Care Home: Crowmoor House

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What the care home does well The staff are cheerful, friendly and helpful and encourage people to enjoy themselves but also try to make sure that they are safe and well looked after. The feedback from surveys conducted by the home indicates that the home provides a friendly and supportive home where people are respected and well looked after. The service offers an excellent range of activities so that people can pursue hobbies and interests inside the home and out. The expert by experience commented that: `From my observations of the home, staff attitudes and interviews with residents and their relatives, I believe that this is a caring home, well organised, calm but with an atmosphere of positive purpose. There appeared to be many staff around, all purposefully engaged and responsive. Given that this was not a typical day as at least half of the residents were off on a trip the few staff/resident interactions I saw were good humoured and relaxed. I thought that the layout of the home, divided as it was into four similar units on one level provided opportunities for residents to sit or eat together in small communal lounges or dining areas, but also to join in activities with other residents in another part of the home. All residents and relatives I spoke with had positive comments to make and overall praise for the home`. What has improved since the last inspection? The involvement of people in the daily life of the home is more noticeable. They spoke of being comfortable with being asked their views which is now common place. People spoken to indicated that changes to information, premises, being asked about care plans, food and recruitment at their regular meetings have been welcomed and makes them feel `noticed`. The transfer of the ten people into the home has gone fairly smoothly with `resident` people and `new` people being given time to adjust to new surroundings and get to know each other. Staff work to better ratios of numbers and skill mix to number and needs of the people. Staff commented that communication is good and that they enjoy their work at the home. What the care home could do better: The management of this service has a good awareness and understanding of what they want to achieve and how to do this including involving people who use the service. The sequence of care plan recording could be better, so staff show that their train of thought regarding assessment, care delivered to meet needs and evaluation is more obvious to the reader. The reports provided to the manager about the conduct of the service could be more resident focused, particularly regarding outcomes of care. Key inspection report Care homes for older people Name: Address: Crowmoor House Frith Close Monkmoor Shrewsbury Shropshire SY2 5XW     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: Pat Scott     Date: 1 0 0 9 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 25 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 25 Information about the care home Name of care home: Address: Crowmoor House Frith Close Monkmoor Shrewsbury Shropshire SY2 5XW 01743235835 01743340804 jan.patterson@shropshire-cc.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Shropshire County Council care home 58 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 58 The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 58 Date of last inspection Brief description of the care home Crowmoor House is a Care Home situated in the Monkmoor area of Shrewsbury and owned by Shropshire Council. It is close to public transport and local shops. There is a pleasant garden and car parking. The statement of purpose and service user guide are available in the home and contain details about the fees. Up to date inspection reports are also available to view. 0 Over 65 58 Care Homes for Older People Page 4 of 25 Brief description of the care home Care Homes for Older People Page 5 of 25 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 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: Although this was a routine key inspection for Crowmoor House, it was the first inspection carried out following the admission of the ten people now using the service who are elderly, but have transferred from a care home for people who have a learning disability. This inspection site visit provided an opportunity for an expert by experience to discuss the move into Crowmoor House with them and staff, and to find out how their developing care needs are now being met, together with their plans for the future. An expert by experience is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector, to help them get a picture of what it is like to live in, or use the service. This report also draws on information received from the home in their Annual Quality Assurance Assessment (AQAA), which is a self-assessment process that requires care Care Homes for Older People Page 6 of 25 services to record how well care outcomes for the people living in their service are being met as well as providing a range of statistical information about the service. We also looked at information we have about how the service has managed any complaints. What the service has told us about things that have happened in the service which would affect the well being of a person. These are incidents such as, accidents, medication errors, outbreaks of infectious disease and any deaths, these are called notifications and are a legal requirement. We also considered the previous key inspection outcomes and the results of any other visits that we have made to the service in the last 12 months. We reviewed relevant information from other organisations and what other people have told us about the service. In addition to reviewing all this information, we spent three hours at the home talking to people who live there and the staff who work there, as well as looking at records and some areas of the living accommodation. We examined the care provided for a number of people in detail, and were able to speak to two of them but not the others as they were out for the day. The manager was available throughout the day to answer any questions. Care Homes for Older People Page 7 of 25 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. Care Homes for Older People Page 8 of 25 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 25 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 25 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. People are provided with good information so that they can make real choices about how their care needs will be met if they decide to move