Care Home: Crossways

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What the care home does well The home is extremely well run with a committed team of carers who have the best interests of the residents at heart. The provider ensures that the home is always well maintained and safe. The service carries out very good assessments prior to admission to the home to make sure that the service can meet the needs of prospective residents. This information is then used to plan care that addresses all the needs of the residents. One resident told us "the owner visited me three times to make sure I had all the information I needed before I moved into the home". The provider/manager is always keen to respond to recommendations made by the Commission. The residents make positive comments about the food, caring staff and the standard of care that they receive. A resident told us "in my wildest dreams I could not have found such a lovely home, the staff are so kind". Another said,"I am unbelievably happy here it is out of this world and the food is very good"; the staff are very kind and patient and good humoured". What has improved since the last inspection? The service has improved its system for keeping good records for assessment of new residents. Records for recruitment have improved with better notes kept of the interview process. Training of staff has improved and more staff have NVQ qualifications or working towards this. What the care home could do better: Ensure that all staff keep accurate records for the administration of ointments and understand the meaning of the term `self administration` of medicines. CARE HOMES FOR OLDER PEOPLE Crossways 1 The Boulevard Sheringham Norfolk NR26 8LH Lead Inspector Mrs Marilyn Fellingham Unannounced Inspection 25th September 2008 09:30 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 Crossways DS0000027294.V372341.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Crossways DS0000027294.V372341.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Crossways Address 1 The Boulevard Sheringham Norfolk NR26 8LH 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) 01263 823164 01263 826185 Mr S Booth Mrs Dawn Clark Mr S Booth Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Crossways DS0000027294.V372341.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th October 2006 Brief Description of the Service: Crossways is registered as a private care home providing accommodation and personal care for up to twenty-three older people. It is sited within walking distance of all amenities close to the centre of the small seaside town of Sheringham and was originally two large, period houses dating from the turn of the century and has been restored, adapted and decorated to a high standard whilst retaining some of the original features and made into one property. There is a shaft lift to facilitate access to all floors and it has bedrooms situated on the ground, first and second floors. All bedrooms are single with a toilet and washbasin en-suite and four bedrooms also have en-suite bathing facilities. The design of some bedrooms gives service users additional living and sitting space and there is communal use of an adapted bathroom on each floor, a lounge, conservatory and large, dining room where all service users have their own dining table. The grounds, although not extensive, are kept tidy and provide small, safe areas to the side and rear of the property where service users can sit and parking to the side of the front of the property with space for a number of vehicles. Crossways DS0000027294.V372341.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 star. the service experience excellent outcomes. This means that people who use This was an unannounced inspection that took place over six and a half hours. The key inspection for this service has been carried out using information from previous inspections, information from some residents, relatives, visitors to the home and people who work in the home. The main method of inspection used was ‘case tracking’. This involved selecting individual care plans and information available about people who live in the home and tracking their experience as a result of the support provided. During our visit a tour of the home premises was undertaken and resident’s records and staff files were looked at. The fees for this home are £358 to £560 per week. What the service does well: The home is extremely well run with a committed team of carers who have the best interests of the residents at heart. The provider ensures that the home is always well maintained and safe. The service carries out very good assessments prior to admission to the home to make sure that the service can meet the needs of prospective residents. This information is then used to plan care that addresses all the needs of the residents. One resident told us “the owner visited me three times to make sure I had all the information I needed before I moved into the home”. The provider/manager is always keen to respond to recommendations made by the Commission. The residents make positive comments about the food, caring staff and the standard of care that they receive. A resident told us “in my wildest dreams I could not have found such a lovely home, the staff are so kind”. Another said, Crossways DS0000027294.V372341.R02.S.doc Version 5.2 Page 6 “I am unbelievably happy here it is out of this world and the food is very good”; the staff are very kind and patient and good humoured”. 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 summary of this inspection report can be made available in other formats on request. Crossways DS0000027294.V372341.R02.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Crossways DS0000027294.V372341.R02.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People who use this service have good information about the home in order to make an informed decision about whether it is right for them. The needs assessment means that people’s diverse needs are identified and planned for before admission to the home. EVIDENCE: We looked at the assessment records prior to admission for three recently admitted residents; the initial assessments for these three residents were good with sufficient information to ascertain if their needs could be met. This information covered aspects of their physical/mobility, social and emotional health care needs. We spoke with two residents to find out if they had been given enough information about the home so that they could make a decision about if they Crossways DS0000027294.V372341.R02.S.doc Version 5.2 Page 9 wanted to live there. Both residents told us that they had been given a lot of information about the home and one told us that the provider had been back to visit them twice to ensure that they were happy with the arrangements for admission to the home. The other resident told us that they had had an opportunity to visit the home prior to admission and liked what they saw. Another resident whom we spoke with dais that the provider had visited them in hospital and a in their home and that they had made two visits to the home before making a final decision. Crossways DS0000027294.V372341.R02.