CARE HOME ADULTS 18-65
Crescent, The (10) 10 The Crescent Pewsey Wiltshire SN9 5DP Lead Inspector
Roy Gregory Key Unannounced Inspection 7 & 11 September 2007 10:00
th th Crescent, The (10) DS0000028316.V349145.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Crescent, The (10) DS0000028316.V349145.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Crescent, The (10) DS0000028316.V349145.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Crescent, The (10) Address 10 The Crescent Pewsey Wiltshire SN9 5DP 01672 562266 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Innovations Wiltshire Ltd Mrs Nanette Patricia Lance Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Crescent, The (10) DS0000028316.V349145.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 21st November 2006 Brief Description of the Service: 10 The Crescent accommodates four adults with a learning disability. It is one of four residential care homes owned by Innovations Wiltshire Ltd. Mrs Nan Lance is the responsible individual and registered manager. The home is in a residential area of Pewsey, within walking distance of shops, doctor’s surgery and other amenities. Two of the other Innovations homes are also nearby. The home is a semi-detached house, furnished to a good standard. People have single rooms, with toilets and bathrooms nearby. They share a living room, kitchen-diner and garden. The home has two members of staff on duty throughout the waking day when all service users are at home, and sleeping-in cover is provided at night. Fees for living in the home are based on individual need and range from £800 to £1,000 a week. Crescent, The (10) DS0000028316.V349145.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. An unannounced inspection visit took place between 10:00 a.m. and 4:30 p.m. on Friday 7th September 2007. A further visit was made on Tuesday 11th September from 2:00 p.m. to 3:00 p.m. to complete looking at records. The inspector met with the staff on duty at the time, which included a senior support worker and support worker. Issues regarding all the services operated by Innovations Wiltshire, including 10 The Crescent, had been recently discussed with the registered provider and manager, Nan Lance. Initially three of the people living at the home were present. It was possible to spend significant time talking with two of them in private. Staff interactions with people were observed, and the inspector joined the three people, with staff, for lunch. The other person from the home returned later during the visit. All shared areas of the home were seen, and two bedrooms by invitation. Records that were read included care records and support plans, and proof of monitoring health and safety matters, including risk assessments and fire precautions. The inspector looked at how medication was used and how the home links up with health professionals and other community resources. As the home had recently conducted a questionnaire exercise with people in the home, their relatives and external professionals, reference was made to responses that had been received. On a visit to the provider company’s office it was possible to look at staff records, including those about training, supervision and recruitment. Other information was contained in the Annual Quality Assurance Assessment submitted by the manager to the Commission, as required annually of all regulated services. The judgements contained in this report have been made from evidence gathered during the inspection, which included the visit to the service and taking into account the experiences of people using the service. The inspector would like to thank the people and staff for their welcome and assistance. What the service does well:
Each person had a support plan. These used standard sections and were easy to follow. People were aware of their plans, which they said made sure their needs were understood. Crescent, The (10) DS0000028316.V349145.R01.S.doc Version 5.2 Page 6 A standard section of support plans concerned provisions for people’s privacy. People were seen at different times choosing to do things on their own. People got up and went to bed when they chose. Support plans emphasised a personcentred approach, to include respect for diverse needs. Two people had got married and there was evidence of the home’s support to them. Daily diaries showed that care and support were offered in line with support plans. The community learning disabilities nurse and a physiotherapist had written about the staff working well with them to make sure people stayed in good health. The home shared use of a car and a minibus with two nearby homes. They went on a variety of trips out. They used local shops and pubs, and also had bus passes. One person said they made decisions about where they would like to go for trips out. People had various occupations during the week. One person had a job for a few hours, one was a voluntary worker, and people went to day resources and college. The bedrooms seen reflected the personalities and interests of the people living there. People seemed proud of their rooms. They said they chose the colour schemes. The home was very clean everywhere, including toilets and the kitchen. Staff were provided with good resources to ensure they understood best practice in maintaining a clean and safe environment. People living in the home were supported to share responsibility for domestic tasks. People could get drinks and snacks when they wanted to. They were each involved in choosing what meals they would have. They could enjoy the privacy of their own rooms as well as having attractive shared rooms and a garden. What has improved since the last inspection?
