Care Home: Crosshill House

What the care home does well People said they were comfortable at the home. The home has a warm and friendly atmosphere and interactions between the staff and people who use the service were observed to be open and respectful. Families spoken to during the day commented on how welcome they are always made to feel. People spoke highly of the service at the home and comments received included `My relative is warm, safe and comfortable now she has moved to Crosshill and she is happier than she has been for a long time`,` They care for the residents as individuals, it is a small and friendly care home, everything possible is done for my mother`,`The day- to- day care is excellent.They suit their care with consideration for the individual` and `All the staff are caring and conscientious, my relative is well looked after`. People who use the service are given choices about their lifestyle.They are encouraged to maintain their hobbies and pastimes, take up new interests and maintain relationships with their family and friends. Special dietary needs are catered for and meals are varied with individual choices ensuring that people who use the service receive an appealing and balanced diet. Comments included ` Food is excellent and varied`. People who use the service and their relatives concerns are listened to and staff make sure they take action to sort problems out quickly. Staff are well trained, supervised and supported to carry out their roles. The home works hard to improve the quality of its service by asking the opinions of the staff, people who use the service, relatives and other interested parties. What has improved since the last inspection? Improvements have been made to the quality of the care plan records however some further improvements would better ensure that staff have clearer information about how to care for people. More decoration and refurbishment of the facilities has taken place. The new extension is a very positive addition to the facilities at the home. The home has achieved the target of ensuring at least 50% of the care staff have achieved NVQ level 2 or 3 in care. What the care home could do better: Although detailed assessments are carried out, some of this information is recorded in the care plans, this information should be separated out to provide more comprehensive assessment records and clearer plans of care, which staff will be able to follow and update more easily. Handwritten medication records should be witnessed and signed by a second staff member to ensure the information is correct. Temperature recordings of the medication fridge and storage areas should be taken regularly to ensure all medications are stored safely. The management must ensure that two written references are obtained for all newly recruited workers before they commence work at the home, this will protect people`s safety. The flooring in the laundry area must be repaired or replaced to ensure that staff can work in this area safely and appropriate standards of hygiene are maintained. A fence should be erected around the pond in the garden to ensure the safety of the people who use the service. The home should take action to ensure compliance is achieved towards the recommendations made by the Environmental Health Officer following their visit in April. Key inspection report Care homes for older people Name: Address: Crosshill House Crosshill House Market Square Barrow On Humber North Lincolnshire DN19 7BW     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jane Lyons     Date: 0 8 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Crosshill House Crosshill House Market Square Barrow On Humber North Lincolnshire DN19 7BW 01469531767 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Oakhills Residential Homes Ltd care home 14 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who may be accommodated is 14 The registered person may provide personal care (excluding nursing) and accommodation to service users of both sexes whose primary care needs on admission to the home are within the following categories: Dementia (Code DE) 12; Old Age, not falling within any other category (Code OP)14 Date of last inspection Brief description of the care home Crosshill House is a small, homely residential home that is situated in the centre of Barrow on Humber close to local amenities. These include a post office, church and chapel, library and shops. It is registered to offer care and support to fourteen people over the age of sixty-five years, some of whom may have needs accociated with dementia. The home comprises of two storeys that are serviced by a passenger lift. There are ten Care Homes for Older People Page 4 of 31 0 3 0 3 2 0 0 9 0 0 Over 65 12 14 Brief description of the care home single bedrooms and two shared rooms, three of the single rooms have en-suite facilities. People who use the service have the use of two assisted bathrooms, one on each floor and three further separate toilets. Crosshill House has a lounge and seperate conservatory area with dining and lounge facilities. The garden is enclosed and well maintained with a large pond and mature plants and trees. Information about the home and its service can be found in the statement of purpose and service user guide, both these documents are available from the management at the home. Current fees range from three hundred and forty-nine pounds to four hundred and twenty pounds per week. