Inspection on 26/07/07 for Crescent House

This inspection was carried out on 26th July 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

Crescent House 19/05/08

Crescent House 10/05/06

Crescent House 22/09/05

Crescent House 12/04/05

Crescent House 28/10/04

Crescent House 27/04/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Crescent House 108 The Drive Hove East Sussex BN3 6GP Lead Inspector Jane Jewell Key Unannounced Inspection 11:30 26th July 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 Crescent House DS0000014193.V339020.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. Crescent House DS0000014193.V339020.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Crescent House Address 108 The Drive Hove East Sussex BN3 6GP 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) 01273 732291 01273 732393 m.mcneill26@ntlworld.com The London & Brighton Convalescent Home Mrs Jennifer Susan Downes Care Home 17 Category(ies) of Old age, not falling within any other category registration, with number (17) of places Crescent House DS0000014193.V339020.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. The maximum number of service users to accommodated is 17 That service users are aged over sixty five (65) years on admission. That the home may accommodate one named service user who has mental health needs That the home may accommodate one named service user who has dementia 12th December 2006 Date of last inspection Brief Description of the Service: The home has been owned for over a hundred years by the London and Brighton convalescent Home, a charity. The home is a detached Edwardian property located half a mile from Hove. Main line train services are within walking distance and the home is near to bus routes into Hove and Brighton. The home is registered to provide care for up to seventeen older people. The home is on three levels, ground, first and second floor, with a chair lift providing access to first floor. Service users accommodation is situated on the ground and first floor with the second floor used as a storage area. All bedrooms are for single occupancy with six having en-suite facilities. There is a shared dinning room, lounge and conservatory. The home has a rear garden with the front garden gravelled to provide off road parking. The homes literature states that its mission is to assist its residents in maintaining a highest quality of life, as well as quality of care. And assures its residents individual care with respect to their privacy, dignity safety and security. The fees have recently increased and are £375 to £394.40 a week. These fees include all services and facilities apart from hairdressing, chiropody and newspapers any taxis required and dry cleaning of clothes, these extras are itemised separately with appropriate receipts. Crescent House DS0000014193.V339020.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The information contained in this report has been comprised from an unannounced inspection undertaken over five hours and information gathered about the home. This includes discussion with relatives and health care professionals. The head of care had completed an Annual Quality Assurance Assessment form prior to the inspection and the information contained in this document has been used to inform the inspection of the home. The inspection was facilitated by Mrs J Downs (Registered Manager) and Mrs K Warne (Deputy manager). The inspection involved a tour of the premises, observation, examination of records and discussion with residents and staff. There were twelve residents living at the home at the time of the inspection. The focus of the inspection was to look at the experiences of life at the home for people living there, this involved observing residents and their interactions with staff and examination of the homes facilities and documentation. In order that a balanced and thorough view of the home is obtained, this inspection report should be read in conjunction with the previous inspection reports. The Inspector would like to thank the residents, staff and management for their assistance and hospitality during the visit. What the service does well: The home continues to provide both prospective and existing residents, with a good level of information about what services are provided and what to expect when living at the home. There is evidence that the home is meeting most needs of residents with residents speaking positively about their experiences at the home. A sample of their comments include: “I like living here”; “The home have been fantastic very caring attitude”; “settled in very well”; “not a bad home” Links with families and friends are valued and supported by the home. The standard of care remains good with staff knowledgeable about the needs of residents, this ensured that residents are treated as individuals and their likes and dislikes respected. The admission procedures ensure residents are assessed prior to an admission being agreed, and have been assured that their needs can be met by the home. Meal arrangements are good ensuring a variety of well-presented meals eaten in a relaxed and informal atmosphere. Resident’s comments regarding the food Crescent House DS0000014193.V339020.R01.S.doc Version 5.2 Page 6 include: “best bit about the home is the meals”; “very good if you don’t like something will offer you an alternative” and “very nice indeed”. Residents live in a clean environment with their private accommodation personalised to suit their taste. What has improved since the last inspection? 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 House DS0000014193.V339020.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 Crescent House DS0000014193.V339020.