Care Home: Crossways Nursing Home

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What the care home does well The home is located in a peaceful and pleasant rural situation and the residents enjoy views of the garden and the Hampshire countryside from their windows. One resident`s relative commented in the survey they completed on their behalf`, `our relative came to Crossways as an emergency placement, but we feel that we have been very lucky in having a placement here. We like the staff, the size of the home, the other residents, the atmosphere, and the fact that our relative is very settled and seems content`. A social care professional spoken with on the telephone was very complimentary about the quality of care provided at the home. They praised the staff for the clarity and quality of their care plans and risk assessments, and stated that the residents were, `looked after well` and that Crossways was, `one of the best nursing homes in the area at the moment with respect to the delivery of care.` A relative recorded in a survey, they had supported a resident to complete, `my relative is always treated in a friendly and respectful manner and, most importantly, the staff understand dementia and how to deal with it. They take good care of my relative medically and emotionally`. Some of the things the staff, who completed surveys thought the home does well included; `good communication with relatives and social events`, and `Crossways, of late, has been made more part of the local community. The local vicar and residents are involved with us now, which is great and supportive`. An appointed manager, who was well-qualified for the post, was in the process of applying to the Care Quality Commission (CQC) to be the registered manager for the home, and to ensure there would be someone with knowledge and experience of nursing care, taking responsibility for the running of the home in the future. What has improved since the last inspection? Since the previous site visit, the statement of purpose and the service user guide had been reviewed. All the required information was included to help prospective residents to decide if it was the right home for them, how to make a formal complaint, and the timescale by which a response should be received. The information was well presented and easy to read. Improvements had been made to the storage facilities in some of the residents` bedrooms. New bedroom furniture, including wardrobes and chests of drawers had been purchased, carpets had been replaced, screens were available in shared rooms to promote privacy, and there was new bedding for the comfort and enjoyment of the residents. Access to the garden had improved by the provision of a ramp to the French window in the dining room. The windows had been secured for the protection of the residents, and a gardener had been employed to improve the safety and maintenace of the garden, for the enjoyment of the residents. A maintenace person had also been employed. The maintenance schedule confirmed the many improvements had been made to the environment by painting walls and carrying out repairs and replacements. The kitchen, which had been condemned by environmental health as unsafe, had been replaced by a modern kitchen to ensure the residents of safely prepared food. Four of the old and unsafe wheelchairs had been replaced for the safety and protection of the residents. All the staff had undertaken moving and handling training from an acredited trainer to ensure the residents would be protected when being supported to move. English lessons had been provided for the staff, who could not communcate verbally, or read or understand English, to enable them to follow the residents` care plans, and some had moved to other employment. The appointed manager was in the process of recruitment to ensure that domestic roles would soon be appropriately filled, enabling the care staff to concentrate on their caring duties. What the care home could do better: Some of the things the staff, who completed surveys, thought the home could do better included, `have a cleaner and build a new and proper bathroom and shower room for the residents`, and `have a wet room installed so it is easier to wash the residents, who may not enjoy a bath. Install a good, practical bathroom and shower room`. The manager commented in her response to the report that, `plans are in place to renew the bathroom, but no date has yet been confirmed`. A relative felt that better kitchen ventilation would keep cooking smells from the living areas and improve the atmophere for the residents. Responses had been made to requirements to improve outcomes for the residents living at the home, but the provider makes resources available in a reactive rather than a proactive way. The home should have a development plan for the modernisation of the premises and a financial plan with budgets allocated to enable the manager to use her nursing expertise to manage improvements to the care and nursing environment for the benefit of the residents. Key inspection report Care homes for older people Name: Address: Crossways Nursing Home Greywell Road Up Nately Basingstoke Hampshire RG27 9PJ     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: Christine Bowman     Date: 2 8 0 8 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: Crossways Nursing Home Greywell Road Up Nately Basingstoke Hampshire RG27 9PJ 01256763405 01256763405 Crosswaysnh@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: S.E.S Care Homes Ltd care home 18 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 to be accommodated is 18 The registered person may provide the following category of service: Care home with nursing (N) to service users of the following gender; Either whose primary care needs on admission to the service are within the following category: Dementia (DE) Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home The home is situated in a quiet village near to Basingstoke and provides accommodation, personal and nursing care, for up to eighteen persons aged 65 and over. The home, which is arranged on two levels and has a lift, can accommodate persons suffering from dementia type illnesses. Communal space includes a pleasant lounge and dining room for the use of the residents, and a large garden and orchard. There are ten single and four shared bedrooms and