Inspection on 01/02/06 for The Crossings

This inspection was carried out on 1st February 2006.

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

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

Other inspections for this house

The Crossings 23/05/07

The Crossings 11/10/05

The Crossings 07/01/05

The Crossings 30/11/04

The Crossings 03/02/04

Similar services:

Flint House

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

The Cotswold Home

Fairways

Treloar College

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 The Crossings 108a Aylesbury Road Wendover Bucks HP22 6LX Lead Inspector Barbara Mulligan Unannounced Inspection 1st February 2006 09:30 The Crossings DS0000023083.V281347.R01.S.doc Version 5.1 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 The Crossings DS0000023083.V281347.R01.S.doc Version 5.1 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 Adults 18-65. 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. The Crossings DS0000023083.V281347.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Crossings Address 108a Aylesbury Road Wendover Bucks HP22 6LX 01296 625928 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) Turnstone Support Limited Mrs Dawn Humphris Care Home 4 Category(ies) of Learning disability (0), Physical disability (0) registration, with number of places The Crossings DS0000023083.V281347.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 4 residents with learning disabilities and/or physical disabilities Date of last inspection 11th October 2005 Brief Description of the Service: The Crossings is registered to provide 24-hour residential care and support to four people with learning and physical disabilities, who transferred from the NHS Manor Trust to the Community in September 2001. Accommodation is a detached bungalow, which aims to provide a family style environment for the service users. Service users have their own rooms and shared social areas. There is a well kept, safe and accessible garden to the rear of the property and car parking to the front. It is situated in a residential area and close to local amenities. Nursing support is provided as needed from the Community Learning Disability Team and District Nurses attached to the local GP Practice. The home is owned and managed by the Turnstone Support Group Ltd. which is a registered charity. The Crossings DS0000023083.V281347.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the inspection summary of an unannounced inspection carried out at The Crossings on the 31st January 2006 at 10:15am by Inspector Ms. Barbara Mulligan. The inspection consisted of looking at a number of records, discussion with the registered manager Dawn Humphris, meeting with staff, service users and a tour of the home. At the time of the visit two service users were at home and two service users were out at their chosen day care activities. The inspector assessed twenty-one of the National Minimum Standards for Younger Adults with nineteen of these fully met and two almost met. As a result of the inspection the home has received two requirement. There are two outstanding areas where the home scored fours and are to be commended. The inspector would like to thank the service users, the staff team and the registered manager for their cooperation during the inspection. What the service does well: The Service Users Guide is excellent. This is in pictorial form and is suitable for service users who are unable to read. The home is to be commended on the Service Users Guide. The home provides a very pleasant and comfortable environment in which service users can live. Individuals are encouraged to personalise their own rooms with their own furniture and personal belongings. Meals are of a high standard and always presented in an appealing way. Service users are able to choose their own menus and take part in meal/food preparation and shopping for food. The home is proactive in implementing systems to enhance communications with service users. Each service user’s care plan contains a communication profile. Service users are given opportunities to make decisions about their lives, with assistance as needed. The home have implemented food tasting sessions e.g. one session consisted of different flavours of ice creams to determine which flavours service users prefer. There is a feedback form that has been adapted into pictorial form. This is excellent and is to be commended. Care planning documentation is of a good standard and each service user’s plan contains a detailed action plan. There is an effective complaints procedure with all complaints and concerns being acted upon promptly within stated time scales. There is a motivated and established staff team that consists of care/support staff. There is good support for the home by the provider organisation, with effective monitoring and quality assurance systems in place. The Crossings DS0000023083.V281347.R01.S.doc Version 5.1 Page 6 There is an extensive range of policies and procedures, providing care staff with relevant information about all aspects of care and the home/organisation. Many of these are being made available in different formats to make them more accessible for service users. The health and safety policies and procedures are clear and informative and care staff receive the relevant training to make certain safe working practices are maintained. All records for health and safety matters are accurate, up to date and well maintained. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Crossings DS0000023083.V281347.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Crossings DS0000023083.V281347.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 5 The homes Statement of Purpose and Service Users Guide provide service users and prospective service users with details of the services the home provides. Pictorial guidance is included to make both documents suitable for the people for whom the home is intended. All service users have a written, individual service contract ensuring that there is an understanding of the homes terms and conditions. EVIDENCE: The homes Statement of Purpose and Service Users Guide are detailed and informative. The Service users Guide is particularly user friendly being available in pictorial form providing service users with details of the services that the home provides. The inspector looked at service users contracts/statements of term and conditions. These cover all areas detailed in Standard 5 and are signed by either service users or their representative. However, these are not signed by service users or their representative. This is a requirement of the report. The Crossings DS0000023083.V281347.