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 4 5 and 6 People who use the service experience good, quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides both prospective and existing residents, with a good level of information about what services are provided and what to expect when living at the home. The home is able to identify and meet the needs of the residents. The admission procedures ensure residents are assessed prior to an admission being agreed, and have been assured that their needs can be met by the home. EVIDENCE: There is a range of well-documented information about the home and the services it provides, this includes a statement of purpose and service user guide which are displayed at the home and made available to prospective residents, representatives and other interested parties. In addition there is a Crescent House DS0000014193.V339020.R01.S.doc Version 5.2 Page 9 useful booklet on the most frequently asked questions about the home. A resident who has recently moved to the home confirmed that they were encouraged to read this information to help them make an informed decision about whether to move to the home or not. Residents are provided with a written contract of terms and conditions of residency with the home. This can be used with residents and their families to make explicit the placement arrangements and clarify mutual expectations around rights and responsibilities. A signed copy of the contract is retained in resident’s files. The home ensures that prospective residents are accommodated only following an assessment of their needs by the home and the placing authority. Advice is sought during the assessment process from health care professionals and others who know and understand the needs of the prospective resident. The head of care who undertakes most assessments is clear on the level of needs that the home is able to meet and is prompt to seek advise when needs go beyond that which the home can meet safely. All but one resident are currently assessed as having low level needs. Amongst this there is a wide variation of the types of residents needs. This includes residents who are assessed as having a learning disabilities and residents who have mental health needs. There is evidence that the home is meeting most needs of residents with residents speaking positively about their experiences at the home. A sample of their comments include: “I like living here”; “The home have been fantastic very caring attitude”; “settled in very well” and “not a bad home”. Residents and their representatives consulted with spoke of being provided with the opportunity to visit the home in advance to assess the quality, facilities and suitability of the home. Most residents consulted said that it was their families that looked around the home on their behalf. Intermediate care is not offered at the home therefore this standard is not. Crescent House DS0000014193.V339020.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 and 10 People who use the service experience Good, quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The arrangement for planning care are generally good ensuring that the health, personal and social care needs of residents are identified and the appropriate guidance is provided for staff on how to meet residents needs. Procedures and practices administration of medicines. in the home generally promote the safe Personal support is offered in ways, which promotes and protect resident’s privacy and dignity. EVIDENCE: Comprehensive information is gathered about each resident and compiled into several documents. These include needs assessments, basic information, daily notes and a plan of care. Due to the amount of information obtained the head of care provides concise care plans that are used by the care staff. Care staff Crescent House DS0000014193.V339020.R01.S.doc Version 5.2 Page 11 were knowledgeable on the individual needs of residents. A resident spoke of being involved in the development of their care plan and had signed it. The risks faced and posed by residents are assessed, recorded and any actions identified in order to reduce or manage the risk are included in residents care plans. An example was noted whereby important information recorded by night staff had not been passed onto the day staff. It was identified that the handover arrangements between shifts did not enable time for an exchange of information. The head of care said they would immediately introduce a system for a signed handover to ensure that essential information is not lost in the future. Records of medical intervention showed that the home works closely with health care professionals including GP’s, District and specialist nurses, chiropodists, to ensure residents receive a range of health care intervention. Residents consulted said that when they have asked to see a Doctor then this has been sought promptly. A resident spoke of the thoughtfulness of staff when they were taken ill during the night and a staff member stayed with them until they fell back to sleep. A health care professional who regularly visits the home said “the staff are very quick to call if they have any concerns”. The system for the administration of medication is generally good with clear and comprehensive arrangement being in place to ensure resident’s medication needs are met. Good practices were noted on the individual instructions provided for staff on the administration of “As required” medication. These made clear the individual requirements for when these medicines should be administered. However, the way in which medication is recorded when it enters the home did not make it easy to audit some medication and as a result it could not be clarified whether there was a medication discrepancy or a recording discrepancy. The deputy manager agreed to look into this issue as a matter of priority. Staff were seen to be respectful and considerate towards residents and visitors. A staff member spoke knowledgeable about good practices in preserving resident’s privacy and dignity when they are undertaking care. Staff were observed knocking on doors before entering and referred to residents by there preferred forms of address. Crescent House DS0000014193.V339020.