Inspection on 16/01/07 for Crelake House

This inspection was carried out on 16th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Crelake House 22/02/06

Crelake House 19/07/05

Crelake House 15/03/05

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Crelake House 4 Whitchurch Road Tavistock Devon PL19 9BB Lead Inspector Helen Tworkowski Key Unannounced Inspection 12:30p 16th January 2007 X10015.doc Version 1.40 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 Crelake House DS0000063094.V316560.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 Older People. 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. Crelake House DS0000063094.V316560.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Crelake House Address 4 Whitchurch Road Tavistock Devon PL19 9BB 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) 01822 616224 Crelake Care Ltd Mrs Patricia Jean Hall Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (19), Physical disability over 65 years of age of places (19) Crelake House DS0000063094.V316560.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The Registered Manager is in full time day to day control of Crelake House The Registered Manager must have completed an NVQ 4 in Care and Management by 1/2/06 22/2/06 Date of last inspection Brief Description of the Service: Crelake House is registered to provide care and accommodation for up to 19 older people who may also have additional physical difficulties. The home is situated on the edge of Tavistock, within easy reach of the town and its facilities. The proprietors live on site in a separate coach house. There are ten bedrooms for residents on the ground floor, three of which have ensuite facilities. On the first floor there are a further six bedrooms. There are two shared bathrooms and two toilets. There is a stair lift to access the first floor. The communal areas comprise two lounges, a sunroom and dining room. The home is equipped with hoists and offers support to residents who have some degree of physical disability. The home is staffed 24 hours a day and there are waking staff on duty overnight. In addition to care staff employed there is also a cook, domestic and handyman. A copy of the Service User is provided to each prospective service user, and additional copies and copies of the Statement of Purpose are kept in the office at Crelake House. Fees start from £450 and are dependant on the level of care needs. Items that are not included in the fee are: Hairdressing, chiropody, newspapers, and toiletries. Crelake House DS0000063094.V316560.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Key Inspection was unannounced and included two site visits: 12.30 pm to 5.30 pm on 16th January 07 and 9.20am to 3.00 pm on 17th January 07. The deputy Manager was present on the first day, and Mr Waft and Mrs Hall were also present on the second day. The Inspection included a tour of the building; the inspector met with three care staff and the cook and spoke with six service users. As part of this inspection the care of three people was looked at in some depth. The Inspector looked at staff recruitment and training records, and the medication and the health and safety systems. Surveys were also send to ten service users, ten were returned; to ten care staff, six were returned, and four were returned by local GPs. The Inspector also spoke with one Social Services Care Manager and with the Continence Advisor. What the service does well: What has improved since the last inspection? Service User plans have significantly improved since the last inspection. These documents now contain very clear guidance to staff on what to do to meet each person’s needs. They are agreed and discussed with service users or their representatives. Staff spoken with said that they are kept up to date with Service Users changing needs. Crelake House DS0000063094.V316560.R01.S.doc Version 5.2 Page 6 The management structure has changed so that there is now always a senior member of staff on duty at all times. Staff feel well supported in their work, and meet regularly with their manager to discuss progress. Staff training has improved since the last inspection; on the day of inspection staff were attending training on Continence. All of the staff responding to the survey said that they were never asked to care for people outside their area of expertise. 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. Crelake House DS0000063094.V316560.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Crelake House DS0000063094.V316560.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s statement of Purpose and Service User Guide provide Service Users and their families with comprehensive information about the services provided. This enables and informed decision prior to moving to the home. Service Users can be confident that their needs will be met when they move to Crelake. EVIDENCE: Crelake House has a Statement of Purpose and Service User Guide, which provide information to prospective Service Users about what Crelake is like and what can be expected. Mrs Hall (Registered Manager) said that each person who is visiting the home is given the information. The information that Service Users are given is in large print, clearly written, and with photos. There were copies of contracts on file, and letters to show that Crelake had confirmed that they were able to meet needs prior to a move to the home. Mr Waft said that the contract had been based on a document that was recommended by the Crelake House DS0000063094.V316560.R01.S.doc Version 5.2 Page 9 Office of Fair Trading. All ten of the people responding to a Service User survey said that they received enough information about the home before they moved in. One person had move to Crelake in recent weeks, and there was information on the file to show that an assessment had been made. The information in the assessment is adequate, but could be more comprehensive and detailed. Service Users and their families are able to visit Crelake before they decide to move. Crelake House DS0000063094.V316560.