Inspection on 22/02/06 for Crelake House

This inspection was carried out on 22nd February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 16/01/07

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 Annie Foot Unannounced Inspection 22nd February 2006 09:50 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.V282400.R01.S.doc Version 5.1 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.V282400.R01.S.doc Version 5.1 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.V282400.R01.S.doc Version 5.1 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 19th July 2005 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 10 bedrooms for residents on the ground floor, 3 of which have ensuite facilities. On the first floor there are a further 6 bedrooms. There are 2 shared bathrooms and 2 toilets. There is a stair lift to access the first floor. The communal areas comprise two lounges, a sun room 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. Crelake House DS0000063094.V282400.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place during the morning and part of the afternoon of the 22nd February 2006. It was the second inspection of the year. The proprietors, Tricia Hall and John Waft oversee the day-to-day management of the home. They were present for the majority of the inspection but had to leave for an appointment, during which time the senior carer was in charge. The purpose of the inspection was to follow up on requirements and recommendation made at the previous visit and to assess progress in other areas. Requirements and recommendations from the previous inspection had all been addressed and met. The senior carer was on duty with two other care staff and the cook. All of the staff were observed in their duties and all were spoken with. Almost all of the residents were met and 4 were spoken to in more depth. The inspection included a tour of most of the premises, and examination of care, medication and staff records. The proprietors have owned the home for almost twelve months and have worked hard to develop and implement various systems for improvement to bring the home up to a high standard. There are a number of exciting plans to improve the premises in the near future and to further extend accommodation for residents and the communal areas. What the service does well: What has improved since the last inspection? A lot of work has been put into developing and implementing new procedures and systems in use at the home. These include the development and implementation of new contracts for residents, a staff handbook and contracts of employment for staff. Crelake House DS0000063094.V282400.R01.S.doc Version 5.1 Page 6 Good progress has been made to improve the efficiency and management of the home. 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. Crelake House DS0000063094.V282400.R01.S.doc Version 5.1 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.V282400.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,5 The home’s statement of purpose and Service User guide provide residents and prospective residents and their families with comprehensive information about the services provided. Documentation enables an informed decision prior to moving into the home. EVIDENCE: Copies of the new brochure, service user guide and statement of purpose were read. These are comprehensive documents containing all relevant information for prospective residents and their families. The layout and design of documents is particularly noteworthy, with photos of the home throughout and large print used in the service user guide. Residents said that their families had found the home for them but had had the opportunity to visit and/or stay before making a final decision to move in. New statements of terms and conditions of occupancy have been developed and implemented. There is a reference to use of independent advocates included with the document, who will provide independent advice to residents and families. Crelake House DS0000063094.V282400.R01.S.doc Version 5.1 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,9, 10 There is a care planning system in place to ensure that resident’s needs are met. But the procedures for review are not reliable making it difficult for changing needs to be consistently met. Medication records and cold storage of medications are not consistent with safe practice. EVIDENCE: Every resident has a file, which is organised in sections to include the care plan and risks assessments. Staff said they had sufficient information to meet residents’ needs. However, from a random sample of six files examined, care plan reviews are inconsistent. 3 had no record of a review, others had been reviewed but at intermittent frequency. Care staff were unable to explain the frequency or process for reviews of care plans. Some files contained photos of the resident some did not. A staff member said that recording methods have improved which “has to be a good thing”. Crelake House DS0000063094.V282400.R01.S.doc Version 5.1 Page 10 Medicines are stored in locked cabinets, which are well organised and safe. Medicines requiring cold storage are stored in an open topped plastic container in the food fridge. The administration of lunchtime medications was observed and seen to be satisfactory. Medication records were inspected. Gaps in signatures on the MARS chart were found. This was brought to the attention of care staff to bring to the owners attention on their return. No specimen signatory list was available and this is recommended. Two residents self medicate and this was discussed