A major change to the service has been the appointment of Mrs McGrorty as service manager to guide development of all the services provided by Innovations. The company has also appointed an administrator. These appointments have enabled more consistent liaison between the company and placing authorities. People’s contracts had been reviewed and the fees paid for them had been increased. It was clear that considerable effort has been put to overhauling systems of working, training and recording. New policies and procedures hade been put in place, and old ones updated. Recommendations and a requirement made at the previous inspection, to improve the safety of practice and recording in administering medicines, had been followed. Practice with “as needed” medicines was very good. Risk assessments were being reviewed regularly. In line with a requirement, an external trainer for abuse awareness training for all staff had been found and provided training to all staff. Crescent, The (10) DS0000028316.V349145.R01.S.doc Version 5.2 Page 7 Quality assurance methods had been researched, as required. There was a system for getting the views of people living in the home, their relatives and external health and social care professionals. This was to be repeated annually to help guide future development of the service. Key workers had a responsibility to assist people in making their views known. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Crescent, The (10) DS0000028316.V349145.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Crescent, The (10) DS0000028316.V349145.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 & 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a clear assessment and admission process to ensure any admission would be appropriate to the individual concerned. Current users of the service have recently renegotiated contracts. EVIDENCE: The people living at the home have done so for several years. They expect to continue living there, as they are settled and the home can continue to meet their needs. Therefore no admissions have occurred for a long time. However, the provider company has developed an admissions policy and procedure within the last year, which has led to well-managed assessments and admissions at two other homes. Since the previous inspection, the company has renegotiated contracts with the funding authority for the people living in the home. This has given the service increased financial viability, leading to greater security for the people living there. Crescent, The (10) DS0000028316.V349145.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s assessed needs are reflected in care and support plans, which are reviewed and changed as necessary. People are supported in making decisions about their everyday lives. Setting of longer-term goals could help give a sense of achievement and progress. Risks are identified, and assessed in such a way as to encourage safe participation in a range of activities. EVIDENCE: The quality of support plans had clearly received a lot of attention since being subject of a requirement to improve at the previous inspection. Plans for people in the home were well written. All used standard headings. They gave concise but clear guidance to people’s own abilities, and to the areas in which some level of support was necessary to promote independence and enjoyment of life. People living in the home were aware of the existence and relevance of plans. For one person, the plan reflected the lifestyle and needs that they had described.
Crescent, The (10) DS0000028316.V349145.R01.S.doc Version 5.2 Page 11 There was good evidence of review of content, showing that support plans were used as working documents. The two people spoken with were familiar with their support plans and spoke about reviews. They could describe the main areas of care and support covered by their plans. Plans included provisions for how to promote privacy. They showed how people liked to use their private rooms and how they wanted staff to make contact. There was evidence that there had been discussion with people about the possibility of using door locks, if they wished. People in the home said staff always knocked at their doors, and waited to be invited in. Observations of care interactions showed that people were consistently offered choices, and able to make decisions about everyday matters. For example, two of the people were recently married. They chose when to be in private, and where, and when they wanted to socialise with others in the home. An improvement to support plans would be to set goals with people. When someone lives in one place for a long time it is easy to settle into a routine without learning many new things. With one or two goals agreed with people, they could concentrate on reaching them for six months or a year. This would help people have a sense of achievement and control. Staff members were keen on such a development. They identified existing meetings between people and their key workers as a good starting point for discussing possible realistic goals. There was a recent policy on risk taking and risk management. The statement of purpose described the service as “risk aware but not risk averse”. Risk assessments seen were of good quality, with an emphasis on promoting rather than limiting activities. They were checked as part of monthly management audits. This practice followed a requirement being made at the previous inspection for a more consistent formalised way of assessing risks. Crescent, The (10) DS0000028316.V349145.R01.S.doc Version 5.2 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 15, 16 & 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Varied activities give people access to the community and opportunities to maintain leisure interests. Relationships with families and friends are encouraged. People participate in everyday tasks and their rights are respected. A healthy diet is offered, and mealtimes are conducted as people want. EVIDENCE: Support plans gave good