the majority have en suite facilities. Care Homes for Older People Page 4 of 31 2 3 0 9 2 0 0 8 18 0 Over 65 0 18 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: This inspection report includes information gathered about the service since the previous site visit on 27th September 2008 under the Commissions Inspecting for Better Lives (ILB) process. The appointed manager completed an Annual Quality Assurance Assessment (AQAA) giving up-to-date factual evidence about the running of the home and informing us of what they think they are doing well, how they have improved the service and of their plans for further improvements. Six residents completed service user surveys, with support from their relatives, giving their views on the service received. Five staff also returned surveys, giving their views on the care and support given to the residents, and on how they are supported by the management to meet the residents needs. One healthcare professional completed a survey, and a care professional also gave their views over the telephone. An unannounced site visit conducted on 28th August 2009, was completed over six hours commencing at 11.00 am, to assess the outcomes of the key inspection standards for older people with respect to the residents living at the home. The appointed manager Care Homes for Older People Page 6 of 31 and the organisations operations manager were interviewed and supported us with the inspection process. We sampled residents and staff files, the staff training matrix, quality assurance documentation, the service user guide, maintenance certificates, samples of policies and procedures and other documents and records. We visited three residents in their bedrooms, spoke with others in the communal living areas, observed the staff as they carried out their duties and spoke with three of them and a visiting relative. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? Since the previous site visit, the statement of purpose and the service user guide had been reviewed. All the required information was included to help prospective residents to decide if it was the right home for them, how to make a formal complaint, and the timescale by which a response should be received. The information was well presented and easy to read. Improvements had been made to the storage facilities in some of the residents bedrooms. New bedroom furniture, including wardrobes and chests of drawers had been purchased, carpets had been replaced, screens were available in shared rooms to promote privacy, and there was new bedding for the comfort and enjoyment of the residents. Access to the garden had improved by the provision of a ramp to the French window in the dining room. The windows had been secured for the protection of the residents, and a gardener had been employed to improve the safety and maintenace of the garden, for the enjoyment of the residents. A maintenace person had also been employed. The maintenance schedule confirmed the many improvements had been made to the environment by painting walls and carrying out repairs and replacements. The kitchen, which had been condemned by environmental health as unsafe, had been replaced by a modern kitchen to ensure the residents of safely prepared food. Four of the old and unsafe wheelchairs had been replaced for the safety and protection of the residents. Care Homes for Older People Page 8 of 31 All the staff had undertaken moving and handling training from an acredited trainer to ensure the residents would be protected when being supported to move. English lessons had been provided for the staff, who could not communcate verbally, or read or understand English, to enable them to follow the residents care plans, and some had moved to other employment. The appointed manager was in the process of recruitment to ensure that domestic roles would soon be appropriately filled, enabling the care staff to concentrate on their caring duties. What they could do better: 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. Prospective residents are supplied with enough information to decide if the home will meet their needs and a full assessment is carried out prior to admission to ensure the home is able to meet those needs. Intermediate care was not provided. Evidence: Since the previous site visit, the statement of purpose and the service user guide had been reviewed. All the required information was included to help prospective residents to decide if it was the right home for them, and the information was well presented and easy to read. A statement promised prospective residents that they would not be discriminated against with respect to equality and diversity issues. Five of the six residents who completed surveys, with support from relatives, thought they had sufficient information to help them to decide about staying at the home. One residents relative commented in the survey they completed on their behalf, our relative came to Crossways as an emergency placement, but we feel that we have Care Homes for Older People Page 11 of 31 Evidence: been very lucky in having a placement here. We like the staff, the size of the home, the other residents, the atmosphere, and the fact that our relative is very settled and seems content. Two completed pre-admission assessments of residents, who had been admitted since the previous site visit, showed that physical, sensory, dependency, mobility, nutrition and personal care needs had been looked at in detail and risk assessed. A social history profile was included and personal preferences, likes and dislikes recorded to enable person-centred care plans to be compiled. The manager wrote in the AQAA that, all residents have full pre-admission assessment prior to admission. Friends and family are invited to view the home to discuss their relatives needs and a months trial period is offered. An improvement made over the previous twelve months, and recorded in the AQAA, was that communication with the local authority had improved allowing care management assessments to be received by the home, and ensuring more initial information was available in the drawing up of initial care plans for the residents. 