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means that the people who use this service experience good quality outcomes. This inspection included an unannounced site visit carried out by Mrs Jane Lyons on the 8th December 2009. This inspection report is based on information received by the Care Quality Commission (CQC) from the last nine months including information gathered during a site visit to the home which took approximately seven hours. Throughout the day we spoke to people staying in the home to gain a picture of what life is like at Crosshill House during their stay. We also had discussions with the registered providers, deputy manager, care staff, the cook, visitors and a community nursing assistant. Care Homes for Older People Page 6 of 31 People who use the service were given surveys and four were returned. Relatives were given surveys and five were returned. Staff that work at the service were given surveys and two were returned. Placing social workers and health care professionals were given surveys and two were returned.Comments and views from everyone have been included in relevant parts of the report. We looked at assessments of need made before people were admitted to the home and the homes care plans to see how those needs were to be met while they were staying there. Also examined were medication practices, activities provided, nutrition, complaints management, staffing levels, staff recruitment, staff training, how the home monitors the quality of service provided and how the home is managed overall. We also checked with people to make sure that privacy and dignity is maintained, that people can make choices about aspects of their lives and that the home ensures they are protected in a safe, clean environment. We observed the way staff spoke to people and supported them and checked out with them their understanding of how to maintain privacy, dignity, independence and choice. We would like to thank the people who were staying at Crosshill House, the staff team and the management for their hospitality during the visit and also thank the people who spoke with us. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: Although detailed assessments are carried out, some of this information is recorded in the care plans, this information should be separated out to provide more comprehensive assessment records and clearer plans of care, which staff will be able to follow and update more easily. Handwritten medication records should be witnessed and signed by a second staff Care Homes for Older People Page 8 of 31 member to ensure the information is correct. Temperature recordings of the medication fridge and storage areas should be taken regularly to ensure all medications are stored safely. The management must ensure that two written references are obtained for all newly recruited workers before they commence work at the home, this will protect peoples safety. The flooring in the laundry area must be repaired or replaced to ensure that staff can work in this area safely and appropriate standards of hygiene are maintained. A fence should be erected around the pond in the garden to ensure the safety of the people who use the service. The home should take action to ensure compliance is achieved towards the recommendations made by the Environmental Health Officer following their visit in April. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Proper pre - admission procedures are in place and followed so that people who are thinking about moving into the home can feel confident that their needs will be met. Evidence: We looked at a sample of files which belong to people who are staying at the home and we saw that these contained a range of assessments undertaken by the home. The assessments cover all aspects of health and personal care needs. In addition to this, information is also requested from the family and health and social care professionals where possible so that the home has as much information about the prospective individual prior to their admission. The format of the current assessment records is mainly tick box in style and advice was given to develop the documentation to allow for more descriptive details of the persons needs and how they would like their assistance to be given. We saw evidence that a lot of descriptive information was contained in the actual care plans, this information would be better recorded in the assessments so the care plans detail clearer guidance for staff on how Care Homes for Older People Page 11 of 31 Evidence: people wish to be supported and how their current needs can be met. Wherever clients are referred through the Local Authority the home has obtained copies of relevant assessment reports and care plans. The assessment process also takes account of peoples cultural and social needs. This information is recorded and made available to carers so they have a good understanding and know how people wish to be addressed and their preferred lifestyle. There was evidence to demonstrate that care staff are continuing to access a range of service specific training, this will help ensure that they have the skills to enable them to deliver up to date care methods and have a better understanding of the varied conditions common to older people. The home has varied their registration so they can accept people with needs associated with dementia, records show that staff have completed a training course in dementia. The home does not provide intermediate care dedicated to accommodate individuals with intensive rehabilitation needs so standard six is not applicable. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are very happy with the care support they receive and the care plans generally provide sufficient information and guidance to staff on how to meet peoples needs. The medication systems at the home are well managed ensuring the promotion of good health. Evidence: Care files for three of the people living at the home were sampled during this inspection visit, we saw evidence that further improvements have been made to the standard of recording however some more developments are needed to ensure staff are provided with clearer directions on how to provide care for people. New care plans have been developed, we saw that the plans contain a lot of assessment information and these could be improved if they focused more on the actual care people needed and how they wanted their care support delivered. The staff should also ensure people or their representatives have signed their care plans to demonstrate they have been involved in the development and have agreed to the content. Daily recording has been well maintained, staff were describing how peoples health Care Homes for Older People