Inspection on 21/06/06 for Croxley House

This inspection was carried out on 21st June 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Croxley House 12/06/07

Croxley House 09/12/05

Croxley House 24/05/05

Croxley House 10/11/04

Croxley House 11/05/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Croxley House Croxley Green Rickmansworth Hertfordshire WD3 3JB Lead Inspector June Humphreys Unannounced Inspection 21st June 2006 10:00 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 Croxley House DS0000019318.V301177.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. Croxley House DS0000019318.V301177.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 Greensleeves Homes Trust Mrs K. Plato 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 Croxley House DS0000019318.V301177.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. 9th December 2005 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 weekly cost of a placement is £425.00 per week. Croxley House DS0000019318.V301177.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report contains the outcomes of the unannounced inspection carried out by two regulation inspectors representing CSCI on 21st June 2006. The inspectors spent time talking to staff and service users, and viewing records maintained in the home. The newly appointed manager has worked hard to meet the requirements made at the last inspection, but there remain several outstanding. What the service does well: What has improved since the last inspection? What they could do better: Care plans provide basic information, which does not clearly state how staff will work with service users. This is of particular concern for service users who suffer from dementia. Risk assessments are not in place for service users who self-administer or the person taking Warferin medication. Staffing levels need to be reviewed due to a number of falls/incidents in the home. Medication procedures still continue to need improvement. Croxley House DS0000019318.V301177.R01.S.doc Version 5.2 Page 6 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. Croxley House DS0000019318.V301177.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 Croxley House DS0000019318.V301177.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): 3, (The home does not offer intermediate care. (standard 6)) Prospective service users are provided with sufficient information to make an informed choice regarding the suitability of the home. The assessment format is adequate, but relies heavily on the judgement of the assessor. The quality in this outcome group is adequate; this judgement has been made using all available evidence including a visit to this service. EVIDENCE: A copy of the statement of purpose, and service user guide is available to prospective service users, carers and families. The manager prior to admission completes the assessment. The overall dependency of services users being admitted has increased and the manager must ensure that staffing levels are reviewed to ensure service users needs can be met. This is particularly important with regard to older people suffering from dementia. The home does not appear to offer any form of specialist Croxley House DS0000019318.V301177.R01.S.doc Version 5.2 Page 9 assessment prior to admission. Care plans do identify individual needs, but do not always provide the level of guidance to staff on the extra support required for managing people with dementia i.e. behaviour, mobility and communication. Croxley House DS0000019318.V301177.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): 7,8,9 and 10 Care plans and risk assessments seen during the inspection had not been updated to reflect recent developments in service users care needs. Despite progress with regard to the administration of medication there continues to be a need for improvement in this area. The assistance offered to service users is of a satisfactory standard. Care staff are unobtrusive and sensitive, but the quality in this outcome group is poor; this judgement has been made using all available evidence including a visit to this service. EVIDENCE: Six care plans were examined as part of the inspection. Whilst information was basic and possibly adequate for service users with limited dependency, better detail must be provided for service users with high needs, particularly those suffering from dementia. The risk assessment format does not clearly identify how the risk will be lowered, or wherever possible eliminated. Tracking several service users care plans over a period of two months provided evidence that a number of incidents (falls) had occurred to same people. Whilst incidents had been recorded, no action had been taken to increase staff Croxley House DS0000019318.V301177.R01.S.doc Version 5.2 Page 11 supervision or implement extra checking of the person. One of the service users was a person suffering from dementia. The manager had started to review if the service could continue to meet their needs. Several staff spoken to disclosed that service users were requiring greater levels of support, particularly new admissions. Limited training has been offered to staff with regard to working with service users suffering from dementia. This was apparent in responses from staff who were asked what extra care was provided. The service does work with outside specialist agencies (e.g. the district nurse service etc) but information documented on the specialist note is not always clear on the homes daily recording sheets. An audit of medication has now been introduced, however medication records were randomly selected, and requirements for improvement remain. 1.Gaps were found in medication records (not signed). 2.Changes of medication were hand writtern, and not properly authorised. 