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. There are plans in place to meet the health and personal care needs of the residents, which they or their representative have agreed to. Medication is managed safely and the residents right to privacy is respected. The majority of staff support the residents in a way that maintains their dignity. Evidence: The statement of purpose recorded clear aims with respect to the planning of individual residents care and these included, working in partnership to ensure your views, wishes and choices shape your individual care plans, value your life experiences, which are reflected in your care plan, recognise your potential, promote your independence and maximize your ability to self-care, and assist you to retain involvement in the community, The three residents care plans sampled included a profile with a photograph, recorded the residents preferred form of address and a named nurse and key care worker to provide consistency and continuity of care for the residents. Care Homes for Older People Page 13 of 31 Evidence: Care plans viewed had been signed by relatives on behalf of residents to confirm acceptance, and there was evidence of regular monthly reviews to ensure the information was up to date, and that any changes had been discussed. All care needs identified in the care plans had details of the planned interventions required to inform the staff and to ensure the residents assessed needs would be met. One resident at risk of falling out of bed had a risk assessment for the use of bedrails. Their mobility needs recorded that equipment required included a hoist, a sling, a slide sheet and a wheelchair and that pressure relieving cushions and mattresses were provided to prevent the development of sore areas on delicate skin. The care plan of one resident, who was unable to feed themselves, clearly recorded the support they required, their likes and dislikes with respect to food, and that a soft diet was required. The food and drink they consumed was recorded and their weight was monitored to ensure that action could be taken to prevent dehydration or malnutrition. Action had been taken to support the staff, who did not speak good English, at the time of the previous site visit. English lessons had been provided and a simplified version of the residents care plans, firstly in their own language and then in English, had been made available so that the residents personal care, moving and handling, nutritional and any other special needs could be carried out by the carers safely. A comment made by a relative in a survey they had completed on a residents behalf, indicated they were still not completely satisfied with the situation. The relative commented under the heading of what the home could do better, ensure the level of English spoken AND understood is adequate for the job by all members of staff, and most members of staff are quite reasonable at taking time for my relative to swallow, when feeding them, but some show a distinct lack of awareness and sensitivity and do not leave them time to swallow. The home had written policies and procedures with respect to the management and administration of medication and the AQAA recorded that they had been reviewed to keep the staff up to date, and that a contract with a specialist disposal service was in place for the disposal of drugs and sharps. Medication was stored appropriately and administered by the registered nurses. The staff training matrix confirmed they had received external training with respect to the administration of medication for the protection of the residents. Observations of the interactions between the staff and the residents throughout the site visit, showed respect and promoted the privacy and dignity of the residents. The training and development files of two staff employed since the previous site visit recorded that the Skills for Care Common Induction Standards had been completed, providing new staff with an introduction to the caring role, which promotes the Care Homes for Older People Page 14 of 31 Evidence: residents rights to be treated as an individual and to have their equality and diversity needs respected. All the shared bedrooms had screens to protect the privacy and dignity of the residents when receiving personal care or undergoing medical examinations. The manager stated that the dining room could be used to enable residents in shared bedrooms to meet with relatives or health or social care professionals to be assured of confidentiality. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are provided with opportunities to engage in recreational and social activities for stimulation and enjoyment. Contact with relatives and representatives is promoted, community involvement encouraged and a balanced diet with a variety of choices is offered. Evidence: The activities coordinator was on annual leave on the day of the site visit, but a copy of the August newsletter was available to inform the residents of the activity programme for the month. This publication was attractively presented with colourful illustrations of the planned events to encourage residents to take an interest, join in and enjoy themselves. The summer barbecue, which had taken place the previous weekend, was the big social event of the month. The manager stated that it had been a great success, and had been well supported by residents families and friends. There was a display of photographs on a notice board near the entrance showing happy residents, their relatives, friends and the staff socialising in the garden, enjoying the food and drink and taking part in a raffle. Activities were scheduled for each day and included reminiscence board games, old movies, sing songs, quizzes (concentrate and listen for tunes you know), flash cards Care Homes for Older People Page 16 of 31 Evidence: (remember all the politicians and film stars), painting and drawing (create and enjoy some music), hairdresser visits, gentle exercise in the lounge, skittles, hand massage, manicures, visits from the local vicar and from Bonnie, the dog, who likes to be made a fuss of. Records were kept in residents files of the things they enjoyed doing in their leisure time and daily logs recorded residents involvement in daily activities, one to one time and visits from relatives and friends. Throughout the day visitors came to see their relatives and one relative commented that they thought, the care is superb. Plans for the next twelve months included creating memory boxes for the residents to help them to