Page 13 of 31 Evidence: and personal needs had been met they were also describing in detail how people had spent their time. The use of risk assessment documentation to form a basis for care was consistent, all files seen contained risk assessments to cover areas such as mobility, falls, pressure damage and nutrition. The risk assessment documentation provides detailed action plans to support the care required to maintain peoples health welfare and safety in each area assessed. Records show that they have been reviewed regularly and updated to reflect any changes in need. Entries in the care files detail where individuals have specific nutritional needs and also note their likes and dislikes. Records show that people are weighed regularly, the seated scales have recently broken but the owners are purchasing equipment which can be used with the hoist. We saw evidence in the records that dietetic advice is sought where necessary. Continence is promoted discreetly by providing toileting assistance at appropriate intervals, some people have been assessed by the community continence adviser and are provided with aids such as continence pads. A number of individuals have medical conditions that impact on mobility, there is a good range of moving and handling equipment available and staff had all received training in how to use the equipment properly to make sure people who use the service and staff were kept safe. Annual reviews take place to discuss peoples care with their family and others who are involved in their care. Information about peoples wishes prior to and following their death is included in the care file where people have chosen to discuss this aspect of their care. Care records show that peoples health is monitored and people have access to health care facilities and any relevant specialists that are necessary, the staff support people in attending appointments. Health care information is recorded in the care records about why people are attending appointments and outcomes from these. During the visit we spoke to a nursing assistant who visits the home regularly, she told us that the home worked well with the community health care team, it was a pleasure to visit the home and all their patients were very happy with the standards of care and support they received. People appeared well dressed and had received a good level of personal care. Comments received during the visit from people who use the service show that they are very satisfied with the care and support offered by the staff. Comments included The staff are wonderful and look after us very well and They cant do enough to help us. Care Homes for Older People Page 14 of 31 Evidence: We looked at the medication systems during the inspection visit which showed that the management had addressed some of the recommendations made at the previous visit but some further improvements are needed. The controlled medication cupboard has now been securely fixed to the wall in line with current guidance however the temperature of the storage area and medication fridge needs to be monitored regularly and handwritten entries (transcribing) on the medication administration records(MARS) should be witnessed and signed by a second staff member to ensure the information is correct. Checks on medication administration records show that each person gets the medication they need at the right time. Storage was seen to be managed well, internal and external medications are stored separately and stock control was noted to be good. People are encouraged to be as independent as possible in controlling their own medication, risk assessments and monitoring systems are in place for those who can self medicate. Records show that staff have now accessed an accredited medication course which ensures they are competent in all areas of medication management and administration. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to make choices about daily living and are involved in a good range of social activities. People are well supported to maintain contact with their friends and family. Meals served at the home are of a good quality and offer choice to ensure people receive a balanced diet. Evidence: Crosshill House is a small, friendly home with a welcoming and family orientated atmosphere. People told us that they are able to exercise choice in all their daily routines, which was observed during the visit. There is a very close knit community around the home and people who use the service continue to receive visits from local church representatives, families and friends; some of the people continue to access regular trips out with relatives and friends, such as outings to the shops for lunch and to the local Methodist Chapel. One individual attends art classes at a neighbouring village each week. Arrangements had been made for people who use the service to attend carol services at local primary and high schools. One of the senior care staff has been given the responsibility for organising activities in- house, entertainment and trips into the local community. There is a monthly theme Care Homes for Older People Page 16 of 31 Evidence: to the social programme which is usually associated with the time of year and holidays.The staff maintain an activity book which details social events and activities arranged and people who have participated. There was evidence in the care documentation of personal profiles, social needs assessments and plans which identify peoples hobbies and leisure pastimes before they entered the home and what they enjoy doing now.Activities are planned in advance and provided by staff each day. Typical activities that take place range from Bingo, dominoes, watching DVDs, reminiscence, sing a longs, crafts, manicures, baking and gentle exercise programmes. Views from people during the day and from comments in surveys were very positive about the activities and entertainment provided, some of these included We get involved in lots of things and I enjoyed the reminiscence boxes they got from the museum. Photographs of people participating in entertainment at