CARE HOME ADULTS 18-65
Crescent Nursing Home 12 The Crescent Bedford Bedfordshire MK40 2RU Lead Inspector
Katrina Derbyshire Unannounced Inspection 13th November 2006 13:30 Crescent Nursing Home DS0000017671.V318790.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Crescent Nursing Home DS0000017671.V318790.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Crescent Nursing Home DS0000017671.V318790.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Crescent Nursing Home Address 12 The Crescent Bedford Bedfordshire MK40 2RU 01234 266933 01234 327993 admin@apexcare.co.uk 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) Apex Care Homes Limited Mr Remigius Mukasa Wamala Care Home 28 Category(ies) of Dementia (5), Learning disability (5), Mental registration, with number disorder, excluding learning disability or of places dementia (28) Crescent Nursing Home DS0000017671.V318790.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Service users admitted to the home must be between the ages of 35 and 64. A maximum number of 10 beds may be used to accommodate existing service users in the category of MD(E) or DE(E). 3rd November 2005 13th July 2006 (Random inspection) Date of last inspection Brief Description of the Service: The Crescent nursing home is within two Victorian houses, which have been converted and extended to accommodate up to 28 people with mental health problems. The residents currently assessed to enter the home are under 65 years of age. There are 26 single bedrooms and one double bedroom, with four rooms that have en-suite facilities. The home has various lounges, dining areas and dedicated smoking areas to meet the needs of the residents. Attached to the home via a covered walkway is a day centre for the homes residents. There are attractive gardens to the rear of the building alongside parking areas. The gardens are made secure by locked gates. The fees for this home vary from £650.00 per week, to £750.00 per week, depending on the funding source and assessed need of the resident. Crescent Nursing Home DS0000017671.V318790.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The purpose of this visit was to undertake a key inspection. This unannounced visit was carried out on 13th November 2006. The Registered Manager Remigius Wamala was present throughout the inspection. During the inspection all areas of the home were visited and the inspector spent time with many of the residents’ in the main sitting area of the home. The care of three residents’ was examined by looking at their records and interviewing the residents’ and staff who look after them. The views of residents were also received and their feedback has been used alongside information from the home through a pre inspection questionnaire to assess the outcomes within each standard. Evidence used and judgements made within the main body of the report include information from this visit and information received by the Commission for Social Care Inspection since the homes last inspection. Observations of care practice and communication between the residents’ and staff was also made at the inspection. The focus of this inspection was to look at the key standards and to follow up on previous requirements. What the service does well:
The home is excellent at seeking the views of the residents on how they feel the home is run, and then acting on their feedback. They send out questionnaires to everyone living at the home, the format of these questionnaires uses both words and pictures to make sure all residents can respond. Feedback is then sought on all areas of living in the home, for example the standard of accommodation and food. The home then looks at resident’s feedback and takes action when someone is not happy with something in the home. An example of this was when a resident had said that they felt their cultural needs were not met. A care plan for this was written and showed that the home had consulted with the resident, found out what they wanted and then made arrangements for them to attended a religious service of their choice on a weekly basis. Residents feel that the food at the home is also of a good standard. Menus have recently changed, so the choices available to residents at mealtimes have increased. Fresh fruit platters have been introduced alongside an increase in the amount of fresh vegetables, so a healthier option is available for residents. One resident said, “the food is lovely, well l always clear my plate”. The home have been making changes to the environment, changing the type of flooring, buying new furniture and adding more pictures, ornaments and
Crescent Nursing Home DS0000017671.V318790.R01.S.doc Version 5.2 Page 6 flowers. This means that the residents benefit from having a more homely atmosphere. Several residents commented on the redecoration of the main sitting area and dining area, all felt that the changes were positive and had made these areas brighter and nicer to sit in. What has improved since the last inspection? What they could do better:
The home still needs to make sure that the documents known as care plans are consistent in the way that they are written. This is needed to make sure all residents receive the care that they need. Some of the care plans contain all the information that would be needed by staff to know how they should care for, and support the resident. However one resident’s care plans did not provide up-to-date information. Their needs had changed from when the plan had been originally written, but no changes had been made for example the resident used to like having showers but they now prefer to take baths. This needs to happen so all staff know how to meet the individual needs of all the residents. Management at the home also need to make arrangements with the people who are the nominated appointee’s for residents. Many of the resident’s living at this home have their personal money managed on their behalf, by the people who are known as the commissioners of their care. If they need small amounts of money to purchase items such as cigarettes or newspapers for example, the home makes a request for a small amount, which is then kept in an individual savings account. However with the current arrangements, residents do not know how much money they have in total. This is important as they have a right to this information concerning their personal financial circumstances. Crescent Nursing Home DS0000017671.V318790.R01.S.doc Version 5.2 Page 7 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 Nursing Home DS0000017671.V318790.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Crescent Nursing Home DS0000017671.V318790.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1&2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems in place to assess the needs of prospective residents are good, ensuring the home has sufficient information to ascertain that they are able to meet the resident’s needs. EVIDENCE: A copy of the homes statement of purpose was seen within the individual care records of the resident’s. The document described in detail the range of needs that the home intended to meet, how residents’ could participate in the running of the home and how residents’ should be involved in their own care planning. The use of pictures and words were used to help all residents understand its content. Evidence was seen within the care records that pre-admission assessments had been undertaken. Combined assessments by the home and placing authority were seen, these were comprehensive and made clear the needs that the home would need to meet. Social and cultural needs had been assessed alongside the physical and social needs of the resident. The care plans in place were directly linked to the assessment of needs. Crescent Nursing Home DS0000017671.V318790.