with them. Both said they store medications in a drawer in their bedrooms. They have a lockable space but do not use them for storage. Crelake House DS0000063094.V282400.R01.S.doc Version 5.1 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,15 Routines within the home are flexible allowing residents to choose how to spend their time, although activities are limited. Meals are freshly prepared and are nutritious and varied. EVIDENCE: Residents are happy living at the home. From discussions with them many of them have found the move from independent living into residential care difficult. Residents admitted within the last year said that the proprietors and staff had been reassuring in helping them to adjust to their new surroundings. Residents talked about their frustrations with old age, and in not being able to do things done in the past. One resident said they felt their independence had gone since moving into the home. This was not a criticism of the home, merely a statement about the situation. Residents say the routines of the home are flexible within the context of the setting. Many of the residents are extremely articulate and have led interesting and diverse lives. Several people are from professional backgrounds. From discussion it appears that residents spend most of their time in their rooms, keeping themselves occupied by reading, watching T.V listening to the radio etc. Daily papers are provided. When asked about activities residents say they are limited, one person said, “what can they do? So many of us cannot Crelake House DS0000063094.V282400.R01.S.doc Version 5.1 Page 12 either hear or have difficulty moving”. Bingo sessions have been arranged but those residents spoken with they were not interested. The cook has been employed for several years. She knows residents well and cater for their likes and dislikes. The kitchen is well organised. A four-week menu is in place. No alternatives are routinely offered but the cook will always provide a choice should a particular dish not be liked. Fresh vegetables are delivered to the home twice a week. Excellent communications were observed between the cook, residents and visitors to the home. Crelake House DS0000063094.V282400.R01.S.doc Version 5.1 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Residents can have confidence in robust procedures in place, which ensures that any complaints, concerns or worries are promptly and appropriately managed. EVIDENCE: One complex complaint has been received at the home in the last year. Details of the investigation were examined. Documentation is extremely thorough and detailed. A meticulous record of events is in place will clear actions and timescales. Discussion took place with the proprietors to complete closure of this complaint. The proprietors take a proactive and robust approach to managing potential allegations of abuse. Both partners have attended training in this area and there are plans to ensure all the staff attend external training, to expand their knowledge and understanding of abuse. The subject is raised and discussed at staff meetings. Awareness of abuse is included with the induction training programme for new staff. Abuse, Bad practice and whistle-blowing policies and procedures have been implemented, and are contained within the staff handbook. Staff were clear that should a situation of abuse arise it should be reported. Crelake House DS0000063094.V282400.R01.S.doc Version 5.1 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,23,25 Residents live in comfortable and safe surroundings, with their own personal items around them. EVIDENCE: The home is warm and comfortable. Residents’ rooms are of varying sizes. Some are quite small and some would benefit from updating. The proprietors are aware of these limits and plan to extend the premises, to include some larger rooms for residents. Residents all said their rooms were comfortable and there is evidence of lots of personal touches and individual items in rooms. One resident has two rooms; one used as a bedroom the other as a sitting room. They spoke very favourably about having this additional facility. Since the last inspection 15 radiators have been fitted with covers, one more is yet to be completed. Two residents have resisted a cover and said that they did not want their radiators covered, as they like to warm clothes on them. In these rooms, furniture has been placed strategically to prevent risk of falling against the radiator. Both residents were spoken, and both were adamant that Crelake House DS0000063094.V282400.R01.S.doc Version 5.1 Page 15 they did not want their radiators covered. The proprietor has completed risk assessments for each of the 3 rooms in question. Radiators in the corridors are not guarded although there is a shelf above each one, providing protection to residents. Thermostats have been fitted to baths since the last inspection to prevent risk of scalding. Temperatures were tested. Devices have not yet been fitted to all water outlets in the home. The water from some wash hand basins is very hot. Safety notices have been fitted above wash hand basins in resident’s rooms, to warn of unregulated temperatures. Window restrictors are not fitted to all first floors rooms to which residents have access. These must be provided. A handyman is employed to attend to minor repairs and replacements as needed. The proprietor explained that a rolling programme of maintenance has been developed but is on hold pending decisions regarding the new extension. The plans for developing the home are currently at Planning Permission stage. These include a new laundry. The proprietors are to send a copy of the plans to CSCI. The home was clean and hygienic on the day of the inspection. Crelake House DS0000063094.V282400.R01.