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The practice regarding the assessment, planning and delivery of care means that the residents can be sure that their personal health care needs will be met. Although there was found to be few anomalies associated with the administration of medicines it does not affect the judgement made. EVIDENCE: We looked at care plans for five residents; they were good with evidence of resident involvement where possible and review. All five resident records had life histories in place. It was noted that for most of the care plans there were detailed instructions for care needs; nutritional and skin integrity assessments had been carried out and regular weight monitoring had also been recorded. We also noted that for all five residents there were mental capacity assessment reviews in place. We did note that although all important information was documented some of the care instructions and assessment of Crossways DS0000027294.V372341.R02.S.doc Version 5.2 Page 11 needs were muddled together; this was the case with a resident who is diabetic and the instructions for care relating to the control of their diabetes was muddled and confusing that could lead to mistakes in care being made especially when related to the administration of insulin. The records fore the residents had good risk assessments in place for falls and these were frequently monitored. There were also good notes about visits to the G.P. or the visits made to the home by the G.P. The home’s medication policies and procedures are being put into practice and auditing of medication entering the home is maintained. We undertook a random check of medicines, which revealed a few anomalies. One resident’s record chart for Temazepam indicated that for the 29/08/08 it had not been given, however when we checked the numbers of tablets left we found that they tallied with it having been given. We also noted that there were a number of ‘gaps’ on the medicine record charts for emollient creams and it made it difficult to ascertain if these had been applied as prescribed. The provider is aware of the gaps on the records and has already spoken to the person responsible for this. The service does spot audits for medicines and we saw records of these. The staff did when questioned seem to be under a misunderstanding about self medication and when they had referred to this it meant that they had left the medication with the resident in their rooms and had not witnessed it being taken. We discussed this with the staff and they agreed that they needed to change the wording for this activity and record on the medicine record charts that the medicines had been made available to the residents. However we did note that risk assessments were in place for this and that the residents were aware of this. We spoke with a number of residents and some visitors to the home; we discussed aspects of care with them. One resident told us “in my wildest dreams I never thought that there was such a lovely place as this”, another resident told us that they were aware of their plans of care and “the staff are all very kind here”. One resident said, “this is a very nice place, all the staff do their best and are quite decent and I do not have to worry about anything”. A further comment made by a resident was “I am unbelievably happy here, it is out of this world”. A relative commented, “excellent care home and we are very satisfied”, another commented, “you would have difficulty finding a care home as good as Crossways”. During our visit we observed that the communication between staff and the residents was dignified, courteous and sensitive. Crossways DS0000027294.V372341.R02.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. A wide range of activities within the home and wider community means that the residents have many opportunities to participate in stimulating and motivating activities. Mealtimes are unrushed and appear to be social occasion for all the residents. EVIDENCE: We were able to discuss with a number of residents and staff about the activities within the home and also in the wider community. A few residents who live in the home are very mobile and choose to take themselves out for socialising and shopping. A number of activities are provided by the home and the residents choose if they wish to join in. One resident told us “I don’t want to go out although the staff offer to take me out; there was a quiz this morning and we do exercises and if we want to go to the theatre staff take us”. Another resident we spoke with told us “I was taken to the bank this morning and they are always taking us out”. Crossways DS0000027294.V372341.R02.S.doc Version 5.2 Page 13 The record of activities showed us that a number of residents had joined in various sessions; we saw photos of three residents cooking and photos for when relatives are invited to a social evening three times a year. The home also holds coffee mornings and if the weather suitable B.B.Q’s in the summer; many more activities take place. We observed lunch being served; the meals are well presented with a choice of two main courses and three vegetables. Those who needed their food cut up had this done before it was taken to them. The mealtime seemed totally unrushed and we noticed a number of residents taking quite a long time to eat their meal, the staff quietly cleared the tables but left the residents who were still eating to finish in their own time. The dining room was very pleasant with separate tables for all the residents; we asked most of those residents that were partaking lunch what it was like. Some of them we spoke with told us the meals were good, some said excellent and others answered that the meals were good all the time. We looked at the menus and found them to be varied and nutritious, quite often fresh local produce is used. The residents can have people to lunch on any day of the week, usually with a little notice although surprise visitors can always be accommodated. Breakfast is served in the resident’s rooms and food preferences are always discussed with the chefs. One of the chefs has delivered training in food safety. Crossways DS0000027294.V372341.R02.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents feel safe and listened to. The staff have been given the knowledge to recognise all aspects of abuse, this means that every effort is made to protect the residents. EVIDENCE: A complaints procedure is in place and available to the residents and their relatives, it was easy to read with clear instructions. We spoke with some residents who stated they knew how to air their concerns and who to go to; they did add that if they have any concerns “they are always sorted out immediately by the management”. One resident told us “I go to meetings in the home and know we can bring up any matters at these”. The home has not received any complaints since the last inspection and neither has the Commission. The staff we spoke with were aware of the complaints procedure. The staff we spoke with were also aware of all issues relating to safeguarding adults and their responsibilities in raising any concerns with the management. We checked the staff records and saw that staff had had training in all issues relating to abuse. Crossways DS0000027294.V372341.R02.