Care Home: The Crossings

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What the care home does well There is information available for service users in a format which they may understand and their needs are assessed before they move to the home to ensure that they can be met. Service users choose how they would like to spend their day and are given support to make as many decisions as they are able. The atmosphere in the home is relaxed and carers were observed to be speaking to service users kindly and with respect. Risk assessments are undertaken to enable service users to undertake a variety of interests whilst minimising the risk of them coming to any harm. Service users go out regularly, individually or as a group, and are supported with their own hobbies. One service user regularly goes horse riding, which photographs show she enjoys. Service users are supported to develop their skills and their achievements, however small, are recognised and supported. Service users are registered with the local health services and staff are very aware of their health needs. They know the service users well and respond quickly if they are unwell. They also regard it as important to stay with service users if they are in hospital. Medication is managed well. The general practitioner said that `staff were knowledgeable and astute and always called her appropriately and in a timely way`. Complaints and safeguarding issues are managed well and concerns are acted upon promptly. They are protected from harm. The home is homely and welcoming. It is well maintained and part of the local community. There is a good access for people with disabilities. Service users are encouraged to personalise their rooms, which are comfortable and clearly reflect their tastes and interests. There is a consistent staff team who have training to meet residents` diverse and complex needs. Recruitment procedures are thorough and should protect service users from unsuitable staff. One family member said `they do everything possible for my daughter`. There is an experienced manager. She is supported by the organisation`s senior management team. The organisation has a quality assurance procedure in place and regularly consults with residents on the standards of care and support offered. What has improved since the last inspection? There has been an ongoing programme of redecoration and refurbishment of the home and adaptations have been made to support service users who have disabilities. What the care home could do better: No recommendation or requirements for further improvements have been made at this inspection. Key inspection report Care homes for adults (18-65 years) Name: Address: The Crossings 108a Aylesbury Road Wendover Bucks HP22 6LX     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: Chris Sidwell     Date: 0 7 0 1 2 0 1 0 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 26 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) 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 Adults (18-65 years) Page 3 of 26 Information about the care home Name of care home: Address: The Crossings 108a Aylesbury Road Wendover Bucks HP22 6LX 01296625928 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Turnstone Support Ltd care home 4 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: The maximum number of service users who can be accommodated is: 4 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - LD Physical disability - PD Date of last inspection Brief description of the care home The Crossings is registered to provide 24-hour residential care and support to four people with learning and physical disabilities, who transferred from the NHS Manor Trust to the Community in September 2001. Accommodation is a detached bungalow, which aims to provide a family style environment for the service users. Service users have their own rooms and shared social areas. There is a well-kept, safe and accessible garden to the rear of the property and car parking to the front. It is situated in a residential area and close to local amenities. Nursing support is provided as needed from the Community Learning Disability Team Care Homes for Adults (18-65 years) Page 4 of 26 4 4 Over 65 0 0 Brief description of the care home and District Nurses attached to the local GP Practice. The home is owned and managed by the Turnstone Support Group Ltd., which is a registered charity. Care Homes for Adults (18-65 years) Page 5 of 26 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 inspection was conducted over two days and included a review of the information we hold about the service, an unannounced visit to the home of six hours and the time taken to write the report. Information received about the home since the last inspection was taken into account in the planning of the visit. Questionnaires were sent to the home for distribution to service users, families, staff and other stakeholders. Care staff helped four service users to complete the questionnaires. Four members of staff and two family members returned the questionnaires. Discussions took place with the manager, senior carer and care staff and some records were checked. Care practice was observed and the care of two residents was followed through in detail. The homes approach to equality and diversity was considered throughout. Care Homes for Adults (18-65 years) Page 6 of 26 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 Care Homes for Adults (18-65 years) Page 7 of 26 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 8 of 26 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 9 of 26 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. There is information about the service for service users in a format which they may understand and their needs are comprehensively assessed before they move to the home. Evidence: The home has a statement of purpose and service users guide which is in pictorial format to help service users understand the information. Records and photographs showed that these had been explained to service users. There have been no admissions to the home since the last inspection which has a stable group of service users. The organisation has comprehensive policies and procedures in place to guide staff should a vacancy arise. All prospective service users