3.Risk assessments were not in place for the service user who self-administers, their medication. A risk assessment is also required for the service user taking Warfarin to make sure that staff are aware of action to take in the event of an accident. Observation of the care staff at work showed that interaction with service users was positive. An example was of the carers hoisting a service user into her wheelchair from her reclining chair for lunch. A screen was used to protect her privacy, and staff spoke in a reassuring manner to ensure she understood what was happening. Croxley House DS0000019318.V301177.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): 12,13,14 and 15 Service users have access to a range of activities both within the home, and outside in the community. They are encouraged to maintain links with family and friends. Overall food appeared to be of a good standard, except for food served upstairs in people’s bedrooms. The quality in this outcome group is good; this judgement has been made using all available evidence including a visit to this service. EVIDENCE: There is a range of activities offered to service users on a daily basis. Activity plans were visible and displayed within the home. Service users are encouraged to engage in activities with peer groups, and also access services and groups outside of the home. Service users remarked on the number of activities available, one person stating ”there’s plenty to do, they keep us busy!” It would be helpful if care plans recorded activities that service users enjoyed, and case notes recorded if the person had enjoyed the activity on the day for people suffering from dementia. The home has a varied menu, providing a good range of wholesome and appetizing foods. However on the day of inspection several concerns were Croxley House DS0000019318.V301177.R01.S.doc Version 5.2 Page 13 raised with regard to service users who choose to eat lunch in their bedrooms. One man said the “food was cold, and that there was no salt and pepper”. He acknowledged that this was not a problem when eating in the dinning room. Another service user spoken to who was diabetic had not eaten the lunch provided. The inspector observed that the food was cold and the banana over ripe. The service user said she kept a stock of food in the fridge on the landing outside her room, as the food was often unsatisfactory. No staff had checked that the person had eaten a meal, and this is of concern due to her diabetes. A 2nd choice of main meal is currently not offered on a Wednesday, Saturday and Sunday, service users spoken to felt there should be a choice. Croxley House DS0000019318.V301177.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 and 18 The service users and their relatives can be confident that complaints will be listened to, taken seriously and acted upon. Training has been organised for staff to fully understand the procedures relating to working with vulnerable adults, and protecting them from abuse. The quality in this outcome group is good; this judgement has been made using all available evidence including a visit to this service. EVIDENCE: The home has a comprehensive complaints procedure in place. A record is maintained of complaints made, detailing actions and outcomes as necessary. All service users have been informed about the complaints procedure, and it is also on display within the home. Feedback from service users revealed that their complaints are listened to and appropriate actions are taken. Comments were received from the service users were very positive regarding the relationship they have with the staff. Those interviewed all said that they would feel able to complain, should it be necessary. Staff reported that they knew how to report an incident, and understood the protection of vulnerable adults policy. They were aware of the training currently being organised and it is important that all staff have the opportunity to attend the basic half-day training. Croxley House DS0000019318.V301177.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 and 26 The environment was clean and tidy, and there is a schedule in place to refresh and redecorate parts of the home to ensure it is well maintained. Unpleasant odours were once again noted in two service users bedrooms. The Community Fire Safety Officer has inspected the home and the manager advised that the recommendations and requirements of this report would be acted on. CSCI request a copy of the homes action plan. Fire risk assessment is generic and does not relate to the individual home and the difficulties that may occur. The quality in this outcome group is adequate; this judgement has been made using all available evidence including a visit to this service. EVIDENCE: The home has been extensively refurbished and converted into a residential home for older people. Overall the home was found to be clean and tidy with a few outstanding issues relating to individual service users bedrooms. Room Croxley House DS0000019318.V301177.R01.S.doc Version 5.2 Page 16 19a requires the heavily stained flooring to be replaced. The odour of urine from the toilet needs to be eradicated. In room 14, there was a strong smell of urine from the en suite bathroom area. Room 23 has steps to the toilet, this could be dangerous for less mobile service users and a risk assessment is required. The bathroom next to room 31 was being used as a storage space for continence pads. If it is no longer in use as a bathroom then it must be kept locked. The fire risk assessment is generic and does not cover adequately all the issues in the building. The remaining checks were seen to be up to date. Croxley House DS0000019318.V301177.