reminisce, developing a reminiscence therapy room and liaising with the local Alzheimers group to gain ideas to develop at the home to support the residents. Of the six residents, who completed surveys with support from their relatives, three confirmed that the home always arranges activities that they can take part in, two that it usually does and one that it sometimes does. Some of the things the staff, who completed surveys thought the home does well included; good communication with relatives and social events, and Crossways, of late, has been made more part of the local community. The local vicar and residents are involved with us now, which is great and supportive. The manager recorded in the AQAA that the menus had improved and that there were more choices for the residents. Three of the six residents, who completed surveys, confirmed that they always liked the meals at the home and the other three recorded that they usually did. Some residents took their meals in their bedrooms and one resident visited was being supported to eat fish with mashed potato and parsley sauce by their relative. The dining room was a pleasant place for the residents to eat, furnished with good quality tables and chairs and with views of the garden. Some residents needed to be prompted to eat and others required support. Staff observed providing this support, did so with patience, and the AQAA recorded that all the staff had received training in malnutrition care and assistance with eating to support them in this task. A relative wrote in a survey they had supported a resident to complete, something the home does well, is that it ensures my relative has eaten and drunk enough. They are always clean and neatly dressed. He likes to listen to classical music and they always make sure it is available for him. Care Homes for Older People Page 17 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. 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. Evidence: The complaints procedure was in the service user guide and displayed on a notice board in the home to inform the residents, their representatives and the staff. It had been updated to include all the information necessary for making a complaint and the current details of the Care Quality Commission (CQC) were included should anyone wish to make contact. The AQAA recorded that there had been one complaint since the last site visit, which had been upheld and responded to within twenty eight days. The complaints log contained a copy of this complaint including the letter to the complainant. All of the six residents, who completed surveys with support from their relatives, recorded that they always know who to speak to if they are not happy and five of the six residents confirmed they knew how to make a formal complaint. The five staff, who completed surveys, confirmed they knew what to do if someone has concerns about the home. The home held a copy of the local authority Safeguarding Adults policy and procedure to inform the staff of the referral process should they need to use it and the staff Care Homes for Older People Page 18 of 31 Evidence: training matrix confirmed that the Protection of Vulnerable Adults training had been accessed by most of the staff within the previous twelve months to keep them up-todate. All the staff, who completed surveys, confirmed that their employer had carried out checks such as Criminal Record Bureau (CRB) and references before they started work to ensure only those suitable to work with vulnerable adults had been employed. The staff training matrix showed that some of the staff had received training in the Mental Capacity Act and the manager and deputy manager had attended training in the Deprivation of Liberty Safeguards. Assessments had been completed for residents and were available in their care plans to show how best interest decisions were made. The AQAA recorded that no safeguarding referrals had been made, but since the completion of this document, a referral had been made and the investigation had reached its conclusion. A social care professional spoken with on the telephone was very complimentary about the quality of care provided at the home. They stated that the home had been praised for the clarity and quality of their care plans and risk assessments, and that the residents were, looked after well and that Crossways was, one of the best nursing homes in the area at the moment. Care Homes for Older People Page 19 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Reactive investment by the provider has led to some essential improvements to the environment for the safety and comfort of the residents, but there are no plans to further modernise or adapt the home for the benefit of the people using the service. The home is clean and odour-free. Evidence: The home was located in a pleasant and peaceful rural setting in a small Hampshire village and a drive led from the road to a car parking area at the side and to the rear of the building. A mature area of garden with trees and shrubs, extended to the side and front of the home. The entrance was to the rear of the building and a corridor led to the communal areas, which consisted of a sitting, and a dining room, both of which benefited from views of the south-facing garden and the countryside. The rooms were comfortable and homely and provided with appropriate domestic furnishings for the comfort and enjoyment of the residents. Attention had been paid to the ill-fitting French windows, which were now secure and a ramp had been provided to enable wheelchair users to access the garden. Windows were not double-glazed to preserve heat loss for the residents in the winter months, or shatter-proof for the safety of the residents. The home was not purpose built as a nursing home, and there was no plan to develop and improve this environment to bring it up to date. Investment had been reactive rather than proCare Homes for Older People Page 20 of 31 Evidence: active, in that the kitchen was only replaced after being condemned by environmental health, and resources have been made available for improvements when requirements have been made. The previous appointed manager had put an electric bath high on her list of priorities last year, to improve the experience for the residents and to support the staff in their work, but this had not been provided. The manager