descriptions of people’s leisure interests and needs, and reflected what people said about how they liked to use their time. There was a balance of regular arranged activities, leisure interests in and out of the home and involvement in every day domestic routines. Crescent, The (10) DS0000028316.V349145.R01.S.doc Version 5.2 Page 13 One person went every weekday to a resource centre. A decision on provision of outreach work was awaited for another person. One person had some hours each week in sheltered employment, and at college, whilst another worked as a volunteer one day a week. There was general uncertainty about the continued availability of some resources in the community. In response, it was intended to provide the home continuously with two members of staff, to enable a greater emphasis on activity provision and encouragement. The management team were continuing to look for other opportunities in the community. One concern was that people must be able to sustain friendships they have made through use of other services. There was evidence of good liaison between the home and the resource centre used. In her response to the service’s quality questionnaire, the manager of the resource centre said the people often referred to things they had done with home staff. She described the home as a “client-led service”. During the inspection visit a person went out to the village shops with a member of staff. People and staff spoke of a lot of use of the local amenities. They liked going to local shops and pubs, and using buses to go elsewhere. All people had bus passes. The group of homes also shared use of two vehicles, which enabled planned and spontaneous trips to take place. People said they made suggestions about where they would like to go. Two people in the home were married. There was evidence of how the home had supported them in planning their wedding, and through their honeymoon away. They were satisfied with how they continued to be given space to develop their relationship. Possibilities for meeting their longer-term future needs were being considered between them and staff and management. People were involved in going shopping for food, including use of a regular farmers’ market. There was a system in use to make sure all people could make choices of meals. Each day of the week, one of the people in the home had special time for support with getting up to date with chores like laundry and bedroom cleaning or tidying. This would also be the day when their choice of main meal would be on the menu. Alternatives were always available for people who disliked the choice. Records showed that people received a varied diet, including some meals out. One person spoke of getting their own breakfast. During the inspection visit they made hot drinks as they wished. The lunchtime was very enjoyable. It gave a picture of how much the people living in the house regard it as their home. There were three people at home. One had a hearty soup, as part of a planned diet. The others had filled rolls, making their choice of fillings. They were invited to have their meal where they wished, and chose to do so at the dining table. A person said they had always been involved in choice of meals. The garden provided an alternative venue for meals when the weather allowed. Crescent, The (10) DS0000028316.V349145.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides personal support in line with people’s preferences and needs. There are good links and systems to ensure physical and emotional health needs are met. People are protected by the home’s medication procedures. EVIDENCE: Support plans were specific in describing personal care needs. They emphasised those areas in which people were self-caring or needed little additional support. The plans also gave good guidance about individual longterm health conditions. For a person with epilepsy, their plan included their epilepsy profile and some more general useful information about epilepsy. There were first aid directions to be followed in the event of a seizure. The person concerned felt very confident of how the home kept them safe with respect to their epilepsy, including a strict medication routine. Crescent, The (10) DS0000028316.V349145.R01.S.doc Version 5.2 Page 15 Another person had difficulties around mood and behaviour. There was a protocol devised with the specialist learning disabilities nurse. This included a scoring system that allowed staff to be specific about what they were addressing at any time, and thus how to respond. The recording of the work as a graph showed that incidents were being contained and prevented from escalation. This work was linked also to a protocol for use of “as needed” medication. Further, the support plan contained a flow chart for staff to follow. Every time the person’s “as needed” medication had been used, there was a full explanation and cross-reference on the reverse of the Medicines Administration Record chart. There was evidence overall that the home and provider had good links with health professionals in the community. People were allocated a “key worker”, who was responsible for maintaining routine health appointments and checking on clothing needs. Otherwise, all staff knew the people well and were able to care and support in a consistent way. Daily diaries were kept for each person. These showed that care and support were offered in line with support plans. A community learning disabilities nurse responded to the home’s quality assurance questionnaire in May 2007. She recognised “good staff attitudes” and wrote: “Requests for information or to carry out guidelines are met.” Another response was from a physiotherapist: “Staff are receptive to advice and positively working in partnership in promotion of health preventative working.” Medications were not used to a great extent in the home. The arrangements for storage and administration of medicines were good. Support plans explained why particular medications were in use. A requirement and recommendations made at the previous inspection, to improve the safety of practice and recording in administering medicines, had been followed. The supplying pharmacist provided quarterly audits, and training in the monitored dosage system used, together with a supporting training pack. The company intended to arrange distance-learning courses in medication use for staff. There was a plan to install medicines cabinets in individual bedrooms, as a means to promote independence and to minimise risk of errors by staff. Crescent, The (10) DS0000028316.V349145.