Inspection on 09/12/05 for Croxley House

This inspection was carried out on 9th December 2005.

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 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

Croxley House 12/06/07

Croxley House 21/06/06

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 9th December 2005 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.V271873.R01.S.doc Version 5.0 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.V271873.R01.S.doc Version 5.0 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 T Whitbourn 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.V271873.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. 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 Room 31, previously used as a staff sleeping-in room, is now registered for residential use. Alteration to Room 22 will not take place whilst the present occupant remains in that room. 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. 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. 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. 24th May 2005 Date of last inspection Brief Description of the Service: Croxley house is a detached two- storey red brick Georgian house, with a slated roof, built about 1770 with several later additions. It has been extensively refurbished and converted for the residential care of older people. The home provides care for 31 service users in single rooms, all of which have en-suite facilities. There are three rooms that are available to couples to share, but only on a positive basis, and with maximum overall occupancy of 33 service users. One room is below the recommended minimum size, and is only used by agreement for the use of short stay care. The home has two lounges and a separate dining room. The kitchen is completely stainless steal, 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 surrounding woodland, and farm countryside. There is a working greenhouse and summerhouse at the rear of the home. There is easy access by means of a pathway around the garden, which has a fitted single handrail for support. The garden houses an aviary, and there are also budgies, a fish tank and cats within the home. The home occupies a rural setting, but is a few minutes drive from the towns of Watford and Rickmansworth. Croxley House DS0000019318.V271873.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the second announced inspection this year (2005). There was also an additional visit carried out in August. Two inspectors carried out this inspection over one day. The overall care in the home is of a good standard, but the current service continues to have very basic record keeping. There has been improvement in this area, but there is still much work required, particularly with regard to care plans relating to service users suffering from dementia. The current manager is retiring from the service at the end of December, she has been in post for a lengthy period of time and has provided much consistency and stability in the care provided to service users. At the time of inspection there was no information relating to the appointment of a new manager, and both service users and staff raised concerns. What the service does well: What has improved since the last inspection? The manager and her team clearly demonstrated that much improvement had been made regarding the storing and administering of medication. This was evident from working with the deputy who clearly was committed to improving, and meeting the standards. All of the previous requirements had been met, but unfortunately further were set, including an immediate requirement regarding the recording of medication. Croxley House DS0000019318.V271873.R01.S.doc Version 5.0 Page 6 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. Croxley House DS0000019318.V271873.R01.S.doc Version 5.0 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.V271873.R01.S.doc Version 5.0 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): Please refer to inspection report of 24th May 2005. Above standards not assessed on this occasion. EVIDENCE: Croxley House DS0000019318.V271873.R01.S.doc Version 5.0 Page 9 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,and 9 Personal care is offered to service users in a sensitive and unobtrusive manner, by staff that clearly know, and recognise individuals needs. Care plans are in place but require further update and review. The administration and storage of medication has improved considerably, but further concerns were raised, and the possibility of introducing an audit was discussed with the present manager. EVIDENCE: The care plans examined were found to contain limited information, and in some cases could have contained better detail as to how the care needs could be met. Cross- referencing of information and instructions between risk assessments and care plans was poor, with limited reference to outside professionals input. An example was a service user who had been admitted to hospital, despite returning to the home there was no risk assessment relating to falls, which appeared to have been a problem. The care plan had no detail on how staff should work with, and observe the person. There were separate notes written by the physiotherapist, but no reference to physiotherapy input in the care plan. Croxley House DS0000019318.V271873.R01.S.doc Version 5.0 Page 10 Further evidence was of a service user who was diabetic, and self – administers his own insulin. It was mentioned in the care plan, but information relating to recording or monitoring of blood sugar levels, or diet was not mentioned. There