the home are displayed on a notice board in the hall. Cultural and religious needs are responded to with services for different faith groups held at the home. Discussion with the people living in the home indicates that the staff support contact with their families and friends. Everyone said they were able to see visitors in the lounge or in their own room and they could go out of the home with family or staff would take them out locally. Visitors were seen coming and going during the day, staff were observed making them welcome and there was clearly a good relationship between all parties. Relatives and visitors to the home are very positive about the service and the staff. Written and verbal comments given to the inspector showed a high level of satisfaction. The home has organised a number of outings to get out and about in the community, including visits to a local garden centre, lunch at a local restaurant, trip to Cleethorpes and a visit to The Deep. The home produces a quarterly newsletter, which people told us they enjoyed reading. During the visit the home held a coffee and mince pie afternoon which was well attended by the people who use the service, their relatives and some people from the neighbourhood. All the comments received during the visit confirmed that the standard of the meals is very good. Comments included The food is very, very good and You cant fault any of the meals, the cook is wonderful. People are consulted on admission regarding their dietary needs and preferences. Menus are planned over a four week period with input from the people who use the service and knowledge of needs and preferences. The cook visits each person daily to discuss menu choices. The kitchen was very clean and tidy. People were observed enjoying their lunch meal in a relaxed and comfortable atmosphere. The meal served was hot, nicely cooked and well presented. We observed staff assisting people to eat in a sensitive and dignified way. Care Homes for Older People Page 17 of 31 Evidence: The cook told us that specialised diets currently provided are diabetic diets. Menus are reviewed regularly in consultation with people who use the service. Records show that staff working in the kitchen area hold current basic food hygiene certificates. Care Homes for Older People Page 18 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Crosshill House are protected by the service and listened to. Evidence: People and their representatives have been provided with a copy of the homes complaints procedure, which is also on display in the entrance hall. The procedure provides people with clear information. Those people spoken with during the day confirmed they knew who to go to if they were unhappy about something, they all told us that the management were very approachable. The home has not received any complaints since the last inspection. We have not received any complaints. Discussions with the management demonstrate that they have systems in place to manage complaints effectively. The home provides training for all staff in safeguarding procedures that protect people from abuse or neglect. It was evident from discussions that staff are knowledgeable about safeguarding adults reporting procedures and know what to do if they witnessed anything that concerns them. All incidents relating to people who use the service are recorded and maintained on file. Appropriate notifications are made promptly to relevant agencies. The management have made two safeguarding referrals since the last inspection, evidence from the safeguarding team at North Lincolnshire Local Authority support appropriate action taken by the home with these matters. The management confirmed that staff will be provided with training on the legislation Care Homes for Older People Page 19 of 31 Evidence: to support Mental Capacity and Deprivation of Liberty legislation in the New Year. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of environment within the home is good, providing people with a comfortable and homely place to live. Evidence: The home provides and maintains comfortable facilities, people said they are very happy living at Crosshill House. The bedrooms seen were personalised and reflected the tastes and preferences of their occupants. People are able to bring personal items with them on admission and can install a private telephone line if they wish. One person told us I love my room, the view out of the window is wonderful, I can watch everyone coming and going. The home has an ongoing maintenance and refurbishment programme, the new extension has been completed and the two bedrooms with en- suite facilities and conservatory are a very positive addition to the facilities at the home. Many areas of the home have been redecorated and refurbished, the decor and furnishings are of good quality and reflect a more contemporary style. All bedrooms have been provided with new flat screen T.Vs. which people can use if they wish. People told us that they had been consulted about some of the decor and pictures, where possible. Discussion with the staff and deputy manager indicates that there is a wide range of equipment provided to help with the moving and handling of people and to encourage Care Homes for Older People Page 21 of 31 Evidence: their independence within the home. Pressure relieving mattresses and cushions are provided by the community services and the home, where people are deemed at risk of developing pressure sores. The atmosphere on the day of the visit was warm and friendly and people looked comfortable whilst sitting in various parts of the home. People spoken with said how pleased they are with the home and the facilities available. A walk around the home found it to be exceptionally clean and tidy and smelling fresh. Comments from surveys and people during the day include the girls work hard to keep the place clean and tidy and good, clean facilities. The home appeared to have good systems in place to control the spread of infection, antibacterial hand gel is placed at points throughout the home with advice to visitors on infection