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 8 There are excellent systems in place for enabling service users to make their opinions of the service provided at the home known, therefore making them feel valued, promoting their individuality and enhancing their self-esteem. EVIDENCE: The Crossings DS0000023083.V281347.R01.S.doc Version 5.1 Page 10 Service users families are involved in the care-planning process if the service user wishes them to be. The home operates a key worker system. Communication for service users living in the home is difficult due to the severity of their learning disabilities. The home is proactive in implementing systems to enhance communications with service users. Each service user’s care plan contains a communication profile, and some information in the care plans are set out with Makaton Symbols. Service users are given opportunities to make decisions about their lives, with assistance as needed. This includes help to make decisions regarding their choice of activity, daily routines, menu planning and preferred daily routines. The home have implemented food tasting sessions e.g. one session consisted of different flavours of ice creams to determine which flavours service users prefer. Pictures and photos are used to assist the service users when making a choice. There is a feedback form that has been adapted into pictorial form. This is excellent and is to be commended. Relatives of service users are invited to join a carer’s conference that is held annually and is an opportunity for relatives/representatives of service users to give feedback to the organisation. The Crossings DS0000023083.V281347.R01.S.doc Version 5.1 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15 and 16 Care planning documentation demonstrates how service users have opportunities for personal development and independence training enabling them to live their lives to appropriately independent levels. Service users are able to access a wide range of amenities which meet their social, leisure and spiritual needs. Service users are presented with ample opportunities for social inclusion and benefit from good staff support to do so. Service users engage in appropriate leisure activities inside and outside of the home, allowing individuals to pursue their own interests and hobbies. The home promotes ‘flexible’ visiting, which enables service users to maintain contact with their friends and family. Service users rights are respected and the daily routines of the home promote individual choice and providing service users with the ability to be as independent as their needs allow. The Crossings DS0000023083.V281347.R01.S.doc Version 5.1 Page 12 EVIDENCE: Service users are given opportunities to maintain and develop social, emotional, communication and independent living skills. However, due to the physical and learning disabilities of the service users living in the home these are small steps. Service users go out to day care activities and are supported to undertake personal activities with the homes staff, such as personal shopping. Literacy, vocational and numeracy training are not undertaken by the service users at the home due to the severity of their learning disabilities. This also includes developing employment skills and maintaining links with careers advice services, local employers and job centres. Service users take part in varied leisure activities and use local community facilities regularly. Examples seen were visits to the local leisure centre, cinema, shops, bowling, health centre and local pubs and restaurants. Service users have access to homes transport and this is used to travel to their chosen activities. Service users do not vote, but are on the electoral role. Individuals are encouraged and supported to pursue their own interests and hobbies. Televisions, videos, music systems and a large selection of C.D.’s are available in each service users bedroom. Families and friends are welcomed into the home and are involved in daily routines and activities. Service users can choose whom they see and can see visitors in their own rooms, in private, if they wish. There are no restrictions about family and friends visiting. Staff knocking on bedroom, toilet and bathroom doors maintain the privacy of individuals. If service users express a wish to have a key to their own bedrooms then this will be facilitated. Staff open mail with the service users, as they are unable to do so themselves and the mail is read to them. Preferred term of address are used for service users and this is recorded in the care plans. Care staff were seen interacting with service users do so with respect and in a manner that is appropriate to the individual. The Crossings DS0000023083.V281347.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 and 21. Personal support is offered in such a way as to promote and protect service users’ privacy, dignity and independence. The systems for the administration of medication are well managed protecting service users and ensuring their medication needs are met. The physical, emotional and health care needs of service users are well met with evidence of good multi disciplinary working taking place on a regular basis. There are good policies/procedures in place to ensure that the ageing, illness and death of a service user will be handled with respect and as the individual would wish. EVIDENCE: The Crossings DS0000023083.V281347.R01.S.doc Version 5.1 Page 14 Information regarding personal care is recorded in the service users care plans. Individuals choose the times they wish to go to bed, bath, have their meals and take part in other activities. It is evident from information contained in care plans that service users choose their own clothes, hairstyles and make up. Service users are supported and facilitated to manage their own healthcare where practicable. Service users visit their G.P. on a needs only basis. Chiropody services are accessed locally on a needs only basis. Additional support is accessed through the local Health centre, where service users can access physiotherapists, occupational therapists, speech therapists and other specialist service they may require. Visits to the home from healthcare professionals take place in the service users bedrooms to maintain privacy. Staff provide support to service users needing to attend outpatient and other appointments. Eye screening is being undertaken on an annual basis at a local optician. The home operates a key worker system. The care plans set out in detail the service users preferred routines, likes and dislikes and partnerships with families, friends and relevant professionals outside of the home. The nutritional needs of service users are identified and their weight is monitored. None of the service users in the home are able to self-administer their own medication. Several service users have epilepsy and occasionally require rectal Diazepam stesolids. The home will call for an ambulance in these circumstances and care staff do not administer rectal stesolids. Records show all medication received, administered and leaving the home, or disposed of. It was pleasing to note that there were no omissions. No controlled drugs are in use. If a service user became ill, an assessment will be carried out with the involvement of their family, and the service users wishes regarding terminal care and death would be discussed, and carried out. The Crossings DS0000023083.V281347.R01.S.doc Version 5.1 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed during the inspection. EVIDENCE: The Crossings DS0000023083.V281347.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed during the inspection. EVIDENCE: The Crossings DS0000023083.V281347.