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a system in place to ensure that service users needs are met. Medication is well managed and service users are treated with respect and dignity. EVIDENCE: All ten of the people responding to the Service User survey said that they always or usually receive the care and support they needed. Information about care needs, should be contained in a “service user plan”, three of these were looked at as part of this inspection. For the two Service Users who had been at Crelake for some time the documents were thorough and detailed. They had been regularly reviewed and had been discussed with the individual. The Inspector discussed with the deputy manager how these documents could be further improved- so that the reviews and changes were included in the main document rather than as separate documents. The Service User Plan for the person who had most recently moved contained very limited information, and some of this was not accurate. The Inspector discussed the need to have an accurate and sufficiently comprehensive service user plan from the time an Crelake House DS0000063094.V316560.R01.S.doc Version 5.2 Page 11 individual moved to Crelake. The files each had a list at the front where staff signed to say that they had read the file, and staff spoken with said that they were aware of needs and did know what people’s needs are and how to meet them. The Inspector discussed with the deputy manager the need to have a “diabetic care plan”, for when individuals have diabetes, to ensure that their needs are being met in relation to this condition. There was also risk assessments on each individual and a moving and handling assessment. These documents are important to ensure that Service users are not exposed to unnecessary risk. The Inspector spoke with the continence advisor who was visiting the home to provide staff training, she confirmed that she was satisfied with the care at Crelake and had no concerns. The Inspector also spoke with a Care Manager from Social Services who also confirmed that she was satisfied with service offered. Four GPs responded to surveys and they are confirmed that staff demonstrate a clear understanding of the care needs of service users. Service Users spoken with said that they were treated with respect, and staff spoken with were very clear about knocking and waiting before entering rooms. Crelake uses a “monitored dose” medication system, where much of the medication is bubble packed by the pharmacist for the staff to administer. Records of administration show that staff are signing for medication when it is administered. There is a record of sample staff signatures, though only senior care staff administer medication. Medication that now needs to be kept cool is now stored in a specific medication fridge. There are records with two signatures where controlled drugs are administered, the inspector discussed with the deputy manager the need to keep better records when “patches” are lost and new ones need to be administered. The home keeps a large file of information about different medications and the effects, this is important as staff need to know what they are administering. The Inspector discussed with the deputy manager the need to ensure that a record is kept of administration of creams and that requests are made to GPs to regularly review medication. Crelake House DS0000063094.V316560.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 24, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Routines at Crelake House are flexible allowing Service Users to make choices about how they spend their time. Meals are well cooked and generally enjoyed by Service Users. EVIDENCE: All ten of the service users responding to the survey said that they felt that staff listened and acted upon what they said. Service users spoken with said that they were happy living at Crelake House, feedback has included: “My mother is always complementary about the care she receives, as am I. The staff are dedicated and are very nice to the residents”. Service users spoken with told the Inspector that they could get up and go to be whenever they wish. Service Users said that they had had a wonderful Christmas and that there had been so much to do. There is a record of activities in the home, though many service users declined the activities that were on offer. The Inspector spoke with the deputy manager about the need to look at individual interests and activities, rather than group activities. Crelake House DS0000063094.V316560.R01.S.doc Version 5.2 Page 13 No money is held on behalf of service uses by the management of Crelake. Small lockable safes have been fitted in all of the rooms at Crelake, so service users can have somewhere secure for their valuables. Eight out of nine people responding to the Service User survey said that they always or usually enjoyed the meals at Crelake House. The Inspector was shown a survey of Service Users where they had been consulted on what they thought of meals that were on the menu, this information had then been used to change the menu. The menu is traditional, and the cook explained that he trying to ensure that people are given five portions of fruit and vegetables a day. Crelake House DS0000063094.V316560.