standard of training within the home is good, with all staff having received the mandatory training necessary to do their job effectively. There was a very warm and welcoming atmosphere.

What has improved since the last inspection?

The appointment of a new manager in April 2007 has injected some fresh enthusiasm into the home, which has been welcomed by both staff and service users. The service users spoke highly of Mr Sole and stated that a range of new activities had been introduced since his arrival. The new manager is also in the process of reviewing and updating all the service users care plans and service users histories. The level of training has improved since the last inspection and staff are now receiving the appropriate dementia training. The general standard of the environment is steadily improving, with several areas being decorated or waiting to be decorated or upgraded. Currently the home`s fire doors are all being updated and replaced. The manager has a plan to upgrade and improve the communal areas of the home, as currently the entrance hall and the main lounge appear quite shabby and dated.

What the care home could do better:

On the day of the inspection there was inadequate evidence to verify that service users who are at risk of choking and who require the use of bedrails had an effective and current risk assessments in place. There was a discussion with the domestic worker on duty and the inspector regarding the use of door wedges. The manager must ensure the fire officer assesses this practice and can confirm that this does not compromise service users, staff and visitor`s health and safety. The manager must complete an up to date fire risk assessment for the home.

CARE HOMES FOR OLDER PEOPLE Croxley House Croxley Green Rickmansworth Hertfordshire WD3 3JB Lead Inspector Julia Bradshaw Key Unannounced Inspection 9:00 12 & 13th June 2007 th 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 DS0000019318.V343734.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. DS0000019318.V343734.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Croxley House Address Croxley Green Rickmansworth Hertfordshire WD3 3JB 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) 01923 775134 01923 897908 sharnbrook@greensleeves.org.uk Greensleeves Homes Trust Vacant Care Home 33 Category(ies) of Dementia - over 65 years of age (5), Old age, registration, with number not falling within any other category (33) of places DS0000019318.V343734.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. Room 21 (8.78 sq m) is to be used only for the purpose of short stay respite care. It will not be permitted for this use after 1.4.07 Rooms 15, 17 and 31 be designated as suitable for couples who through positive choice wish to share a room. A max. of 2 rooms to be used at one time. Room 22 (20.83. Sq m) will be altered to allow for the increase in size of Room 21 to meet the 12 sq m requirement. Alteration to Room 22 will not take place whilst the present occupant remains in that room. The home may accommodate five named service users who have a diagnosis of dementia. The manager must inform CSCI when any of the five service users permanently leaves the home for any reason. 14th March 2007 Date of last inspection Brief Description of the Service: Croxley House is a detached two-storey red brick Georgian dwelling house built about 1770 with several later additions. It has been extensively refurbished and converted for the residential care of older people. The home provides for up to 31 service users in single rooms, all of which have en-suite facilities. There are three rooms that are available for couples to share but only on a positive basis and with the maximum overall occupancy of 33 service users. One room is below the recommended minimum size standard and is used only by agreement for short stay respite care. The home has two main lounges and a separate dining room. The kitchen is completely stainless steel equipped with freezer and refrigerated food storage. The homes laundry is equipped to handle all the requirements of the home. Croxley House has its own access driveway across the green and stands in immaculately maintained grounds with beautiful views across the green and surrounding woodland and farm countryside. There is a working greenhouse and summerhouse at the rear of the home and the pathway around the garden has a single handrail for support. The garden houses an aviary and there is a fish tank, budgies and cats within the home. Whilst the home occupies a rural setting, it is but a few minutes drive from the towns of Watford and Rickmansworth. The home has a service user’s guide and statement of purpose that are provided to prospective service users. Copies of the latest report on the home from the Commission for Social Care Inspection (CSCI) are available in the home. The range of fees are from £460 - £530 DS0000019318.V343734.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report draws on information obtained during two unannounced site visits carried out on the 12th and 13th June. The inspection process included an opportunity to speak to people living in the home, to visitors and staff and to inspect some key records, including those for medication, staff recruitment and care planning. The manager was present during the visit on the 12th June and the deputy manager was on duty during the manager’s absence during the visit carried out on the 13th June. This report also draws on any information received by the CSCI about Croxley House since the last inspection report in June 2006. Staff and service user surveys are part of the ongoing inspection of this service and any issues arising from these will be assessed and will then inform further regulatory activity by the CSCI in respect of Croxley House What the service does well: The standard of care provided to people who live in the home is good; “They are really very kind and helpful” was one typical comment received. There is a well established and committed staff team who work consistently strive to meet the aims and objectives of the home. The original building dates back to the 1700’s and continues to need updating and maintaining regularly. However the home presents as homely and comfortable with various areas of the home having been decorated since the last inspection was carried out. The standard of training within the home is good, with all staff having received the mandatory training necessary to do their job effectively. There was a very warm and welcoming atmosphere. DS0000019318.V343734.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. DS0000019318.V343734.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 DS0000019318.V343734.