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 14 and 15 People who use the service experience good, quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are helped to exercise choice and control over their lives with flexible routines being an integral part of daily practice at the home. Meal arrangements are good ensuring a variety of well-presented meals eaten in a relaxed and informal atmosphere. Resident’s lives could be further enhanced by increased opportunities for occupation and for outings and trips outside of the home. EVIDENCE: There is evidence that residents are treated as individuals. Observation of the daily routines and discussion with residents continue to confirm that staff accommodate resident’s personal wishes with regard to meal times, going to bed, rising and bathing. During the inspection residents were observed to move around the home choosing which room to be in and what level of company they wanted to enjoy A resident said that residents have the opportunity of attending a local day centre up to three times a week. One resident attends regularly with several Crescent House DS0000014193.V339020.R01.S.doc Version 5.2 Page 13 others having tried sessions and decided that they did not wish to attend any further. An activities board showed the organised activities planned to be undertaken each week. This ranged from nail pampering to card making with the latter proving very popular with residents. There are several small animals at the home, which residents were clearly enjoying caring for. Staff and residents continue to confirm that staffing levels enable individual time to be spent with residents. A staff member said “that during the afternoon shift you usually have time to sit and chat with residents”. Feedback was received from residents and relatives that there was limited opportunity to go out other than with family. A resident said “staff don’t take you out I would love to go for short walks”. It is recommended that residents be provided with the opportunity, where possible, to go out on outings or trips in order to enhance there lives further. In response to the inspector’s question, if there was anything the home could improve upon the majority of residents consulted with and a relative felt that the number of organised activities could be improved. The head of care had identified as part of the homes own quality assessment the need to expand the opportunities for occupation and stimulation for residents and therefore it has not been required that this area be improved instead it is agreed that the manager monitor the improvements in this area. Visitors commented upon how welcomed they are made to feel during their stay, this included being offered beverages or meals. A resident commented: “all of my visitors have said how friendly the staff are”. A relative said: “I can just turn up at any time offered refreshments or can make yourself one at any time”. Residents consulted with all felt that the home continues to provide good meals and that they are offered an alternative meal if they don’t like what is on the menu. The inspector had lunch with residents and the meal at inspection was presented well with resident’s individual preferences observed. The mealtime was relaxed with staff providing discrete assistance. The majority of residents eat their meals in a pleasantly decorated dining room. A sample of residents comments regarding the food include: “best bit about the home is the meals”; “very good if you don’t like something will offer you an alternative” and “very nice indeed”. A relative commented: “there is no fruit and the cooking is not professional but my mum is not unhappy with it” Crescent House DS0000014193.V339020.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 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has a complaints system in place with evidence that residents feel that their views are listened to and acted upon. Staff have the guidance necessary to show them what to do if abuse is suspected. EVIDENCE: There is a clear and accessible complaints procedure for residents, their representatives, and staff to follow should they be unhappy with any aspect of the service. Residents and relatives consulted with said that they felt able to share any concerns they had with staff. A relative said that where they have raised a minor issue in the past this was dealt with promptly and efficiently. The home has made several safeguarding adults referrals over the last twelve months, which have been investigated by socials services. The outcome of these investigations has resulted in the home taking disciplinary action against two members of staff. Recommendations made by social services following their investigation have been addressed by the home. There are written policies covering safeguarding adults and whistle blowing. These make clear the vulnerability of people in residential care, and the duty of staff to report any concerns they may have to a responsible authority for investigation. Staff consulted with confirmed that they had attended training in Crescent House DS0000014193.V339020.R01.S.doc Version 5.2 Page 15 the protection of vulnerable adults and demonstrated that they understood their roles and responsibilities in this area. Crescent House DS0000014193.V339020.R01.S.doc Version 5.2 Page 16 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 20 21 22 24 25 and 26 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Resident live in a clean environment with their private accommodation personalised to suit their taste, however standards of décor are variable and needs to be addressed in order to provide a comfortable and pleasant environment throughout. EVIDENCE: The home is a converted detached domestic dwelling situated on a main road on the outskirts of Hove. The home continues to undergo a gradual upgrade and refurbishment and where redecoration has been undertaken this has been completed to a good standard. Despite this refurbishment the home still needs considerable investment to improve the overall facilities. This includes the redecoration of remaining bedrooms, replacement carpets and upgrade of the Crescent House DS0000014193.V339020.R01.S.doc Version 5.2 Page 17 call system. In addition the manager spoke of applying