into the home. Assessments are in place so that peoples needs are carefully considered prior to admission and the ability of the home to meet them. Evidence: The statement of purpose and service user guide are available in the foyer and are reported by the manager to be given to all new people using the service. The statement of purpose is in a standard format supplied by Shropshire Council. The service user guide has been developed by the staff at the home. The options for people are presented in a way that is meaningful, interesting and easy to understand. An easy read format is also being developed. The manager receives assessments from the placing authority. These are usually Care Homes for Older People Page 11 of 25 Evidence: within enough time to allow her to make a decision on whether the home can meet the needs of the person and to offer/accept a placement. The manager conducts her own assessments if people are being admitted from hospital. Examples of both these were seen on the care files examined. It is the managers intention to begin to conduct assessments on all new people prior to being admitted. This is key to improving the admission process further so that individuals can be supported and encouraged to be involved in the assessment process. The manager stated that she could then fully ensure that the facilities, staffing and services provided by the home meet the ethnic and diversity needs of the individual through face to face contact. The expert by experience spoke with a new resident, who had been in the home around seven weeks. She said she had help from a Help the Aged worker prior to moving into the home and that he still came to visit her here. She said that she was happy with the home and settling in well. Care Homes for Older People Page 12 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans show that people receive personal healthcare and support by staff in a way that they prefer so that changing, diverse needs can be met. The management of medication provides protection to people who require help with their medication, supporting their continued good health in a dignified way. Evidence: Care plans seen show that people receive personal and healthcare support that has been thought out between both parties and delivered in a way that respects their individuality and independence. In addition, pictoral personal support plans have been developed for those people with a learning disability to keep in their rooms. The service has recruited more male carers to that people can have a choice of male, female and age related preferences when delivering personal care. All care, including assisting someone to have their medication, is conducted in the privacy of the persons own bedroom. Staff files show that they receive spot checks on their competency to administer medication. The manager conducts an audit to ensure that Care Homes for Older People Page 13 of 25 Evidence: medication is handled in line with the policies and procedures of the home and that people receive the correct medication at the right time. Staff have been provided with training in learning disability so that they can be alert to changes in mood, behaviour and general well being and understand how they should respond and take action. The expert by experience noted that: All the residents I spoke with were well groomed, clean and looked well-looked after physically. Care Homes for Older People Page 14 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A range of activities within the home and community mean the people have opportunities to participate in leisure pursuits. The provision of meals ensures people have a wholesome meal. Evidence: Care files seen show that individual assessments are carried out regarding preferred activities for each person taking into account, interests, capacity and diversity. A varied programme of activities is provided for the home by the staff who produce a monthly newsletter for everybody. Photos and records of activities undertaken were seen on the notice boards around the home. Care plans address maintaining important links and relationships. As a response to peoples wishes staff try to arrange individual visits from the clergy for religious services, from singers, dance organisers, hairdresser and joint organisation of an inhouse shop. Flexible visiting times are in operation and visitors were seen to be welcomed. Information for people and their relatives and friends on advocacy and support services is provided in the service users guide. People bring in personal possessions where possible. The service offers a choice of menu and flexibility at meal times where possible. Hot Care Homes for Older People Page 15 of 25 Evidence: and cold snacks are provided at lunch and evening meal. Individual preferences are taken into account as the kitchen staff recently held a tasting event, the results of the most preferred dishes will appear on the next seasonal menu. Specialised crockery and cutlery is provided where required and a choice of seating and meal times is available. To improve the meal provision further the service has puchased cold sweet trolleys so that people can choose a dessert at the time of eating. Comments from residents inlcude: There is plenty to eat and if you dont like the food you can always have something you like. She said that at first she bought her own breakfast cereal, the one she particularly liked, but that now a member of staff ensures that she has it provided every day. The expert by experience noted: I did not actually witness any activities taking place, because the majority of residents were out on a trip, and the regular scheduled activity had been suspended. I was reliably informed that there is a structured and varied programme of regular activities, and outings provided in this home. One member of staff is qualified to deliver the Extend programme of exercise to music for residents. I was shown the club room which is a new addition and which provides day service activities in the morning and in the afternoon. Some of these are painting, exercise classes including yoga, quizzes, craft activities, films etc. There was a computer with internet access which I was told would be used to allow some residents to access use email etc. in the future. I was shown the outdoor garden areas and was able to sit outside talking to a resident and her daughter in a pleasant seating area. I learned there had been a garden party with music recently that had been enjoyed by residents and their relatives. Another trip on a canal barge was scheduled for later in September. I saw the potting shed which had just been purchased