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are appropriate procedures, including staff training, to protect people from harm, and to receive and act on complaints. EVIDENCE: In line with a requirement made at the previous inspection, an external trainer for abuse awareness training for all staff had been found and provided training to all staff. There was provision for updating this every two years. Staff had been issued with the latest version of the “No Secrets” brief guidance to local inter-agency safeguarding procedures. The senior management team recently attended refresher safeguarding training with people from the community team for people with a learning disability. There was a new policy on abuse, which included “whistle blowing” provision. There has been good co-operation with local multi-agency safeguarding procedures regarding issues in other homes run by the company. There was an effective policy and procedure covering any incident of a person going missing. Individual files contained an information sheet that was to be used in such an eventuality. Crescent, The (10) DS0000028316.V349145.R01.S.doc Version 5.2 Page 17 There was a good standard of recording of incidents and accidents, including use of body maps to record any injury sustained. Support plans included guidance on individual support to people’s use of personal money. There were systems for safekeeping and for recording any transactions. There was evidence of support and guidance being readily available from the Wiltshire County Council appointee, who in turn monitored safe practice. There was work in progress, including obtaining appointee advice, on ensuring people received full entitlement to mobility allowances. Work had been undertaken to ensure people knew how they could raise any concern or complaint. There was a well laid out leaflet that included a page that could be filled out as a means to make a complaint. It had addresses for contacting the community team and the Commission. It was a key worker responsibility to remind people periodically about the leaflet and of their rights to make complaints. The complaints information provided to people’s representatives was also satisfactory. No formal complaints had been received by the service since the previous inspection. A person said they had never had cause to complain. They said it was easy to say things to staff either over the meal table or in private. They said staff were good at helping resolve any issues that arose between the people living in the home. Crescent, The (10) DS0000028316.V349145.R01.S.doc Version 5.2 Page 18 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25 & 30. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. 10 The Crescent provides a homely environment, maintained and kept clean to a high standard. Individual bedrooms reflect people’s needs and lifestyles. EVIDENCE: The house had a homely feel in the shared rooms and individual bedrooms. The home was well maintained. One bedroom had an en-suite shower room and toilet, but as a result of risk assessment the person was unable to use the shower. They were fully aware of and in agreement with the assessment, and satisfied with the alternative bathing arrangements available. The four bedrooms reflected the personalities and interests of the people living there. They were attractively furnished. For the married couple, space was at a premium and it was an ongoing endeavour to make the best use of their private rooms. They continued to enjoy using the shared parts of the house and garden. They said they had chosen the colour schemes for their rooms. Crescent, The (10) DS0000028316.V349145.R01.S.doc Version 5.2 Page 19 There was a recently developed policy on infection control. This was based on Department of Health “Essential Steps” guidance. All parts of the home were cleaned to a good standard, including bathrooms and the kitchen. There was an effective system that ensured all parts of the home were cleaned routinely. Staff signed off tasks as they were completed, allowing the manager to monitor standards. Each person in the home had a day a week when their cleaning needs received particular attention. This in turn provided one-to-one interaction between staff and residents. The married couple overlapped their respective support times, and were increasingly establishing ways of supporting each other. There was a utility room with washing machine and drier, and washing was dried outside when the weather allowed. Crescent, The (10) DS0000028316.V349145.R01.S.doc Version 5.2 Page 20 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32 – 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are supported by competent, trained staff, who experience regular supervision and are supported by an employer committed to staff development. Recruitment practices ensure people are protected from being cared for by unsuitable staff. EVIDENCE: Two support staff were on duty at any time, except for one time in the week when only one of the people living in the home was in. This staffing level was achieved by three staff working overlapping shifts, between 7:00 a.m. and 10:00 p.m. One of the staff members on duty during the inspection visit was designated as the senior support worker to 10 The Crescent. As such, he spent most of his duty time there and people living there identified him as their main support. Other staff were rostered to work at any of the company’s houses in Pewsey, so people experienced a variety of