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Opportunities for residents to make decisions about their lives are good and make residents feel in control of their own lives. EVIDENCE: Care plans were seen to be in place for all assessed needs. Most of the care plans viewed contained the signatures of resident’s and through discussion with one resident it was confirmed that they were involved in the development of their own plans. For one resident their care plans were comprehensive and gave clear guidance and instructions to staff on how to meet their needs. However another resident’s plans had not been updated where their preferences had changed. This resident’s plan originally written two years ago informed staff that the resident preferred showers, however they now wanted baths. Crescent Nursing Home DS0000017671.V318790.R01.S.doc Version 5.2 Page 11 Records seen contained evidence of the resident’s involvement in decisionmaking. Also Peer support was available to residents from the local centres and support groups they attended, information in relation to this was within the individual files and it was confirmed through discussion with two residents’. Staff advised that resident’s are able to choose what time they rise and retire. Care records seen also indicated that residents are involved in selecting their clothing, and some residents visit local shopping centres to purchase their clothes. Observations during this visit showed several instances when residents were offered choices and the carers respected these decisions. Examples included, leaving the home alone to visit the local shops, receiving a visitor and one resident deciding that they wanted to go and have a rest on their bed in the afternoon. Through examination of care records documents that described varying activities undertaken by residents were seen. The activity had been described and it gave clear guidance on the required support needed for each person, so that any risk associated with that activity would be reduced. Examples of activities included leaving the home alone and smoking. Risk assessments were also in place on all files tracked relating to moving and the physical support required by the residents. Many of the resident’s living at the home have their personal money managed on their behalf by the commissioners of their care. Management of monies held by the home were noted to be satisfactory with a balance sheet maintained for each resident and receipts of all expenditure incurred. However with the current arrangements, residents do not know how much money they have in total. Arrangements should be made by the home to seek this information on behalf of the residents. Crescent Nursing Home DS0000017671.V318790.R01.S.doc Version 5.2 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements for activities for residents are good and provide a varied social life for the residents. EVIDENCE: Within the care records of residents, entries were seen to show that residents participated in a variety of activities and occupation. Residents attended varying day care services where they were able to participate in a curriculum of activity and development. In addition it was noted that one resident had also attended a local drama therapy group to assist in increasing their assertiveness. Staff confirmed that residents supported by themselves attended events within the local community. Residents had a good knowledge of the local area and all facilities available to them.
Crescent Nursing Home DS0000017671.V318790.R01.S.doc Version 5.2 Page 13 A choice of meals is available and menus are displayed in the home, a brief observation of the teatime meal, showed it to be unrushed and enjoyed by the resident’s. Recent changes to the menu show that a healthier alternative is now available to residents with an increase in fresh fruit and vegetables. Nutritional risk assessments were also seen within the care records of residents. All residents spoken with gave compliments regarding the food at the home and they reported an improvement in the standard of cooking following a recent appointment of a new cook. The homes day centre has a planned programme of activities for residents to participate in if they so wish, it was noted that activities available are advertised so that residents could choose to participate. Information provided by the home show that activities provided include, baking, watching films, shopping, 10-pin bowling and arts and crafts. Crescent Nursing Home DS0000017671.V318790.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management of medication ordering, storage and administration is good so residents receive prescribed medication in a timely manner by trained staff using current guidance in best practice. EVIDENCE: Qualified nurses are responsible for the administration of medication in the home; staff confirmed that they had also undertaken further training in this area. The systems for the ordering of medication showed that the home maintained clear records to ensure that the medicines ordered were received from the pharmacist. Medication administration sheets contained the balance of stock and contained staff signatures to show when medication had been given. The amount of stock kept at the home was at acceptable levels. Management in the home undertakes regular audits and records of these are maintained. A collection service with sealed dispensing is used for the removal of unused medicines. Crescent Nursing Home DS0000017671.V318790.R01.S.doc Version 5.2 Page 15 Observations of the personal support to residents by staff were noted to be sensitive and respectful, the guidance and transfer of a resident seen was explained fully to the resident. Through observation and confirmation by the residents it was confirmed that clothes, hairstyle and makeup reflected their individual personalities. Guidance and support regarding personal hygiene was offered and the level offered by staff was reflected in the care plans examined on this inspection. All residents were registered with a General Practitioner and any needed referral to access other healthcare services would be made through the General Practitioner. This would be following their assessment and subsequent referral. Documentation of this was seen within the care records of residents. Crescent Nursing Home DS0000017671.V318790.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home continues to have a satisfactory complaints system where resident’s feel that their views are listened to and acted upon. EVIDENCE: Within the individual care records of the resident’s a copy of how the resident could complain was seen, this practice was also noted to have been in place at previous inspections. The homes complaints procedure is comprehensive and included to whom the resident could speak to and this included details of how to contact the Commission for Social Care Inspection, and in addition how long the resident would have to wait before a response. Residents feedback through the comment cards sent to the Commission for Social Care Inspection detailed that they were aware of the how they can complain and feel comfortable doing so. The homes protection of vulnerable adults policy alongside local guidance was noted to remain in place, this as previously assessed gives sufficient guidance in this topic. Both give clear guidance on how to report a suspicion of alleged abuse and give details on the types of abuse, including physical, emotional and financial. Training records provided by the home show that staff had attended training workshops on protecting vulnerable adults. On interviewing a staff member, they were able to demonstrate that they knew how to report a suspicion of abuse and confirmed that they had been trained in this area.