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service Users can have confidence that there are robust procedures in place, which ensure that any complaints, concerns or worries are promptly and appropriately managed. EVIDENCE: Ten people responding to the Service Users survey said that they always or usually knew who to speak to if they were not happy. One person commented that if they had to “raise a point with management they always react promptly and positively”. There is a complaints procedure and the Inspector was shown evidence that the home dealt with complaints in a thorough manner, and kept very comprehensive records. Staff have received training in relation to the protection of vulnerable adults, and the deputy manager is qualified to train if this area. All six of the staff who responded to the survey said that were aware of adult protection procedures. There is a Senior Carer on duty at all times and there are clear lines of management, such systems help to monitor the quality of care. Crelake House DS0000063094.V316560.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Crelake provides a good standard of comfortable and clean accommodation. EVIDENCE: A major extension to Crelake is currently being built, apart from affecting the front patio and seating area, this is having a minimal affect on the home. The inspector looked at all areas of the building during this inspection. The bedrooms vary in size, some are of a good size others are smaller. All were well furnished, homely and clean. Some service users had chosen to bring in items of their own furniture or processions to decorate the room. There is a comfortable lounge area and dining room. Radiator covers have been fitted throughout most of the home, where they have not items of furniture have been placed in front of them. Crelake House DS0000063094.V316560.R01.S.doc Version 5.2 Page 16 Nine out of the ten people responding to the Service User survey said that they thought that they home was always fresh and clean. This was found to the case at this unannounced inspection. Staff confirmed that they had access to the gloves and aprons that they needed to do their job. The Inspector discussed with the manager issues relating to cross infection. Crelake House DS0000063094.V316560.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff at Crelake are competent and well trained, there are sufficient staff to meet the needs of service users. EVIDENCE: All seven of the staff responding to the staff survey said that they felt well supported to do their job and they were not asked to care for people outside their area of expertise. The rota shows that there are generally three staff on duty in the mornings and afternoon, with two care staff on in the evening. There is one waking night staff on at night, with support from Mr Waft and Mrs Hall who live on site. The staff confirmed that they felt that there were sufficient staff to meet the needs of the service users. The deputy manager said that they had focussed on training since the last inspection. New staff received an in house induction, and then a second induction that is externally recognised. Staff said that they felt well trained, and on the second day of the inspection staff were attending a training session on continence. Each member of staff had a training file, the inspector looked at four of these files. Staff had also received training in relation to Protection of Vulnerable Adults and Moving & Handling. Crelake House DS0000063094.V316560.R01.S.doc Version 5.2 Page 18 The staff recruitment records of two new members of staff were looked at. Care homes are expected to ensure that they have a robust recruitment procedure. As part of this procedure two written references and a full employment history must be received, also a Protection of Vulnerable Adults check must be completed (this is part of a Criminal Records Bureau check), before employment. One of the files showed that whilst references had been taken, they had not been received before employment. No Protection of Vulnerable Adults check had been received, to date. The second file was for a person who had been recruited via an employment agency. The employment history was incomplete, and no check had been made to see if the references taken by the agency were genuine. Staff said that they were well supported in their work, and could always approach a manager for advice. The deputy manager said that she supervised staff every 8 weeks, and a record of these supervisions is kept. Crelake House DS0000063094.V316560.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Crelake is well-managed service where the views of service users are taken into account. EVIDENCE: Crelake House is managed by Mrs Hall, who has many years experience of managing care services. The Inspector was told that she in the process of completing her NVQ 4 in Care and in Management. There is also a deputy manager and senior care assistants. There is now a senior carer on duty at all times, and staff felt that this provided a better service. Crelake House DS0000063094.V316560.R01.S.doc Version 5.2 Page 20 There is a quality assurance system, which has involved seeking the views of service users. As has already been noted Service Users feel confident and happy to talk to staff if they have any concerns. No money is held on behalf of Service Users at Crelake House, but each Service User now has a small safe in their room where they can keep items that are of value. The fire log was looked at as part of this inspection; regular checks had been made to ensure that the home was safe. Regular training in relation to fire safety is provided. There is a blank fire risk assessment, however this has not yet been completed. It needs to be completed. There were risk assessment in relation to other aspects of safety in the building. Crelake House DS0000063094.V316560.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 2 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Crelake House DS0000063094.V316560.R01.S.doc Version 5.2 Page 22 No Are there any outstanding requirements from the last inspection? 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. Refer to Standard Good Practice Recommendations Crelake House DS0000063094.V316560.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Devon Area Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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