Care Home: Crossways Residential Home

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What the care home does well The home is extremely well run with a committed team of staff who have the best interests of the residents at heart. The providers and the manager ensures that the home is always well maintained and safe. The residents make positive comments about the home. One resident told us "I like living here it is my home". A relative told us that the staff "know how to look after the residents properly". The records needed for inspection purposes are in good order. Residents care plans were very informative and well evaluated. The service provides many opportunities for the residents to socialise, join in leisure activities and pursue educational development. The home ensures that all the residents are involved with the running of the home. The home has strong links with family and friends and professionals which enhances their communication system. What has improved since the last inspection? Some areas of the home have been re furbished since the last inspection, these include the re refurbishment of some bedrooms, some doors and windows have been replaced and the kitchen has been re fitted. A new three piece suite has been bought for the lounge along with a flat screen television and a computer for the residents use with access to the internet. What the care home could do better: To increase further communication with the community as a whole. Key inspection report Care homes for adults (18-65 years) Name: Address: Crossways Residential Home North Terrace Mildenhall Suffolk IP28 7AE     The quality rating for this care home is:   three star excellent 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: Marilyn Fellingham     Date: 1 5 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 Adults (18-65 years) Page 2 of 24 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 Adults (18-65 years) 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 24 Information about the care home Name of care home: Address: Crossways Residential Home North Terrace Mildenhall Suffolk IP28 7AE 01638515556 01638712730 chris.taylor@nas.org.uk www.autism.org.uk National Autistic Society Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Christine Joy Taylor Type of registration: Number of places registered: care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home Crossways is part of the National Autistic Societys East Anglia Service, which comprises Crossways and Middlefield Manor (the second, larger Care Home situated approximately 2 miles from Mildenhall in Barton Mills). The Home provides residential care for eight young adults with Autistic Spectrum Disorders. The Home is a large detached house (formerly a private residence) in a residential area close to Mildenhall town centre, at the junction of two main roads. The entrance to the Home is from Folly Road and there is a small parking area for the Homes two vehicles as well as for visitors. The Home is well maintained, clean, light and airy and the eight service users are accommodated in single bedrooms; three on the ground floor and the remaining 5 on the first floor. Two bedrooms have the additional benefit of en suite facilities and there are sufficient bathrooms and toilets to meet the needs of the seven residents. The Home has a fitted kitchen, a laundry area, a large lounge, dining room as well as a Care Homes for Adults (18-65 years) Page 4 of 24 Over 65 0 8 Brief description of the care home separate but adjoining quiet room. The residents also have use of a pay phone for incoming and outgoing telephone calls. At the time of the inspection, the manager stated that fees for the home ranged from £1500 to £1700 per week. Service users would provide items such as their own clothing, toiletries, activities and holidays. Care Homes for Adults (18-65 years) Page 5 of 24 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: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection that took place over five hours. The key inspection for this service has been carried out using information from previous inspections, information from some residents, visitors to the home and people 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. Care Homes for Adults (18-65 years) Page 6 of 24 What the care home does well: What has improved since the last inspection? 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 Adults (18-65 years) Page 7 of 24 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 24 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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. New residents to the home can expect that their individual needs and aspirations are assessed before admission to the home. Evidence: The service has not admitted any new residents for the past thirteen years; however we did look at the paperwork for this procedure and discussed with the manager the process that would be used. The procedure for admitting new residents covered all aspects to ensure that the prospective resident would be assessed fully before the home made a decision whether the person would be suitable for the home and that the service could meet their needs. The format used would cover all aspects of daily living and behavioral disorders, language, communication and physical fitness. Although the present manager has never admitted anyone to the home she is very familiar with the process and realises how important the assessment process is especially in relation to the client group in the home. The prospective residents would be involved with the whole process of assessment before any decisions were made. Care Homes for Adults (18-65 years) Page 9 of 24 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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. The residents can be assured that they will have a plan of care that staff know and understand; these plans of care are extremely detailed to enable staff to deliver fully determined care goals in a consistent way to ensure peoples safety regarding their very challenging care needs. Evidence: We looked at two care plans for residents living in the home; the first one was for a resident with very complex needs. We noted that this resident had an extremely good person centered profile plan in place, the information about this resident had been gathered using information from relatives and form the resident. There was also a behaviour support plan in place related to this residents behaviour that highlighted triggers that changed this persons behaviour which enables staff to meet the extreme needs of this resident. Risk assessments had been carried out regarding physical aggression to others and to self, these had been updated and information added related to