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): 27,28,29 and 30 The unit has a caring and committed team of care staff, who with the correct levels of training and supervision could meet service users’ needs. There is a possibility of service users being put at risk, if staffing levels are not reviewed. The quality in this outcome group is adequate; this judgement has been made using all available evidence including a visit to this service. EVIDENCE: Service users stated that staff were caring and supportive, however they do not appear to have the specialist knowledge or expertise to work with people who suffer from dementia. Staff spoken to acknowledged this. Greater training is required, and must include completion of care plans; to enable these people to keep safe. The manager advised that the manager, deputy and assistant manager have small teams of staff that they now supervise, and where necessary coach. This will hopefully assist in developing greater depth and understanding of risk assessments. Staff interviewed could only provide very basic information about how to improve the safety of service users who had been involved in a number of falls. Croxley House DS0000019318.V301177.R01.S.doc Version 5.2 Page 18 Two new care staff files were seen and all necessary CRB checks and references had been completed. The manager, and deputy’s recruitment files were not available and they will be looked at later in the inspection year. Six care workers either held the National Vocational Qualification (NVQ) Level 2 in Care or had nearly finished it. Some staff members are also taking NVQ Level 3. The manager explained that a new improved process was being looked at with regard to this qualification and she was in touch with the local college. Staff interviewed were generally appreciative of the new manager who they described as ‘supportive’ and ‘helpful’, but at handover it was clearly stated that the needs of service users now living at the home had increased and that staff felt that the workload had increased and was heavier. The manager is in the process of reviewing certain service users placements and has agreed to look at staff ratios. Croxley House DS0000019318.V301177.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): 31,33,35 and 38 Service users, relatives and representatives are invited to give their views and to influence how the home is run. Some care practice concerns need to be addressed to make sure that service users and staff members are not put at risk, but generally service users’ health and safety is protected. Service users financial records are satisfactory. Infection control is good both within the kitchen and the laundry. Staff are able to describe what is good and bad practice. The quality in this outcome group is good; this judgement has been made using all available evidence including a visit to this service. Croxley House DS0000019318.V301177.R01.S.doc Version 5.2 Page 20 EVIDENCE: The new manager was appointed in January 2006, and has now registered with the Commission. A deputy manager has also been appointed to strengthen the management team. Maintenance and health and safety records were looked at and all checks were seen to be up to date, but the manager must complete a more in depth fire risk assessment, as the generic one is insufficient. A copy of the fire safety assessment is also to be forwarded. If the home is to continue to have five beds registered for people with dementia, then it must ensure that staff is trained in this specialist area of work, and that care plans and risk assessments have sufficient detail to keep service users safe. Three sets of financial records were seen on the day of inspection and no concerns were found. The manager recently consulted with carers and relatives via a questionnaire that was sent out. The manager felt the response had been good. Infection controls both in the laundry and kitchen are satisfactory with gloves and aprons in use. However as previously stated the registered manager must make necessary arrangements for the disposal of specialist waste, and ensure staff adhered to this practice. Croxley House DS0000019318.V301177.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 X 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 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Croxley House DS0000019318.V301177.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 12 (1) (a) Requirement Service users plans require greater detail on how care needs should be met, and the actions to be taken by staff. Appropriate information should cross reference on both care plans and risk assessments. (This requirement remains unmet from the previous inspection.) The registered person must ensure staff adhere to the correct signing, and administration of medication. Staff working in the home should not alter Medication administration sheets. That risk assessments are completed for any service users taking Warfarin medication. That risk assessments are completed for service users who self-administer medication. The registered manager must make necessary arrangements for the disposal of specialist waste, and ensure staff adhered DS0000019318.V301177.R01.S.doc Timescale for action 31/10/06 2. OP9 13 (2) 27/06/06 3. OP9 13 (4) 27/06/06 4. 5. OP9 OP38 13 (4) (16) (2) (j) 27/06/06 28/06/06 Croxley House Version 5.2 Page 23 to these practices. 6. OP26 16(2)(k) The manager must ensure that the environment is free from offensive odours. (Bedrooms 3,14 and 16) All staff must receive dementia care training (This requirement remains unmet) 31/08/06 7. OP30 18(1)(c) 31/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP28 Good Practice Recommendations Staffing levels must be kept under review and increased to meet the needs of service users. 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