control. Records show that staff have not recently accessed training in infection control, however staff are scheduled to access this course in January. People told us they were happy with the laundry arrangements, however when we looked at the laundry facilities we noted that the flooring needs attention where a number of the tiles have been removed which could pose a risk to health and safety management in this area.The owners confirmed that new flooring was included in the maintenance programme, however this work needs to be carried out as a priority. kitchen areas were visited during this inspection. The Environmental Health Officer had made a number of requirements and recommendations at their visit in April, we saw evidence that recommendations relating to the facilities were being actioned.The Kitchen had been redecorated, a new cooker provided, the boiler moved and a number of the units replaced. The gardens at the home are at the rear of the property and are very attractive with a pond and lots of mature plants and trees. When we varied the homes registration to accept persons with needs associated with dementia we advised the management to erect a small fence around the pond, this work needs to be carried out to ensure peoples safety is adequately protected. Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Crosshill House are supported by a dedicated staff team who are appropriately trained and supervised. Overall the recruitment practices are much safer however closer scrutiny to the number of written references received for new staff will help in making sure that people are not at risk from unsuitable workers. Evidence: The home has a stable staff team. Discussions with staff and people who use the service and from observation during the day evidenced that there are enough staff rostered to meet peoples needs. At the time of the visit there were fourteen people residing at the home. Staff told us they had enough time to carry out their tasks and spend time with people which was observed during the day. The staffing levels at the home should be assessed using Department of Health Guidelines, The Residential Forum a dependency tool, which provides the number of hours needed from the dependency scores of each individual accommodated at the home. The deputy manager has recently applied to us for her registration and since the last inspection has taken on more responsibility for the day to day management of the home, she told us that she feels very supported by the registered providers . The home employs a full time cook and kitchen assistants, a gardener and cleaner have been appointed and the care staff are responsible for all laundry duties. Observation of the staff during the visit showed that the home was quiet, calm and well organised. Care Homes for Older People Page 23 of 31 Evidence: All people spoken to during the day were extremely complimentary about the staff at the home. The staff here are wonderful, they make sure we are well looked after and You cant fault the staff, they are all very kind were comments received during the visit from people who use the service. The home employs ten care staff. Records show that the home has now achieved the target of having 50 of the care staff have qualified at NVQ in care at level 2 or 3. This helps to ensure that people are receiving care from staff with the right skills and knowledge. Records show that new staff follow a five day induction programme where they work alongside an experienced staff member. New staff complete an induction and foundation training package that meets the specification of the Skills for Care targets. The home provides a programme which includes mandatory, general and some service specific training. The management maintain a training matrix on the computer and we also looked at some staff training files, which contained the relevant certificates. Records show that staff are up to date with mandatory courses in fire safety, moving/ handling and basic food hygiene.Training in first aid has been arranged for all staff in January. Other courses they have accessed are: medication, safeguarding adults, health and safety, falls prevention, continence and dementia. Courses arranged for staff in next years training programme include infection control, tissue viability, palliative care and Deprivation of Liberty legislation.Views expressed by staff on this inspection indicated that they are feeling well supported, that they are receiving good training, supervision and encouragement to develop their skills and potential. Staff employment records were checked to make sure that all of the appropriate safety checks had been completed before they were employed to have any contact with people living in the home. We looked at four sets of records. One file contained one written reference and a verbal reference taken over the phone, the management needs to ensure that two written references are obtained from previous employers to ensure people in the service are properly protected. The three remaining staff files contained two written references from previous employers. All files seen contained a Protection of Vulnerable Adult register check (Pova 1st) and a Criminal Records Bureau check (CRB police check), photograph, application form, proof of identification, a contract and terms and conditions of employment. Care Homes for Older People Page 24 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have confidence in the management at the home. Quality monitoring systems allow individuals and their families to comment on and in part affect the way in which the service is operated. The environment is generally safe for people and staff because appropriate health and safety practices are carried out. Evidence: The registered providers Jane and Emma Grey have continued to oversee the management and administration improvements in the home since they took over in June 2008. As at the previous inspection we saw evidence that they are committed to providing a service which is well run, provides high standards of care and has the individual at the