was also no risk assessment detailing protocol, or procedure. Croxley House DS0000019318.V271873.R01.S.doc Version 5.0 Page 11 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): 15 The present manager is actively involved in providing a range of social activities, which are regularly reviewed and updated taking into account service users requests and choices. Visitors are welcome, and activities are often offered for relatives and friends to participate. A varied diet is offered to service users, but it would be helpful to include the provision of specialist diets in individuals care plans. EVIDENCE: Service users spoken to generally expressed that the food offered was of a high standard. However on the day of inspection there was no alternative to the two fish dishes offered, other than salad. Care plans do not include information relating to likes and dislikes, and this would be particularly useful in reference to service users who are deteriorating and may not be able to chose in the future. They also do not indicate when a service user requires a specialist diet i.e. diabetic. Croxley House DS0000019318.V271873.R01.S.doc Version 5.0 Page 12 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): Please refer to inspection report of the 24th May 2005. Above standards not assessed on this occasion. EVIDENCE: Croxley House DS0000019318.V271873.R01.S.doc Version 5.0 Page 13 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): 3 Croxley House offers a comfortable and pleasant living environment. The home is clean and well maintained. Service users bedrooms are personalised and homely. EVIDENCE: The building was seen to be in good repair with only two concerns raised with the manager on the day of inspection. The bathroom opposite room 19 was seen to be housing a number of empty boxes, and various items were also waiting to be unpacked. This made for a cluttered area, making usage difficult and possibly hazardous for service users. There was an unpleasant odour in the ‘guest room’, which is used for the purpose of respite. The manager was asked to investigate this. The inspectors observed afternoon tea being served. The food being served was sampled and was of a good standard. There was however concern relating to the teapots in use. They do not appear to pour properly causing the possibility of scalding. Croxley House DS0000019318.V271873.R01.S.doc Version 5.0 Page 14 Croxley House DS0000019318.V271873.R01.S.doc Version 5.0 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28 The manager appears keen to actively seek the views of both service users and carers. All staff needs to be actively involved in this process, as the manager will be leaving in the near future (31/12/05). Staffing records continue to show that more rigorous checks are required, as documentation was incomplete in several files viewed. Service users suffering from dementia require specialist support and all staff requires related training. EVIDENCE: The service users spoken to talked very positively about the quality of care received, particularly the manager. They said that their views were listened to and that they could raise any concerns if needed. Several staff files were viewed. Documentation relating to the employment checks of staff remained incomplete prior to staff taking up post. This has previously been discussed with the registered manager and it was disappointing to see only minimal improvement was seen. Croxley House DS0000019318.V271873.R01.S.doc Version 5.0 Page 16 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): 32,38 The present manager has provided stability and security to service users. Many have known her for a long time. It is important to provide information to service users relating to the new manager as soon as possible. EVIDENCE: The present manager is retiring on the 31st December, and has been in post for a long period of time. Service users expressed concern that they were not aware of who would be ‘taking over’ in this role. The provider, Greensleeves homes Trust, must advise the commission of the arrangements for the running of the home as detailed under regulation 38(2) Croxley House DS0000019318.V271873.R01.S.doc Version 5.0 Page 17 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 x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 x 2 x x x x x x x STAFFING Standard No Score 27 x 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x 2 x x x x x 2 Croxley House DS0000019318.V271873.R01.S.doc Version 5.0 Page 18 Are there any outstanding requirements from the last inspection? 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. The registered person will ensure staff; adhere to the correct signing, and administration of medication. Staff should not use tippex on MAR sheets. Timescale for action 06/02/06 2. OP9 13(2) 09/12/05 3. OP19 23(2)(c) A regular assessment of equipment should be carried out. (Teapots which do not pour properly, must be replaced in case of scalding.) 31/12/05 4. OP26Op26 16(2)(k) The manager must ensure that the environment is free from offensive odours. The respite room should not be used until this is investigated. 19/12/05 Croxley House DS0000019318.V271873.R01.S.doc Version 5.0 Page 19 5. OP30OP30 18(1)(c) All staff must receive dementia care training. 28/02/05 6. OP31Op31 8(1) Greensleeves management trust must advise the commission regarding the appointment of a new manager. 01/02/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Croxley House DS0000019318.V271873.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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