support workers. This had the advantage of allowing people interaction with staff of both genders and different ages. Each person had a key worker from the staff group, responsible for helping maintain people’s routine appointments, clothing needs and so on. Crescent, The (10) DS0000028316.V349145.R01.S.doc Version 5.2 Page 21 The company had been recruiting staff, including relief staff, over preceding months. Recruitment records sampled showed that prospective members of staff completed an application form and were interviewed in a consistent way, with records kept. It could be easily seen that new staff did not start working for the company until after the company had received disclosures from the Criminal Records Bureau (CRB) and confirmation that the individuals were not listed on the Protection of Vulnerable Adults (POVA) list. Two references were obtained for each person recruited. There were photographs of all members of staff. Identity cards were being developed, so that in any situation outside the home, staff could prove to others their duty of care. Senior support workers were responsible for supervision of support staff and were themselves supervised by the registered manager. All senior staff had received training in supervision of staff. Records showed staff were receiving supervision every four to six weeks, each session ending with setting a date for the next one. There was recent experience within the company of supervising individuals more frequently for particular reasons. Supervisions were recorded on a standard format, which proved them to be a meaningful exercise. In the company office there was a training matrix showing what training each member of staff in the company had achieved, and when renewals were due. Copies of certificates were held in individual staff files. The company employed 14 support staff across the three homes in Pewsey. Of these, five had achieved National Vocational Qualification (NVQ) in care, level 2, and three were currently working towards it. An induction programme for new staff, compliant with “Common Induction Standards”, was ready to use with staff currently being recruited. There was evidence of arrangements being made to secure a training provider that can provide support to the staff’s induction, mandatory and NVQ training needs. Crescent, The (10) DS0000028316.V349145.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management team provides leadership and direction so people benefit from a well run home. Quality assurance systems include obtaining the views of service users’ and their supporters to monitor and improve the service. There are systems in place to identify and promote the health and safety needs of residents and staff. EVIDENCE: Since the previous inspection, the company has appointed Mrs McGrorty as service manager, and there is also now an administrator. These appointments have enabled more consistent liaison between the company and placing authorities. Better funding for placements had been negotiated. This resulted in improved provision for people using the service: new vehicles, more staff recruitment and environmental improvements. Crescent, The (10) DS0000028316.V349145.R01.S.doc Version 5.2 Page 23 Mrs McGrorty, Mrs Lance and Miss Britten, the other registered home manager in the company, have established a management team identity. It was clear that considerable effort has been put to improving systems of working, training and recording. New policies and procedures have been put in place and old ones updated. Managers carry out a number of internal monthly monitoring checks. Following a requirement made at the previous inspection, an annual quality assurance exercise has been put in place, including a feedback tool for key workers to use with people living in the home. Questionnaires were sent to a range of professionals in May 2007 and a number of full responses had been received. There was also a staff questionnaire and another sent to people’s near relatives. The management team used collated responses to identify areas for development. Health and social care professionals who responded identified management changes as having been effective. One said changes had been “not too fast for service users to understand.” Within the home, mealtimes were still seen as a forum for giving information to and receiving ideas from people, but they had also introduced key worker meetings as a structured way of assisting feedback for individuals. People said the managers were frequent callers at the home and always wanted to know whether people were satisfied. Monthly monitoring visits acted in part as an audit of health and safety measures, including fire precautions and drills. Records were sampled. Action points were indicated where any shortfall or developmental need was found. There were arrangements for the training of staff in moving and handling, fire safety, first aid, food hygiene and infection control. Use was being made of the Food Standards Agency “Safer food, better business” guidance and monitoring tool. Staff signed to show they had read elements of this, such as safe chilling guidance. One of the senior support workers had delegated responsibility for health and safety issues in all the homes, whilst another was designated fire officer. Changes to the home’s fire risk assessment were shown. There were good records of checks on fire precautions and fire drills. Crescent, The (10) DS0000028316.V349145.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 4 25 3 26 X 27 X 28 X 29 X 30 4 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 4 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 4 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Crescent, The (10) DS0000028316.V349145.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA20 Good Practice Recommendations Aim to set goals as part of the care planning process. Crescent, The (10) DS0000028316.V349145.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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