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1- 5 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The assessment process is thorough and ensures that only those whose needs can be appropriately met, are admitted to Croxley House. EVIDENCE: The statement of purpose and service user guide were both available on the day of the inspection and reflected fully the current service provided. The information provided for prospective service users is presented in a format that is both informative and interesting. The four files inspected contained initial assessments compiled prior to service users moving into the home, completed by the referring team/social worker. Risk assessments were seen on the files inspected and had been reviewed. DS0000019318.V343734.R01.S.doc Version 5.2 Page 9 Croxley House does not offer intermediate care but does offer a respite care service. The manager stated that all service users had individual contracts on file stating the conditions of their stay and the current charges. This was confirmed during a random inspection of service users files. Care plans identify individual needs and have improved since the new manager has been in post. The process of updating these files is very time consuming and therefore manager stated that he will have completed this process by July 2007. DS0000019318.V343734.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 –11. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Service users could be assured that their care needs are identified in a plan; however, they may be at risk due to inadequate medication procedures. EVIDENCE: Care plans inspected had improved since the last requirements were made In June 2006. However the manager must ensure that individual risk assessments are completed for all service users who are at risk of choking or who use bed rails that individual risk assessments are completed for all service users who are at risk of choking or who use bed rails. Files inspected contained details of doctors/dentists/optician appointments. Service users are weighed on a monthly basis. DS0000019318.V343734.R01.S.doc Version 5.2 Page 11 A district nurse who was visiting at the time of the inspection stated that the service users who require her service are mainly for insulin injections and having dressings changed. The district nurse stated that she had “always found the staff very professional and caring”. “The home was both inclusive and friendly” and she had never had an occasion where the standard of care provided was inadequate or below standard. Four service users care plans were inspected and contained the required information. Detailed records of visits carried out by other professionals were recorded and up to date. The district nurses recorded are held separately, in the main office. The medication is held within a large locked cupboard on the ground floor of the home. All medication is dispensed from the main trolley. There are rigorous medication procedures in place and an identified member of staff is responsible for the ordering and returning of medication. The home uses the dosette system for the dispensing medication, on a weekly basis. The MAR sheets were checked and no errors were found. However during the inspection of controlled medication it was discovered that a controlled drug belonging to a service user who had left the home had not been signed off even though the medication had been transferred to the new home. The manager must ensure that all medication procedures are adhered to at all times. DS0000019318.V343734.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 –15. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The range and frequency of activities currently available in the home is good and provides regular, dependable stimulation for people living there. EVIDENCE: On entering the home it was apparent that everyone was made to feel welcome and the atmosphere was both relaxed and informal. There were several relatives visiting who spoke very highly of the staff and services provided at the home. There is a wealth of pictorial evidence displayed around the home of recent activities and trips, which have been organised, by the home. The new manager has made a concerted effort to improve upon the previous activities programme and since April the service users have enjoyed several day trips out, including on the day of the inspection, a trip to Whipsnade Zoo. The home also organises regular musical events, including a saxsaphonist, violinist, and harpist. There is the opportunity for service users to receive religious services from a variety of denominations who visit the DS0000019318.V343734.R01.S.doc Version 5.2 Page 13 home regularly. There is a service users notice board in the hallway of the home in which people have the opportunity to see the activities planned for the week and information regarding the services the home currently provides. The manager and staff are also in the process of organising a summer fete for the 14th July. This is an initiative, which has been re-introduced by the new manager. Service user meetings are held on a two monthly basis, or sooner if there are particular issues the manager would like to discuss with the service users. Several service users confirmed that during the local elections in May 2007 they were assisted in travelling to the local polling station in order to cast their votes. The home has a “motability” scooter, which is available for all service users to access. One service user spoken to confirmed that he uses it to travel to the local shops. Service user questionnaires have been sent out and are currently being reviewed and an action plan created to incorporate the views of the service users and their relatives. DS0000019318.V343734.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 inspected at least once during a 12 month period. 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. Procedures are in place to safeguard service users. There is a comprehensive complaints protocol in place which service users and staff appear comfortable about using. EVIDENCE: The home has an appropriate written complaints policy. Two complaints have been received since the last inspection took place. Both of these have been resolved to a satisfactory conclusion. The home has written procedures in place for Adult Protection and a Whistle blowing Policy, which staff were aware of. The home also has policies for handling service users’ monies. A random check was carried out on three service users personal monies and found to be accurate. DS0000019318.V343734.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 –26. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Service users live in a comfortable, well-maintained and clean environment. EVIDENCE: The original part of the home was built in 1770’s and therefore is constantly requiring repair and regular maintenance. Several areas of the home have been re-decorated since the last inspection was carried out and future decoration includes the front lobby and several service user bedrooms. The home employs a full time maintenance person. DS0000019318.V343734.R01.S.doc Version 5.2 Page 16 The premises appeared tidy and well maintained. The bedrooms inspected appeared comfortable, neat and clean. The service users spoken to said that they are very pleased with their bedrooms and the facilities provided. The items displayed reflected their individual lifestyles. Service users stated “there is always something to do”. “The manager even drives the minibus”. “The manager has given us more opportunities to go out” There is a continuous programme of redecoration going on in the home which looked bright and clean during the visit. There is emergency lighting throughout the building and the hot water was being delivered at a safe temperature. Several areas of the home are in the process of receiving new carpets/flooring/curtains. A new floor in the downstairs bathroom has been replaced. The manager also stated that there were plans to have a ramp fitted to the front entrance of the home to assist service users access. On the day of the inspection the chair lift was out of order .The manager confirmed that this would be rectified immediately. All fire checks were inspected and the latest weekly fire check was carried out on the 7/06/07. All fire checks were inspected 22/03/07. The manager must ensure the current fire risk assessment is updated. The fire alarms were checked on the 7/06/07.The emergency lighting was checked on the 12/06/07.The latest fire training took place on the 16/04/07.The latest fire certificate issued was on the 22/03/07. DS0000019318.V343734.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 –30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The numbers and quality of staff are such as to provide a good level of care and to adequately meet service user’s needs at most times. EVIDENCE: All the staff have demonstrated their dedication to their work in caring for the service users in the home. This was further evident by the complimentary remarks received from the service users interviewed during the inspection.” They are all so kind and caring”. The members of staff present confirmed that they are given opportunities to attend external and in-house training programmes. Staffing levels during the daytime hours are adequate. However the manager must ensure that service users needs are regularly reviewed and assessed as the current arrangement of only two waking night care on duty each night could present as inadequate if the needs of the service uses change or service users with dementia deteriorate and require more support. The manager confirmed staffing levels as 5 care staff plus the deputy manager. The home also has 3 chefs/kitchen staff and full time domestic support. The standard of staff training is good and records proved that all staff are receiving the mandatory training required including, Dementia care, DS0000019318.V343734.R01.S.doc Version 5.2 Page 18 medication training, manual handling, safeguarding adults. The manager must confirm with the Commission when the latest training in infection control was carried out and how many staff attended this training. DS0000019318.V343734.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 –38. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Service users benefit from living in a well managed home where procedures for maintaining records, promoting safety and supervising staff ensure that the welfare of service users is promoted at all times. EVIDENCE: The temporary manager has been in post for a period of three months and has made some significant improvements to the home and to the service that people receive. The appointment of a permanent manager is expected within the next two months. The administration and management of the home are DS0000019318.V343734.R01.S.doc Version 5.2 Page 20 consistently well maintained. The management approach creates an open, positive and inclusive atmosphere. This is further evidenced from the complimentary feedback that the manager works as part of a team with the deputy and those spoken to said that this group works effectively and well. Staff and service users said that they were clear about procedures in the home and that the manager and deputy were approachable and supportive. The senior staff carry out supervisions to all staff. Annual appraisals are due to be carried out in June/July. Staff meetings are held every six weeks and senior meetings are held in addition to these full staff meetings. The manager must ensure the home has a current fire risk assessment, risk assessments on service users who are at risk of choking, who use bedrails, the risk assessment in relation to the use of a door wedge by the cleaner and medication procedures are adhered to at all times. Staff were aware that service users and families could access their records, subject to individual permission and the Data Protection Act. The accident records were well kept, with an overview maintained so that trends could be monitored, and the system complies with the Data Protection Act. The home provides the CSCI with details of all significant accidents and incidents and with regular reports from Head Office staff visits. DS0000019318.V343734.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 3 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 3 3 3 3 3 2 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 3 3 3 3 3 3 2 DS0000019318.V343734.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. 1. Standard OP7 Regulation 12 (1) (a) 13 (4) Requirement Service user care plans must contain a current risk assessment, where appropriate, in relation to the risk of choking and the use of bedrails in order to safeguard the health and safety of the service users Timescale for action 01/07/07 2. OP9 13 (2) The registered person must 14/06/07 ensure staff adheres to the correct signing, and administration of medication. In particular the procedures in relation to controlled medication. In order to ensure the health and safety of the service users. The manager must consult with the fire service in relation to the current arrangement of using a door wedge when the domestic is cleaning the upper floors of the home. The manager must ensure there is an up to date fire risk assessment in place. 30/06/07 3. OP18 23 (4) 13 (4) (a) 4. OP19 23 (4) 30/06/07 DS0000019318.V343734.R01.S.doc Version 5.2 Page 23 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 OP28 Good Practice Recommendations Staffing levels must be kept under review and increased to meet the needs of service users, in particular during the nighttime hours. DS0000019318.V343734.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Hertfordshire Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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 DS0000019318.V343734.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. 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