all changes associated with risk management. There were detailed records for this persons communication needs and educational objectives and also the Care Homes for Adults (18-65 years) Page 10 of 24 Evidence: personal care that is required and support that was needed. We also noted that there were life long learning goals in place that had been planned with input from the resident. The second care records we looked at were also very informative and would allow for any support worker to give the most appropriate care for this resident. All the care plans were clear with an informative pen picture relating to this resident. There was an extensive personal profile in place and known triggers related to changes in behaviour were recorded that gave clear instructions for staff to enable them to adequately meet the complex needs of this resident. This resident also had risk assessments in place that covered risk to self. We noted that the second resident had care plans for special dietary needs and significant events affecting dietary intake. This resident also had a plan for personal care that was very detailed and informative and an education plan and the progress taking place. The daily records for both these residents were extremely informative and related to all aspects for care. We were able to talk with one relative who was visiting and they shared with us what they liked about the home. They told us that their relative liked being at Crossways and that the staff enabled him to make choices which was a big plus. They also shared with us that their relatives particular needs were well supported: they went on to say that the home was good because of the small numbers of residents and the setting did not appear institutionalised. They told us they were very happy with their relatives placement and that the resident had their own room and that their privacy was also respected. A resident who we spoke with said I like living here, it is my home. Care Homes for Adults (18-65 years) Page 11 of 24 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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. The residents are given many opportunities to take part in appropriate and meaningful activities. Meals are managed well and the residents are provided with a healthy diet. Evidence: During our visit we noted that a number of residents were coming and going, some were returning from their daily activities and some who had returned were arranging to go out again. The service facilitates many planned activities these are numerous and include, college placements, work in a sheltered work shop, pottery classes, IT courses, some residents attend a learning development centerer and one resident attends a music mission where they are given the chance to play different musical instruments. The service provides a lot of activities which include theme nights that each resident has the opportunity of choosing what the theme will be; the residents Care Homes for Adults (18-65 years) Page 12 of 24 Evidence: often visit a local pub, go swimming and shopping: one resident has a manicure at a local beauty salon. During our visit we observed one resident negotiating a visit to the shops who was also going to be accompanied by another resident. Another resident works at a resource centre, they go on their own in a taxi and this forms part of their daily skills activities. One resident we spoke with told us about their computer course and about their recent visit to the pub; they also shared with us some of the photos they had taken whilst on a home visit. This resident also told us that they were quite busy and had music on Mondays and plays snooker in the evenings. The service has a quality action group and holds meetings every Thursday to discuss with the residents what they want to do and where they would like to go on holiday, the residents are also asked to give their opinions on the activities that are provided. We were shown photos of holiday visits that had taken place on Wroxham Broads and visits to Somerset. The residents are asked to provide feedback in relation to the holidays they have undertaken so that the staff can continually ensure that they are facilitating appropriate activities and holidays for all. Menus for the residents are varied and planned in relation to individuals needs and choices; the residents have access to snacks, drinks and fruit and those who are unable to cater for themselves do so under supervision. Whilst we were making a tour of the home we observed one resident reminding a member of staff when their drink time was. The dining room is attractive with plenty of room for staff and the residents as meal times are treated as a social occasion. One resident we spoke with told us that they enjoyed their meals and shared with us that sometimes they go out for a meal and choose what they are going to have before they go to the pub, this enables those who have communication problems to choose their food using pictures. Care Homes for Adults (18-65 years) Page 13 of 24 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents are given the support they need in a way that they prefer. There physical and emotional needs are met. The residents are well protected by the homes medication policies and procedures. Evidence: The residents are well supported by the staff and in way that they wish, this was evidenced in a number of areas and by records that we looked at. Staff are aware of ritualistic behaviour and this is also identified in care plans so that the residents do not suffer interruptions to their routines and get the support that is required. The residents preferences are well documented and the plans of care give clear guidelines to how the residents can be and wish to be supported. There are also records in place from other professionals who have input into the care of the residents which helps to maintain a consistent approach to the support needed. As already mentioned previously in this report the daily records are very informative and identify the support needed if it has changed and then it is also well documented in the care plans. No one self medicates as this is the residents choice; a spot audit was carried out of Care Homes for Adults (18-65 years) Page 14 of 24 Evidence: the medication and all medicines tallied with what had been signed for as being given. We found no anomalies relating to the administration and record keeping of medicines. No resident is prescribed prn (as required) medicines; we noted that there was a policy and procedure in place for homely remedies. All senior support staff are trained to give medicines and training records evidenced this. The GP does annual checks in relation to individuals medicines and all the residents go to Newmarket