would be assessed by the home, their care manager and would be introduced to the existing service users living at the home to ensure that their needs could be met and that they would settle in and be comfortable with the established service users. Care Homes for Adults (18-65 years) Page 10 of 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users needs and wishes are identified with them and their care plans hold detailed information to guide carers and to support service users to engage in everyday activity in a relaxed and safe way. Evidence: The care records of two service user were examined in detail. They held comprehensive support plans which described the care which has been agreed. Neither service users were able to speak but carers were very aware of the manner in which they expressed themselves. This was described in their support plans. There was information to show that the service users families had been involved in developing the plan. Aspects of the support plan were available to service users in a pictorial format and there was information to show that the key worker had engaged them in looking at their support plan. The plan had been updated regularly and a regular review had been held with the service users, their families and care managers. Carers included service users in daily activities, one was sitting in the kitchen watching Care Homes for Adults (18-65 years) Page 11 of 26 Evidence: and helping with the preparation of meals. They took time to explain to service users what they were doing, to ask permission before going into their rooms and to enjoy service users company. Comprehensive risk assessments were in place to support service users in their activities and to reduce the risk to them arising for their disabilities. One went horse riding regularly which photographs showed she enjoyed. Care Homes for Adults (18-65 years) Page 12 of 26 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. Service users enjoy a varied lifestyle in of their own choosing and are a part of the local community. They are supported to develop their abilities and achievements, however small, are recognised and supported. Meals are good meeting service users nutritional and social needs. Evidence: None of the service users are able to speak and do not have a work placement but all have full and active lives. Care staff were observed to have a good understanding of service users non verbal communication cues and body language. There is daily programme of activities and excursions which are undertaken as a group or individually. These are documented in the support plans. Service users are a part of the local community and regularly shop in the local town. The local church is supportive and visits on a monthly basis to lead a church service. There was evidence Care Homes for Adults (18-65 years) Page 13 of 26 Evidence: in the service users files to show that they remain in contact with their families who are welcomed at any time. Carers have also facilitated renewed contact for one service user with her mother who lost contact when she was a child. Care staff worked hard to help service users develop their own abilities. They recognise that progress would be slow but persevered. One service user had been helped to use a whisk for cooking to the extent that with support she could now hold it and switch it on, another had gradually been supported to wash her own hands after she had cleaned her teeth. One had gone on her first holiday away overnight with her carers. There is a varied menu, with three meals a day, breakfast, lunch and supper. Records are kept of the meals provided. These show that the meals are well balanced nutritionally and varied. The meal on the day of the unannounced inspection was well cooked using fresh produce, appetising and presented well. Mealtimes were observed to be a sociable occasion. Nutritional advice had been sought for one service user who was losing weight and for another who had swallowing difficulties. Care Homes for Adults (18-65 years) Page 14 of 26 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. Service users personal, healthcare and medication needs are met consistently, safely and in a timely way, promoting their health and well being. Evidence: Service users health care needs are met reliably. There are clear records showing when routine appointments are due. There is good liaison with local healthcare teams and clear evidence in the service users records that they see the general practitioner and other members of the healthcare team on a regular basis. They visit the dentist regularly. The general practitioner said that staff were knowledgeable and astute and always called her appropriately and in a timely way. One resident had to spend sometime in hospital recently and carers stayed with her to support her in an unfamiliar environment. There are medication policies and procedures in place. All medication was recorded. The medication administration charts had been completed in full. The manager audits medication management on a monthly basis and the local pharmacist comes to the home on a six monthly basis to check that medication is managed correctly. Staff said that medication was never hidden and given to service users without their knowledge, Care Homes for Adults (18-65 years) Page 15 of 26 Evidence: although agreement has been reached that one service users essential tablets can be placed on top of a spoon of lemon curd which she the then takes willingly. None of the service users are able to manage their own medication. This is kept in a locked cupboard in their own rooms. All care staff have had training in medication administration. Care Homes for Adults (18-65 years) Page 16 of 26 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. Peoples concerns are listened to and thoroughly investigated. The home has systems in place which should protect residents from harm. Evidence: The organisation has complaints and safeguarding policies in place. There is an easy read version available for service users. Everyone had a copy of the complaints policy in their personal file. Complaints are monitored as part of the organisations quality assurance programme. The manager said that there has been one complaint since the last inspection. Records were seen to show