Crescent Nursing Home DS0000017671.V318790.R01.S.doc Version 5.2 Page 17 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Recent replacement of furnishings and flooring provides residents with a bright homely atmosphere in the communal areas of the home. EVIDENCE: The home is indistinguishable from other homes in the area and accommodation to residents is provided over two floors. Furnishings and fittings were noted to be domestic and a programme of replacement of the soft furnishings in the lounge area had commenced. In addition wood flooring has been fitted in the main lounge and dining area of the home. Further changes since the last inspection include new pictures and floral arrangements, assisting in creating a more homely environment. All residents spoken with spoke highly of these recent changes and felt that they had improved the home.
Crescent Nursing Home DS0000017671.V318790.R01.S.doc Version 5.2 Page 18 The home was clean and tidy throughout and residents rooms contained personal items, which reflected their individual personalities. Crescent Nursing Home DS0000017671.V318790.R01.S.doc Version 5.2 Page 19 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 & 35. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The approach and organisation of staff training in the home is good so residents are cared for by competent and knowledgeable staff. EVIDENCE: Training of staff is organised through the head office of the home in consultation with the manager. All statutory training and additional training is detailed on individual records and then entries are made to show if the staff member has undertaken this, and the date that they did so. Staff spoke of the training available to them. Training undertaken by staff included fire safety training, understanding mental health, and assessment of need and Protection of Vulnerable Adults. Information through discussions with residents indicated that they felt well cared for, that staff treated them well, respected their privacy and that they felt safe at the home.
Crescent Nursing Home DS0000017671.V318790.R01.S.doc Version 5.2 Page 20 The homes staff team had clearly defined roles and the observations on the day of inspection demonstrated staff were clear in their roles and were able to advise and explain their post and associated responsibilities. Examples were when a resident makes a complaint, staff were aware that they would need to seek guidance from senior staff at the home in certain instances, to provide the best outcome for the resident. Staff rotas show that there is a time period of one and a half hours a day when there is only one member of staff on duty. Although an on call system is in place where someone can be called in, this area needs to be reviewed. Care records contained entries that showed several residents living at the home can present with Crescent Nursing Home DS0000017671.V318790.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The systems in place for resident consultation are excellent, as they act upon the resident’s views. EVIDENCE: Both staff and residents reported how they felt supported by the manager at the home. Staff said that they found the manager to be both organised and approachable. Residents said that the manager was nice and their comments suggested that they felt confident in his abilities. Clear management systems are in place with clear reporting lines and accountabilities, this results in an organised home. Crescent Nursing Home DS0000017671.V318790.R01.S.doc Version 5.2 Page 22 The health and safety policies in the home are detailed and gave clear guidance to staff on how they should manage this area. Staff had all received training in a variety of Health and Safety subjects and these included food hygiene, moving and handling and infection control. Certificates or copies of certificates of attendance are maintained within the training files at the home. Residents and their representatives had been asked their opinion on the services offered by the home as part of the quality assurance system. The results and how the home acted upon the views of the residents were available for inspection. Alongside the analysis of the survey results, the home had responded individually to residents. Care plans of the action needed in response to the resident’s views were seen, alongside the entries to show the action taken by the home to make changes and improve the outcomes for that resident. Crescent Nursing Home DS0000017671.V318790.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 Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 4 X X 3 X Crescent Nursing Home DS0000017671.V318790.R01.S.doc Version 5.2 Page 24 Yes 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. 1. Standard YA6 Regulation 12(1)(a) & 15(1) Requirement Care plans and care documentation must be accurate and clear in their guidance to staff on the care and support needed by all residents. (Previous requirement, timescale of 30/09/06 not met) Timescale for action 31/12/06 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 YA7 Good Practice Recommendations The home should make arrangements for the residents to gain access to the balances of their money, managed on behalf by their nominated appointees. Crescent Nursing Home DS0000017671.V318790.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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