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29,30 Robust recruitment procedures ensure that appropriately skilled staff are employed to be meet residents needs. There are good arrangements for the induction and training of staff. EVIDENCE: The proprietors have undertaken work to improve recruitment policies and procedures. These are complete. Staff have now received a statement of their terms and conditions of employment. A newly introduced staff handbook is comprehensive and includes a job description, terms and conditions, policies and procedures. New staff undergo a six-month probationary period. A random selection of 4 staff files was inspected for staff, appointed since the proprietors took over. These included all the required documentation, apart for the identity of one person. Two written references are obtained for staff and CRB checks made. If a previous employer is unwilling to provide a reference for an individual, employment will not be offered. Some of the staff have been employed at the home for many years, the proprietor said that information in their files had previously been scanty and in some cases nonexistent. However, over the last twelve months all existing staff had undergone CRB checks and these are held on file. Two of these files were seen to confirm the check. There has been a low staff turnover and staff were said to be a good team and work together well. Crelake House DS0000063094.V282400.R01.S.doc Version 5.1 Page 17 Induction training for new staff is in place and a newly appointed staff member confirmed this. Staff are encouraged to undertake NVQ at Levels 2,3 and 4. An element if training is included in staff meetings. A key working system is in place. In discussion with staff this appeared more for practical purposes rather than for residents individual care. A managing absence policy is currently being formulated. Crelake House DS0000063094.V282400.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,38 The proprietors have a clear development plan and vision for the home and have a good understanding of areas in which the home needs to improve. Planning is in place for the resource and management of new developments. EVIDENCE: Since taking up the ownership and management of the home almost a year ago, the proprietors have made a great deal of progress in improving the operating systems and recording methods in use. The proprietors have extensive experience of working with older people and own another care home in Devon. There is business plan in place, which is currently under review. The proprietors have many exciting plans for the development of the home described elsewhere in the report. In addition they intend to develop a senior staff structure within the home. At Crelake promoting a senior staff member Crelake House DS0000063094.V282400.R01.S.doc Version 5.1 Page 19 to deputy manager, who will be trained to take over the managerial responsibility of the home in the future, has already started the process. Both residents and staff spoken with said that the home has improved since the new owners took over. Staff feel well supported. The monthly staff memo provides a newsletter for staff to keep them informed with changes and progress and news within the home. Tricia Hall has over 20 years experience working with older people and takes lead responsibility for the care of residents. John Waft has a background in fire inspection, health & safety and risk assessment. He is well conversant with the regulations and requirements. Records seen were up to date and consistent. Noted that Residents’ room risk assessments were neither dated nor signed. This would be good practice. Crelake House DS0000063094.V282400.R01.S.doc Version 5.1 Page 20 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 3 x x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x 3 x STAFFING Standard No Score 27 x 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 x x x x x 3 Crelake House DS0000063094.V282400.R01.S.doc Version 5.1 Page 21 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. 1 2 Standard OP7 OP9 Regulation 15 (2) 13 (2) Timescale for action Care plans should be reviewed at 01/03/06 least monthly to reflect changing needs of residents. Arrangements must be made to 23/02/06 ensure that medication records are consistently signed at the time of administration. Window restrictors must be fitted 30/04/06 to all first floor windows to which residents have access. Requirement 3 OP19 23 (2) (p) 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 2 Refer to Standard OP9 OP9 Good Practice Recommendations Medicines requiring cold storage should be stored in a separate drugs fridge or sealed container. A list of specimen signatures and initials should be held alongside medication records. Crelake House DS0000063094.V282400.R01.S.doc Version 5.1 Page 22 3 OP25 To risk assess all water outlets to which residents have access and where risk is identified to fit pre-set valves to taps. This applies to wash hand basins. To complete the annual training programme for staff. 4 OP30 Crelake House DS0000063094.V282400.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 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. Extracts may not be used or reproduced without the express permission of CSCI Crelake House DS0000063094.V282400.R01.S.doc Version 5.1 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!