for medication reviews. Good records are kept of medicines for those residents who go home on visits, the relatives are given a copy of the medication record chart and this is returned to the home with the resident after the home visit. All medicines are checked back into the home on arrival. We asked one resident if they went to the doctors and they told us that if they wanted to go the staff helped them do this. We noted during our visit that one resident was being taken to the dentist, they were well supported and given information about the dental appointment. Care Homes for Adults (18-65 years) Page 15 of 24 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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 and relatives feel that they are 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: The home has a complaints procedure, it was clear and it is also written in an easy to read format for those residents that need it in this way. The procedure is also made available for all relatives and important others. We received six surveys back from the residents and these indicated that they knew who to go to and what to do if they were unhappy. One relative we spoke with told us that they felt quite happy to speak to the manager of the home if they had any concerns. A resident who we spoke with told us that they understood what they had to do if they had any concerns about their care or the way they were being treated. We looked at the homes records for complaints they had not received any since the last inspection; we did note that the home kept a record of all small issues raised by the residents and how they were dealt with. Training evidenced that the staff have completed training in all issues related to safeguarding adults. We also noted that when we were looking at care plans for the residents there were strategies for dealing with those residents who self harmed. Records were in place and well maintained for handling residents monies and all transactions that have taken place. Care Homes for Adults (18-65 years) Page 16 of 24 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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 live in a safe, comfortable and homely environment. Evidence: We undertook a tour of the home and found it to be very clean, tidy, comfortable and homely. We spoke with three residents who told us they liked the home and two showed us their rooms, these were well furnished and reflected the individuals personalities and had evidence of their own belongings. Some bedrooms have been redecorated, the kitchen has been refitted, some doors and windows have been replaced. A new suite has been purchased for the lounge and the residents have a new flat screen television; there is also a new computer that has access to the internet. The exterior of the house has been repainted and the garden is pleasant with seating arrangements. Care Homes for Adults (18-65 years) Page 17 of 24 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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 are well supported by adequate numbers of skilled and knowledgeable staff. The residents are protected by the homes recruitment practices. Evidence: We looked at the duty rosters and these confirmed that the home was well staffed, there is always two members of staff on duty for day and night shifts and always three staff members for activities; there is also always a senior member of staff on every shift. One resident we spoke with felt that they were well looked after and a relative told us that they felt that the staff knew how to look after the residents properly. Members for staff we spoke with said that they felt that the home was always a good ratio of staff on duty to meet the needs of the residents, this was also echoed in the staff surveys we received. Records for newly appointed staff were looked at, these were seen to reflect a robust checking system before staff are employed. New members of staff we spoke with told us that they had had a thorough induction, one told us that they had shadowed a senior member of staff for a number of shifts and had also worked with the manager. We saw records for this and noted that all mandatory subjects had been covered during the induction period. We looked at the training matrix which is reviewed continually to ensure that training Care Homes for Adults (18-65 years) Page 18 of 24 Evidence: is on going; we saw from this that the training contained subjects related to the residents conditions. Further conversations with the staff members confirmed that they had a good understanding of their roles and that they were well supported from the management. We also noted from the training matrix that some members of staff have completed training in the Mental Capacity Act. Staff receive formal supervision and we saw records for this. Care Homes for Adults (18-65 years) Page 19 of 24 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. 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. 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 is protected and promoted because of the management structure of the home. Evidence: We talked with the manager about her role within the service, she is very knowledgeable about the diagnosis of all the residents and was able to locate all records we needed to look at for the purpose of the inspection. We noted that the communication system between staff and the manager was good, minutes of meetings were in place that showed us that the meetings were used as a vehicle for passing on information. Two staff members told us that the manager was easy to approach and whilst we were visiting the home, residents, staff and a relative took opportunities to speak with the manager. Overall comments made to us suggested that the staff, residents and relatives were getting the support they needed from the manager. We looked at health and safety related information these showed that there are Care Homes for Adults (18-65 years) Page 20 of 24 Evidence: servicing arrangements for all equipment, these included the tumble dryer, PAT testing, legionnaires testing and the gas boiler. Fire safety records are in place and we saw records for all fire training which included fire training for the residents. The service carries out many quality monitoring exercises and health and safety audits are carried out. Care Homes for Adults (18-65 years) Page 21 of 24 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 Adults (18-65 years) Page 22 of 24 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 Care Homes for Adults (18-65 years) Page 23 of 24 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. 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. 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