for local grants to improve the driveway, bathing facilities and carpeting. Communal space consists of a dinning room, lounge, conservatory and a newly established smoking area. These are decorated to a good standard with furnishings that are domestic in character. There is also a rear secure garden, which is well maintained and popular with residents during clement weather. All bedrooms seen had been individualized with personal belongings and in some cases items of small furniture. Eleven bedrooms are below the recommended 10sq meters. However, all residents consulted with said that they liked their bedroom with one resident saying “bedroom a bit small but it is ok” There are an adequate number of toilets located around the home including six bedrooms, which have en-suite facilities. There are currently two assisted baths on the ground floor and a standard bath on the first floor. It has been required for some time that suitable bathing facilities are provided on the first floor as historically all residents could only use the ground floor assisted baths. As a result the bath on the first floor was slightly raised to enable ease of access to residents. The manager spoke of the difficulties in obtaining the funding in order to convert this area into a shower. The head of care reported that currently several of the residents residing on this floor use this bathroom therefore it was agreed that this bath provided suitable bathing facilities at this time. However should this situation change the home would need to ensure that there are suitable bathing facilities throughout the home. Although there is a call system throughout the home, which in some cases is a doorbell type mechanism attached to a wall, it is not accessible to all residents. This system is gradually being updated room by room over the last eighteen months. In the interim the head of care continues to assess residents for the suitability of the current call system in their bedroom and will manage the phased installation according to priority. A resident spoke of being unwell and said: “had to ring the bell constantly for help and the staff were so kind” Areas of the home inspected were observed to be clean with a good standard of hygiene maintained with all persons consulted saying that the standard of cleanliness is good, a relative commented that the home was “always clean”. Crescent House DS0000014193.V339020.R01.S.doc Version 5.2 Page 18 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 and 30 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The staff group includes a stable core group who have worked at the home for many years, who know them and who are suitable recruited, trained and employed in sufficient numbers as is necessary to meet their needs. EVIDENCE: Both staff and residents felt that there was sufficient numbers of staff on duty for staff to undertake their roles in a timely manner and for residents to receive the support they needed, when they wanted it. In addition to care staff during the morning there is a medication co-ordinator, a manager and the head of care. Staffing levels at night have recently been increased to ensure the adequate protection of staff and residents during this period. There is a core group of staff who have worked at the home for a number of years and who have considerable experience with working within a care setting. There has been some turnover of staff in the last twelve months along with several staffing issues, which have lead to disciplinarians, dismissals and redeployment. It was reported that due to continuing difficulties in staff recruitment and retention the home uses a number of agency staff to cover shifts each week. Where possible the same agency staff are used to try and ensure consistency. Notwithstanding this several residents commented that Crescent House DS0000014193.V339020.R01.S.doc Version 5.2 Page 19 there had been a lot of new faces recently and how this can be quite unsettling. The head of care reported that in order to try and address some of the recruitment difficulties a different method of job advertising is now being used along with changes to the way that police checks are carried out on prospective employees, to try and speed up the process. Staff consulted with were knowledgeable about residents individual assessed needs and interactions between staff and residents, observed during the inspection, were courteous and respectful. This was confirmed by a health care professional who said: “Staff all seem to know what is going on with each resident”. A sample of residents comments made regarding staff include: “staff very nice”; “good laugh”; “You could not get any better staff”; “excellent” and “pretty good”. A relative said “very friendly with clients”. The home has been proactive in ensuring that over half of the staff have completed National Vocational Qualifications (NVQ ) in Care. The personal files of a newly appointed staff were inspected and this showed that a recruitment process is followed which includes the use of an application form, interviews, CRB checks and written references prior to employment commencing. Staff consulted with said that they had undertaken all of the compulsory training such as moving and handling, safeguarding adults, first Aid, medication, food hygiene and Fire safety in order to work safely with residents. In addition some specialist training in risk assessment and supervision has been undertaken by some staff. Crescent House DS0000014193.V339020.R01.S.doc Version 5.2 Page 20 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 32 33 35 36 and 38 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The homes management structure is complex and well established but needs to ensure that there is a continuity of standards to ensure that residents receive a consistent service. The health, safety and welfare of residents and staff are promoted and protected. EVIDENCE: The registered manager reported that they are completing a management course. The management structure of the home is that key management tasks Crescent House