heart of all they do. The deputy manager Michelle Barker has completed her NVQ level 3, has enrolled on the Registered Managers course and has recently submitted her application for registration with the CQC. Since the last inspection she has worked closely with the owners, gaining competence and confidence in the management and administration systems. People, staff and relatives said they were all happy to approach the deputy manager at any time for advice, Care Homes for Older People Page 25 of 31 Evidence: guidance or to look at any issues. The homes quality assurance and monitoring systems are developing well. The deputy manager has completed regular audits of staff practice, the environment and records which will be more formalised when new documentation is introduced in January. Meetings for the staff and people living in the home are taking place regularly; minutes are kept and are available for any interested parties to read. A social committee has also been appointed, which is run by relatives and people who use the service. We spoke to some of the people who are involved with this during the visit, they were very complimentary about the management and how their suggestions and requests had been carried out. One person told us The management are great, we had a meeting to decide what Christmas activities should be arranged and they have done everything we have asked from changing the times of the dinner to arranging a mince pie afternoon. Feedback is sought from the people using the service and relatives through regular meetings and satisfaction questionnaires. The management need to produce an annual report as part of this process to describe the qualitative improvements made to the service and how the management team is addressing any shortfalls in the service. The returned service and CQC surveys show that people are very happy with the home. North Lincolnshire council carried out an assessment of the services at the home in September, six of the seven areas assessed achieved a good rating and an excellent rating was given for the seventh area which looks at involvement. The registered provider told us that the homes policies and procedures were in the process of being reviewed and updated, the home has contracted with consultants who are carrying out this piece of work with the management to ensure the documents reflect current legislation and guidance, and are reflective of the working practices at Crosshill. All staff said that they receive regular supervision and regularly meet up with their manager to discuss ways of working and training, checks of records confirmed this. Some people have small amounts of personal money that is held safely at the home by staff. Records are available to show when money is deposited on behalf of people. The records show the individual cash balance for each person and how their money is used on their behalf, including receipts for goods and items purchased. Two peoples finances were checked during the visit and were found to be correct. The homes social fund is managed by the social committee, there was evidence that the homes management checks this regularly. People are protected by the way their finances are dealt with. Care Homes for Older People Page 26 of 31 Evidence: Regular safety checks are made of the facilities and equipment to make sure the home is a safe place to live and work. The staff are trained in safe working practices and are updated on a regular basis. We looked at some of the records of safety checks, like fire safety, and these were generally found to be up to date, staff access regular fire drills however records detailing who attended and the outcome of the drill should be recorded. Maintenance records such as checks on equipment and hot water were also looked and found to be up to date and satisfactory. Accident records were also seen and these are audited by the manager to see if measures can be taken to reduce the risk of accidents. The environmental health officer had visited the home in April and inspected the kitchen facilities, a number of recommendations were made and we saw evidence that the home is working towards compliance in this area. Bed rails were in use to support the care for one individual; a risk assessment was in place however the home should obtain guidance from the medical devices agency which provides more detailed guidance for staff on the safe management of bed rails, which will better protect peoples safety. Care Homes for Older People Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 38 23 Repair or replacement of the 15/02/2010 laundry floor must take place. This will ensure the safety of the people who live and work in the home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 3 The assessment records should be developed to include more descriptive detail on peoples needs and how they would like to receive their care. Care plans should be further developed to clearly describe the care people need and how they prefer to receive their care support. The plans should be signed by the individual or their representative to demonstrate their involvement and agreement. Handwritten records on medication administration documentation should be witnessed and signed by both staff members. Temperature monitoring of the medication fridge and storage room should take place regularly. The home should utilise the Residential Staffing Forum dependency tool to support the staffing levels provided. Page 29 of 31 2 7 3 9 4 27 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 5 29 The management should ensure that two written references are in place for all newly recruited staff prior to them starting work. The management should produce an annual development plan which describes the qualitative improvements made within the service. The management should ensure that all recommendations made by the EHO following their visit in April, are actioned. A fence around the pond area in the garden should be provided. 6 33 7 8 38 38 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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