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The continual maintenance and renewal of equipment and facilities means that the residents are not at risk and live in a safe, well decorated, pleasant and homely environment. EVIDENCE: We toured the premises inside and outside; we found them to be exceptionally well maintained and safe. The entire lower floor including the reception area and stairs have been re carpeted. New armchairs have been purchased along with a portable hoist; lockers for staff valuables have also been purchased. The first floor and top floor of the home have been re decorated. Having Crossways DS0000027294.V372341.R02.S.doc Version 5.2 Page 16 gained permission from a number of residents we looked in their rooms and found them to be very well furnished and maintained. Those residents we spoke with said that they were satisfied with their accommodation; they also told us that the home was always very clean. One resident said “the home is very clean and tidy” and a relative said “the establishment is always beautifully clean and welcoming” and another relative said “ attractive, clean and tidy environment”. There is a continual programme for maintenance in place and this was most evident on our tour of the home, which we found to be clean and tidy, with no offensive odours”. The reception area is homely and inviting with chairs for those residents who want to wait for their visitors to arrive. Up to date records were in place for the maintenance and servicing of all equipment in the home including the lift. The garden looked well kept and pleasant, there were seating arrangements for those who enjoy being outside. Crossways DS0000027294.V372341.R02.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The improvements that have taken place in relation to training means that there are better outcomes for people using the service. EVIDENCE: The duty rosters were examined and showed that the home was very well staffed at all times, the staff included on a daily basis sufficient carers to meet the needs of the people living at the home, the Provider/manager and his partner were also in the home every week day. The service does not use any agency staff. Records for newly appointed staff were looked at; these reflected a robust system for recruitment with all required checks being in place. One staff member told us “the staff are all willing to cover shifts due to illness or holidays, there is always enough staff to cover the shifts”. Discussion with staff showed that they had a good understanding of their roles and they felt they had the necessary skills to carry out care for the people in the home. The staff also told us that they have attended a number of courses including safeguarding adults, we saw records for training that has taken place. We were told by a reasonably new member of staff that she had had Crossways DS0000027294.V372341.R02.S.doc Version 5.2 Page 18 an induction and this had covered all mandatory training, we also saw records for this. Discussions with staff showed that they have a good understanding of their roles and they also told us that they felt very well supported in their roles by the management. The staff have had further training in the handling and administration of medicines and also for safeguarding adults. The cook has delivered training to all the staff for safe food handling. One senior carer has just completed her R.M.A. and NVQ training is ongoing; records for fire training were in place and up to date. Other records confirmed that the staff continually receive training in relevant subjects such as dementia and quality and diversity and infection control, the staff told us that they discuss their professional development in the supervision sessions. Crossways DS0000027294.V372341.R02.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. There is an excellent management structure in place, which ensures, that the service is being well run and in the best interests of the people who use the service. The health and safety of the residents has been protected and promoted because of the excellent management of the home. EVIDENCE: We looked at the records for formal supervision, these showed that they were taking place and that all staff were involved, this was also confirmed by those staff members we spoke with. The residents we spoke with were aware of the management arrangements for the home and one relative commented that Crossways DS0000027294.V372341.R02.S.doc Version 5.2 Page 20 they were involved with residents meetings, read the monthly newsletter and that the management were always available; another commented that the home “is managed by someone with great empathy”. A resident told us “the manager is very approachable”. One resident said “nothing is too much trouble for Steve and Sandra and they always deal with anything straight away. One staff member commented, “our manager is always available to clarify any issues concerning care, work or a problem we feel we may have. We have ongoing supervision and regular appraisals”. Overall the comments made to us suggested that the residents, relatives and staff were getting the support they needed from the management. We noted whilst we were at the home a number of visitors and residents popped in to the manager’s/providers office to speak with them. We looked at health and safety related information these showed that there are servicing arrangements for all equipment, these included the hoist, the lift and the two bath hoists. We also noted that the boiler and cooker had servicing certificates. The Provider told us that he has had an ‘magic eye’ put in the lift to ensure those who are less nimble, do not get caught in the doors. There were records in place for fire testing. The service carries out quality questionnaires with the residents, however they did say that the residents have voiced at meetings that they get fed up with answering these and are confident about the running of the home and the care that they receive. The management does need to keep more formal records for monitoring the quality of the service it offers. Crossways DS0000027294.V372341.R02.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 4 x 4 4 3 x HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 4 4 x x 4 4 4 4 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 4 x 3 3 3 4 Crossways DS0000027294.V372341.R02.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations It is recommended that all staff are encouraged to sign medicine record charts when they have applied a prescribed skin cream. This will make sure that residents are not being denied their treatement. Crossways DS0000027294.V372341.R02.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Crossways DS0000027294.V372341.R02.S.doc Version 5.2 Page 24 - 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. 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