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34, 35 and 36 Recruitment procedures at the home are robust, which ensures that staff are compelled to apply for legislative clearances that render them appropriate for the post applied for and in turn suitable to care for and support service users with a Learning Disability. There is a staff training and development programme that ensures staff fulfil the aims of the home and meet the changing needs of service users. Service users benefit from having staff who are supervised and whose performance is appraised regularly. EVIDENCE: The Crossings DS0000023083.V281347.R01.S.doc Version 5.1 Page 18 A random selection of staff files were looked at. These contain most of required documentation as detailed in Schedule 2. However, the only evidence available regarding CRB checks is a tick list that asks if a CRB check has been obtained. This is ticked under yes or no. The home need to ensure that further evidence of staff CRB checks is held in the home and is a requirement of the report. All staff appointments are subject to a six-month probationary period. Training needs are identified during staff supervision and their annual appraisal. All staff receives a TOPPS induction and a company induction programme. This covers equal opportunities training, recognising discrimination and multi cultures training. The organisation’s induction covers fire safety, moving and handling techniques and core skills training. Training and development are linked to service users’ needs and individual care plans. The registered manager and the senior support worker undertake formal staff supervision. Each staff member has an annual appraisal, where training needs are identified and the line manager reviews performance against the individual’s job description. Staff meetings are held monthly and the inspector saw evidence of this. The inspector saw the homes grievance and disciplinary procedures, and was told that all staff are given copies of these. The Crossings DS0000023083.V281347.R01.S.doc Version 5.1 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 38, 39, 42 and 43. The management approach of the home creates an open, positive and inclusive atmosphere. Effective quality assurance and quality monitoring systems, based on seeking the views of service users, are in place to measure success in achieving the aims, objectives and statement of purpose of the home. There are systems within the home that are used to ensure that service users health, safety and welfare are protected and promoted. The overall management of the home ensures the effectiveness, financial viability and accountability of the home. EVIDENCE: The Crossings DS0000023083.V281347.R01.S.doc Version 5.1 Page 20 The registered manager has the overall responsibility for ensuring the homes written aims and objectives are achieved, the homes budget is properly managed, policies and procedures are implemented, and certificates are displayed and that the home complies with the Care Standards Regulations. The manager communicates a clear sense of direction and leadership to the staff team by leading by example. The registered manager has completed her Registered Managers Award. Further training undertaken by the registered manager include interview and recruitment, PDP training, management finances and all mandatory training. Service users and other stakeholders can voice their concerns via service users meetings and the homes advocate chairs these. Staff have regular meetings, four-weekly supervision and an annual appraisal. The home has an annual development plan for the home, based on a systematic cycle of planning-action-review, reflecting aims and outcomes for service users. There is evidence of continuous self-monitoring, and the home receives feedback from service users families, friends and advocates. Feedback is also obtained via service users meetings, staff meetings and staff supervision. The organisation has devised a service user satisfaction questionnaire in pictorial form and this is to be commended. Policies and procedures were regularly reviewed in light of changing legislation and the inspector saw evidence of this. There is evidence of moving and handling techniques and training is carried out in the home and all staff are up to date. Fire alarm testing is maintained weekly. There is a weekly test of the homes emergency lighting and the inspector saw the homes fire floor plan, fire risk assessment and evacuation procedure. Fire training is carried out on an annual basis. There is an organisational policy for infection control and this covered all areas as detailed in standard 42. All staff undertake a one day training course for emergency First Aid. All staff complete Basic Food Hygiene training and this is updated as necessary. Hazardous substances are stored appropriately and COSHH sheets are completed and up to date. There is evidence of water temperature recording, work placement risk assessments, accident and incident reports, health and safety risk assessments and the maintenance of electrical systems and electrical equipment. The homes oil boiler was last serviced on the 15/12/2005. PAT testing was last completed in August 2004 and there is an electrical installation certificate that was carried out in 2001. This needs to be undertaken again in 2006. The assisted bath was last serviced on 05/01/2006 and the hoist was serviced on 24/08/2005. There is a certificate of disinfection dated 12/11/01. The inspector observed insurance certificates on display in the home. The Crossings DS0000023083.V281347.R01.S.doc Version 5.1 Page 21 There is a home and organisational managers flow/structure chart and this allows the staff to understand lines of accountability within the home and the organisation. A business and financial plan for the home was not seen at the inspection. There are systems in place to ensure budget monitoring, supervision, training and appraisals of managers and quality monitoring. The Crossings DS0000023083.V281347.R01.S.doc Version 5.1 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 4 2 X 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 x ENVIRONMENT Standard No Score 24 X 25 X 26 X 27 X 28 X 29 X 30 x STAFFING Standard No Score 31 X 32 X 33 x 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X X 4 X x LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 X 3 3 X x 3 3 The Crossings DS0000023083.V281347.R01.S.doc Version 5.1 Page 23 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 34 Regulation Schedule 2 Requirement The registered manager is required to ensure that the home obtain further evidence of staff CRB checks. Timescale for action 30/03/06 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 The Crossings DS0000023083.V281347.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Aylesbury Area Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury HP19 8JR 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. Extracts may not be used or reproduced without the express permission of CSCI The Crossings DS0000023083.V281347.R01.S.doc Version 5.1 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!