in the garden area. I was told that the plan is to grow flowers for the tables in the home. I hope that residents will be encouraged to get involved with growing plants etc. in the future. I was shown a newsletter by several residents whilst visiting, which was lively and interesting, showing that there is quite a lot of activities and events going on a regular basis. Care Homes for Older People Page 16 of 25 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. The service has a complaints procedure which is accessible to people and their relatives so that they have information of how to make complaints about the home. Adult protection training is provided for staff so that service users are protected from abuse and have their legal rights protected. Evidence: The home has a complaints policy and procedure displayed in the hall and within the service user guide. The few complaints received have been dealt with through these procedures and resolved. All staff working at the home have the relevant criminal record bureau (CRB) and protection of vulnerable adults (POVA) checks including references. Staff files show that adult protection is discussed during induction and supervision and updates are provided. Good interaction is observed between staff and residents. They are relaxed in their company and showed no signs of distress. Care Homes for Older People Page 17 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The layout and fittings of the home have improved so that people live in a bettermaintained, private and comfortable environment. Evidence: There have been significant improvements to the presentation and facilities of the accommodation, such as, new carpets, new lighting, refurb of a bathroom to provide a bath and shower facility and provision of a garden lounge. The manager has also reduced the size of the units so that a maximum of 16 people are supported by the same number of staff that previously supported 20. The expert by experience commented that: I detected no unpleasant odours anywhere in the home, which was freshly decorated with some refurbishments. The corridors were fitted with recessed lights in the ceiling to improve visibility and grab rails on the walls. The home was clean and fresh and there was an atmosphere of quiet efficiency throughout. Although the rooms are not ensuite, the ones I saw were furnished pleasantly with many personal belongings, photographs etc, and were tidy, clean and homely. Although I did not sample the food, I was shown the kitchen and spoke with the chef. It was a large and well equipped kitchen and I saw some home made tea bread just cooked and I formed the impression that a good variety of food here is cooked and prepared with care on the premises. I asked about the care cords were which all the residents had around their necks to call for attention if required and was told that these were used and that staff responded to a call promptly. A persons Care Homes for Older People Page 18 of 25 Evidence: daughter said that her mothers room was lovely. The provider has installed a utensil disinfection machine so that hygiene and cleanliness is improved. Care Homes for Older People Page 19 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are trained and are in sufficient numbers to fill the aims of the home and meet the changing needs of residents. Evidence: Copies of original staff files held centrally at Shire Hall are now kept at the home. Discussion with the manager showed that these are helpful in determining on a day to day basis the experience of staff and their ability to be matched to certain residents. Staff files seen show the home provides induction training for each new staff member and continues to provide a good variety of additional supportive training to compliment skills and broaden knowledge and understanding. Staff were seen to be sensitive and supportive with regard to the needs of the residents. Training records are maintained and supervision is regularly undertaken with each staff member. Due to the reconfiguration of the building the units now consist of one unit of sixteen, one unit of fifteen, one unit of sixteen and one unit of ten, which enables the manager to utiilise the staff skill mix across the building ensuring residents needs are met as well as increasing the staffing ratio and allow more time for each resident. The rotas and staffing also reflect the differing levels of need during any 24 hour period. The manager reported that she is trying to encourage people who use the service to participate in the recruitment process. Care Homes for Older People Page 20 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home talks to people so they know that their opinions matter. The service has quality assurance systems in place so that people are assured that the overall conduct of the home is formally taking into account their views. Peoples opinions are central to how the home develops and reviews its practice, and the service is developing appropriate ways of making sure they get things right. So, people have confidence in the care home because it is run and managed well. Evidence: The manager finds out what people like by talking to them, involving them in their care and holding resident meetings so that any issues can be discussed. The AQAA contains information that is supported by evidence and informed us of changes planned to make any improvements to the service over the next 12 months. The organisation considers the views of people through surveys to relatives and residents. People are supported to manage their own money and records are kept. Care Homes for Older People Page 21 of 25 Evidence: People who use the service say that they trust the staff and feel safe in the home. Comments from people include: I am shown kindness and wonderful attention, the manager finds time to listen, Willing to discuss problems. The manager has introduced the concept of person centred thinking and including residents to shape the delivery of the service. The service is regularly monitored by Shropshire Council, a report of which is produced and available for inspection. These reports tell us whether systems, policies and procedures are complied with by staff but gives little indication of the quality of the outcomes achieved for individuals using the service and the impact this has on their lives. Care Homes for Older People Page 22 of 25 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 23 of 25 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 Older People Page 24 of 25 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). 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