confirmed in her response to this report that, plans are in place to renew the bathroom, but as yet no date has been fixed. Three residents, visited in their bedrooms, were all peacefully relaxing, and by their appearance, were well cared for. Bedding, clothing and the residents themselves were beautifully clean and well-manicured. Bedrooms were appropriately personalised with residents photographs, pictures, plants, vases of fresh flowers, televisions and other personal items. Some residents had brought small items of furniture to make their rooms more homely and familiar. There had been an improvement in the quality of the furnishings in the bedrooms sampled. New chests of drawers and wardrobes had been purchased and some of the bedrooms had new carpets. The AQAA recorded environmental improvements completed since the previous site visit as; a new kitchen, the decoration of some rooms, the replacement of carpets in some rooms, new bedding and some new bedroom furniture. The garden had been made safer, with safer access and gardeners every two to three weeks to keep it wellmaintained, and a maintenance person had been employed to do general repairs. Plans for improvement over the next twelve months included the installation of a new bathroom, shower room, more bedroom furniture, lounge curtains, two adjustable beds, two air mattresses and the replacement of more bedroom carpets. The maintenance schedule for July 2009 showed on-going problems with the plumbing, outstanding work on the boiler, the need to replace a carpet in a bathroom for hygiene purposes, instruction in cleaning for the care staff, and many issues, which the maintenance person had completed, such as repair work and painting, which was seen to have improved the interior of the home for the comfort and pleasure of the residents. There was a long list of tasks for the maintenance person to complete. The manager commented in her response to this report that, regarding the maintenance plan, there has been a maintenance person in post since October 2008, who left in February 2009, so maintenance issues were being addressed at that time. The staff training matrix confirmed that the majority of the staff had undertaken training in infection control. Some of the things the staff, who completed surveys, thought the home could do better included, have a cleaner and build a new and proper bathroom and shower room for the residents, and have a wet room installed Care Homes for Older People Page 21 of 31 Evidence: so it is easier to wash the residents, who may not enjoy a bath. Install a good, practical bathroom and shower room. Five of the six residents, who completed surveys with support from their relatives, thought the home was always clean and fresh. One residents relative recorded that it was usually fresh and clean but, there needs to be much better ventilation and extraction of smells from the kitchen, as frequently there is a strong smell of cabbage cooking as you enter the home. 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. The residents benefit from safer support through improved training, and more continuity and consistency of care, due to a more settled staff team. Recruitment is carried out safely to ensure only people who are suitable to work with vulnerable adults are employed. Evidence: The AQAA recorded a total of nineteen staff, six of which were part time, were currently working at the home.The appointed manager stated that she had recently advertised locally for staff and that a maintenance person had already been appointed. A chef and two carers were waiting for recruitment checks to be verified. The manager had also tried to ensure that domestic tasks were not being carried out by staff appointed to care roles, but the provider had not sanctioned this, and was waiting until there was a full compliment of clients to cover this expense. Carers had received training in domestic duties and completed these tasks at the end of their care shifts to prevent any spread of infection. Over the previous year, the AQAA recorded that five staff had left the employment of the home and the manager stated that the staff, whose first language was not English and had not responded to English lessons had taken other employment. The agency, which had supplied these staff, and which had promised they would already have received English lessons and been registered to undertake National Vocational Qualifications at level 2, had gone into liquidation. Five of the six residents, who completed surveys, recorded that they always received the Care Homes for Older People Page 23 of 31 Evidence: care and support they needed, and that the staff were always available when they needed them, but only one of the staff thought there were always enough staff to meet the individual needs of all the people who use the service. The AQAA recorded that none of the permanent staff had completed a National Vocational Qualification (NVQ) in Care or Health and Social Care at level 2 to support them in their role. The manager explained that the company responsible for providing the service had gone into liquidation before the work had been completed, but that all the care staff had now been enrolled with another provider to complete this qualification. One staff member had achieved a NVQ at level 3 and another was an assessor. New staff had completed the Skills for Care common induction standards, which provide an introduction to the caring role and promote the residents rights to be treated as an individual with respect to their equality and diversity issues. Evidence of induction training signed off by the manager was seen in staff files viewed. The three staff, whose files were sampled, had been recruited in accordance with regulations, and all the necessary pre-employment checks had been carried out for the protection of the residents. The six staff, who completed surveys, confirmed that their employer had carried out checks, such as Criminal Record Bureau checks and references, before they started work. The staff training matrix showed that mandatory training, including moving and handling, fire safety, food hygiene, infection control, the protection of vulnerable adults had been updated using the accredited training DVDs and that some of the staff had received this training from external trainers. All the staff had received practical manual