that this was investigated thoroughly and appropriate action taken. There are safeguarding policies and procedures in place. The home has a copy of the local multi agency procedures. Staff have had training in safeguarding vulnerable adults from abuse and knew how to raise a concern. We have not been told of any concerns about safeguarding issues raised with the local authority, which is the lead agency in these matters. The home does not manage peoples finances on their behalf. There are systems in place to safeguard personal cash and valuables. Care Homes for Adults (18-65 years) Page 17 of 26 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 home is maintained well and has good access for people with disabilities. It is a comfortable and homely place for people to live. Evidence: The home is a detached bungalow with good access for people with disabilities. There is an ongoing refurbishment programme. Service users are encouraged to personalise their rooms which were homely and reflected their personal interests. The manager said that service users helped to choose the colours to redecorate their rooms. The home was clean and tidy on the day of the unannounced visit and there were no offensive odours. There is a garden which is accessible to service users. A new gate with door bell has been installed to support a service user who likes to open the front door but may then leave the building and be at risk on a main road. She can now open the door when the bell rings, which she enjoys, but not leave the grounds and be at risk from passing traffic. There are infection control policies and procedures in place. Staff have had training in infection control. All care is given in service users rooms and the communal bathrooms and toilets were spotlessly clean. The laundry area is separate from the kitchen. Staff do not wear a uniform but have protective aprons and gloves for use Care Homes for Adults (18-65 years) Page 18 of 26 Evidence: when giving personal care. Care Homes for Adults (18-65 years) Page 19 of 26 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. Residents receive support from well trained and enthusiastic carers. The recruitment procedures should protect residents from unsuitable care staff. Evidence: Carers were observed to be communicating well with service users who were not able to verbalise their feelings and wishes. Carers were aware of behaviours which residents might use to express their feelings. The training records showed that they had training in communication, autism and epilepsy awareness. The records showed that mandatory training in safe working practices such as moving and handling was also up to date and that an ongoing programme was in place. All but one of the carers held the National Vocational Qualifications in Care at level 2 or above. The atmosphere was relaxed and peaceful. The manager said that she has three staff vacancies at the moment. She is in the process of recruiting to them and some shifts have had to be covered by staff working additional hours and sessional workers employed by the charity. They have only used agency staff who are known to the service users. The staff are flexible and the rotas are constructed around service users needs and their outings. The recruitment files of one sessional worker and one permanent member of staff Care Homes for Adults (18-65 years) Page 20 of 26 Evidence: recruited since the last inspection were checked. A summary of the documentation held at the organisations head office was available in the home for the sessional worker. This showed that appropriate checks had been made. The recruitment files for the permanent members of staff are being reorganised at present and were in the head office on the day of the inspection. The home held copies of documentation which showed that all the required documents were present and checks had been made as to the suitability of the staff member before they started work. Family members who returned the surveys said that care staff gave the support and care to relatives that had been agreed and that care staff had the right skills and experience to look after people properly. One family member said they do everything possible for my daughter. Care Homes for Adults (18-65 years) Page 21 of 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed in the interests of the service users. Evidence: There is an experienced manager in post who is supported by a team leader. She is experienced in supporting people with learning disabilities and managing a care home. She holds the National Vocation Qualifications in Care and Management at level 4 and has registered with us. The atmosphere in the home was relaxed and care staff were aware of peoples needs despite the fact that they could not verbalise these. The manager has updated her skills and has attended a course about the new Deprivation of Liberty Safeguards which have recently come into effect. She has recognised that peoples liberty should not be restricted and has taken steps to give service users as much freedom as possible consistent with their safety. She is advised to consult the local authority about one resident who might try to leave the home when the door is opened. The home is operated by an established company, which has systems in place to monitor the quality of care. Regular audits are undertaken by the manager which are Care Homes for Adults (18-65 years) Page 22 of 26 Evidence: validated by the service manager. The service manager visits the home regularly and records of her quality monitoring visits are kept in the home. Families said they were always welcome and there are regular service users meetings. There are health and safety policies and procedures in place. Maintenance records show that servicing of essential services and equipment is undertaken regularly. Records relating to health and safety checks were in good order. Training records show that staff have had training in safe working practices, including moving and handling and first aid. Care Homes for Adults (18-65 years) Page 23 of 26 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 24 of 26 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 25 of 26 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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