DS0000014193.V339020.R01.S.doc Version 5.2 Page 21 are delegated amongst the management team, which is made up of the, manager, deputy, head of care and medication co-ordinator. The registered manager remains aware that they are however overall responsible and accountable for the day to day running of the home. The delegation of the main managerial tasks often meant that the manager was not always fully conversant with particular aspects of the service. For example care planning and medication. This can become an issue when the management member responsible for an area is not around and continuity needs to be maintained. Of concern was that only one person out of the residents, relatives and health care professional consulted with knew who the manager was instead sighted other members of the management team as the manager and the person in overall charge. A resident said that the home often lacks direction and is largely run by other members of the management team. Comments made about the manager once informed who the manager was includes: “jenny very good when around asks what the dinner is like”: “in and out a lot” and “excellent could not be better”. The manager often spoke of their frustrations in not being able to make decisions involving finances/expenditure as this has to be decided collectively by the committee. This can often take some time with several written quotes for works having to be obtained before any decision can be made. It was discussed that this process clearly affects their ability to fulfil their roles and responsibilities as the registered manager and an issue that has been raised with the responsible individual in the past. In order for the manager to keep updated on changes in legalisation, good practice guidelines and to be able to communicate effectively outside agencies it was suggested that the home have access to a compute and internet. It was reported that the responsible individual for the service delegates their responsible to visit the home at least monthly and to produce a report on the standards at the home. The head of care reported that their representative last visited three months prior to the inspection but a copy of their report could not be located. It is of concern that the responsible individual does not ensure an effective system for the monitoring of standards within the home. This is an area that has been raised during previous inspections. There are several mechanisms in place for the home to obtain feedback on the quality of the services provided and whether it is achieving its aims and objectives. This includes the use of feedback questionnaires on the quality of the facilities and services being offered. In addition the inspector observed the manager and staff asking for feedback on the meal served. A resident said “they seem very keen to find out if everything is ok and are forever asking if there is anything they can do to improve”. The head of care reported that they Crescent House DS0000014193.V339020.R01.S.doc Version 5.2 Page 22 intend to expand the questionnaires to obtain feedback from stakeholders involved in residents care for example relatives and health care professionals. Residents are encouraged to retain control of their own finances for as long as they are able to do so and if unable then this responsibility is taken on by a relative or the homes accountant. The manager reported that where monies are held at the home for individual residents a clear audit trail is maintained. In order to address the concerns previously raised by the Commission for Social Care Inspection and Brighton and Hove Older people Assessment unit, a member of the management team is now rostered to be on duty during the afternoon and weekend. This has enabled staff during the afternoons and evenings to be directly supervised by management. The manager continues to report that this arrangement has lead to improved care standards and meals during the afternoon. In order to monitor standards at night, it has previously been discussed with the manager the need to provide appropriate checks and supervision of night staff. The manager reported that they can now gain access to the building at night and is undertaking spot checks. The head of care reported that systems were in place to support fire safety, which included: regular fire alarms and emergency lighting checks, staff training and maintenance of fire equipment and fire drills. Maintenance staff reported that a fire risk assessment has been undertaken within the last twelve months, which records the actions to be taken to ensure adequate fire safety precautions in the home. Crescent House DS0000014193.V339020.R01.S.doc Version 5.2 Page 23 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 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 3 3 2 x 3 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 2 3 3 x 3 Crescent House DS0000014193.V339020.R01.S.doc Version 5.2 Page 24 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 Standard OP19 Regulation 23(2)(b) & 23(2)(d) Requirement Timescale for action 30/08/07 2 OP31 10(1) That all parts of the home are kept in a good state of repair and are reasonable decorated to ensure that residents live in a safe and comfortable environment That the registered provider and 30/08/07 the registered manager shall having regard to the size of the home, the statement of purpose, and the number and needs of service users carry on or manage the care home with sufficient care, competence and skill. 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 OP12 Good Practice Recommendations That service users have the opportunity of going out of the home on outings or trips of their choice in order to enhance their lives. DS0000014193.V339020.R01.S.doc Version 5.2 Page 25 Crescent House Crescent House DS0000014193.V339020.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. Extracts may not be used or reproduced without the express permission of CSCI Crescent House DS0000014193.V339020.R01.S.doc Version 5.2 Page 27 - 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!