handling training from an external trainer to ensure safe practice and to protect the residents. Sufficient numbers of staff had received first aid training to ensure there would always be a first aider on duty in case of an emergency. The registered nurses had attended training in the administration of medication, dementia care, the Mental Capacity Act and some had attended other clinical specialist training such as skin care, continence and Parkinsons Disease. A nurse spoken with, stated that she took responsibility for arranging her own training to ensure her registration would continue. All of the six staff, who completed surveys recorded that they were being given training, which is relevant to their role, helps them understand and meet the individual needs of the residents and keeps them up to date with new ways of working. Two thought the training did not give them enough knowledge about health care and medication. The relative of a resident, who supported them to complete a survey recorded, residents are engaged with as individuals and personal needs, medical and social are Care Homes for Older People Page 24 of 31 Evidence: dealt with sensitively and quickly. My relative has established relationships with many of the carers and values their attention and interest in her. Another wrote, my relative is always treated in a friendly and respectful manner and, most importantly, the staff understand dementia and how to deal with it. They take good care of my relative medically and emotionally. Care Homes for Older People Page 25 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. The residents benefit from having a suitably qualified and experienced appointed manager in post to ensure the home is run in their best interests. Lack of business planning to provide financial resources to support the manager in her role has led to a reactive rather than a proactive response to the development of the home. Effective systems are in place to promote the residents health, safety and welfare creating a safe environment for them to live in. Evidence: Since the site visit last year, the appointed manager, who had been very enthusiastic about her plans to improve the home, had resigned prior to applying to register with the CSCI. (The regulatory body was at that time the Commission for Social Care Inspection). An equally enthusiastic manager had been appointed in the meantime and was, at the time of the site visit, in the process of applying to the Care Quality Commission (CQC) to become the registered manager for the home. She had the Care Homes for Older People Page 26 of 31 Evidence: qualifications and experience necessary for the post, being a registered general nurse with more than thirty years of experience. She had a Diploma in Management Studies, several years of experience of care home management, and had been involved in setting up nursing and homecare agencies. Whilst working for the National Health Service she had specialised as a sister in the orthopedic and trauma ward, caring for elderly people following hip fractures. More recently she had completed an accredited course in Dementia awareness to support the residents needs. The AQAA had been completed in a satisfactory manner and all the required information including factual information about the home, how the home had improved outcomes for the residents over the previous year, and the managers plans for further improvement were recorded. An operations manager carried out visits on behalf of the provider and the monthly reports on these visits were available. Questionnaires had been completed on an annual basis to gain feedback from relatives and residents, with respect to the quality of the service they had received, and were due to be sent out in the near future for the current year. However, the manager stated, there had been good feedback from relatives who attended the barbecue at the weekend. The homes annual development or business and financial plan were not available for inspection to show how budgets supported the managers plans for the development of the service, and to show the providers plans for future investment and commitment to the modernisation of the physical environment. The home does not hold for safekeeping or manage any monies for people who use the service and any additional costs such as hairdressing or chiropody are invoiced to the individual or their representative. The health, safety and welfare of the residents were promoted by staff training in moving and handling, fire safety, first aid, food hygiene and infection control. The staff training matrix showed that this training had been updated to keep the staff up to date with current practise, and certificates were viewed on the three staff files sampled, also confirmed this. The Annual Quality Assurance Assessment, completed by the manager recorded that policies and procedures with respect to health and safety were in place to keep the staff informed, and that the essential maintenance of equipment had been carried out according to manufacturers recommendations to ensure it was safe to use. A sample of certificates, seen on the day of the site visit, confirmed that maintenance checks had been carried out in a timely fashion. The kitchen, which had been condemned by Environmental Health, had been replaced soon after the previous site visit last year and other health and safety issues with respect to the ill-fitting French window and access to the garden had also been completed to safeguard the residents. Care Homes for Older People Page 27 of 31 Evidence: A relative, who completed a survey on behalf of a resident wrote, I have known Crossroads for more than three years and standards of care have improved steadily and impressively in terms of facilities and standards of care. We are pleased with the overall quality of the care, as well as the homeliness. Care Homes for Older People Page 28 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 29 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 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 34 The annual business and financial plan should be available for inspection to show how the provider intends to provide resources to support the managers planned improvement of the home. 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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