CARE HOME ADULTS 18-65
The Crescent Nursing Home 12 The Crescent Bedford Beds MK40 2RU Lead Inspector
Katrina Derbyshire Unannounced 22 June 2005 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 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 Stationary 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. The Crescent Nursing Home I51 s17671 The Crescent v234669 220605 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service The Crescent Address 12 The Crescent Bedford MK40 2RU Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01234 266933 01234 342557 Apex Care Homes Ltd Vacant Care Home with Nursing 28 (5) (5) (28) Category(ies) of DE - Dementia registration, with number LD - Learning Disability of places MD - Mental Disorder The Crescent Nursing Home I51 s17671 The Crescent v234669 220605 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 22/02/05. 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. Attatched 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 Crescent Nursing Home I51 s17671 The Crescent v234669 220605 stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 22nd June 2005. A senior Nurse Ms. Angela Masih was present during most of the inspection. During the inspection many of the areas within the home were visited and the inspector spent time with many of the residents’ in the lounge area of the home and garden. The care of three residents’ was examined in depth by looking at their records and interviewing the residents’ and staff who look after them. Observations of care practice and communication between the residents’ was also made at the inspection. What the service does well: What has improved since the last inspection?
A new Acting Manager has started working at the home and he is making some changes. The way the home writes about the care given to residents has changed; these plans are trying to be clearer so the staff know exactly what the individual needs of each resident are. The staff have also now begun to have regular meetings with a senior member of staff, these meetings are called supervision; how the staff member works at the home and what they need to improve on is discussed during this time. This means that the standard of care will improve as staff have an opportunity to look at the way they care for residents, and receive advice and guidance on how to improve. The Crescent Nursing Home I51 s17671 The Crescent v234669 220605 stage 4.doc Version 1.30 Page 6 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 Crescent Nursing Home I51 s17671 The Crescent v234669 220605 stage 4.doc Version 1.30 Page 7 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 Standards Statutory Requirements Identified During the Inspection The Crescent Nursing Home I51 s17671 The Crescent v234669 220605 stage 4.doc Version 1.30 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2 & 4. Information available to new residents is of a good standard and is sufficient in its content for prospective residents to make an informed decision on whether to move into the home. EVIDENCE: The home had developed a document, which it had named a ‘welcome pack’. This pack contained the service users guide and statement of purpose and each resident had their own copy. The document described the home and the company that owned it in great detail, and was very clear in the services that the home could provide. Assessments undertaken within the home had improved in recent months and within the care files of residents recently admitted to the home these documents were in place; they were comprehensive and clear in showing the physical and social needs of the resident. One resident who had only lived at the home for a short time said, “ l was able to visit here before l said l was going to move in, that was important to me”. The home had a clear policy on how new admissions to the home should be managed and that residents should always have an opportunity to visit and stay prior to their decision to move in permanently. Staff through discussion confirmed that they were aware of these protocols and how they should support a resident at this very important time.
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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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6 & 9. Risks to residents are assessed and managed in a supportive way, which means residents remain safe but are able to maintain their independence. EVIDENCE: Care planning within the home has changed and on the day of this inspection both the Acting Manager and Deputy Manager were attending ‘care planning’ training. Each resident care file contained care plans; each assessed need had an associated plan of care. The plans that had been changed to the new and improved format were just sufficient to guide staff in showing them the care that needed to be offered. The home still needs to continue to make improvements for example providing more specific information on the exact care to be given to the resident. Risk assessments were also in place within the care records, they showed that consideration had been given to various areas of the resident’s lives; these included smoking, leaving the home independently and overall general health and safety. Residents confirmed that the only restrictions in place, e.g. only smoking in designated areas were always discussed with them and they understood the reasons for these restrictions.
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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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13 & 17. Some of the systems in place within the kitchen are not sufficient and put the residents at risk. EVIDENCE: Most of the residents spoke of the good standard and choice of food that they were offered in the home. However a random sample of food within the main kitchen was checked and one item from the fridge was found to be past its best before date. In addition various items of food had been opened and no date had been written on them to indicate when it had been opened or for how long it was safe to use. This is not safe practice and puts the residents at risk of becoming seriously ill. The remaining checks of the kitchen area were noted to be satisfactory. Residents spoke of their knowledge and use of the local community facilities. For those residents unable to access local facilities independently staff supported these. Local churches, pubs, parks and shops were used on a weekly basis. Other outings were also arranged and the home had recently visited a safari park.
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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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 & 19. The care and support given to residents by staff is supportive and results in them receiving care whilst maintaining their dignity. EVIDENCE: Staff were observed to interact with the residents in a very supportive way during the inspection. There was a good rapport between both the staff and residents as they were seen to engage in ‘easy banter’ throughout the day. Staff used the residents preferred choice of address at all times and approached each resident in a sensitive way when providing any personal care. Residents confirmed that they found the staff to be very supportive in meeting their personal care needs. Within the care records of each resident was correspondence from a variety of healthcare facilities, these included dentist, optician and community psychiatric nurses. These documents evidenced that residents had regular access to any healthcare that they required and if needed staff would assist the resident in attending any appointments. Also within the daily notes there was evidence that prompt referral was made to the appropriate specialist when potential complications were identified through daily monitoring. The Crescent Nursing Home I51 s17671 The Crescent v234669 220605 stage 4.doc Version 1.30 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: These standards will be assessed at the next inspection. The Crescent Nursing Home I51 s17671 The Crescent v234669 220605 stage 4.doc Version 1.30 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 28 & 30. Areas of carpeting in the home are of a poor quality due to staining and having a strong odour of urine; this is not a pleasant environment for the residents to live in. EVIDENCE: The front hall carpet and front stair carpet to the home was noted to be very stained and the odour of urine throughout this area was very strong. Although cleaning of this area had been undertaken this was not sufficient and the home must arrange for this carpet to be replaced. Resident’s bedrooms and other communal areas in the home were clean and free from odours. One of the lounge areas was in need of redecoration as the paintwork and general decor was worn and chipped. Other areas of the home had recently been redecorated and these sections were clean, bright and homely. The outdoor space has a very good amount of garden furniture and sun protection and residents spoke of its constant use by them especially to enjoy a barbecue. One resident said of the home ‘it is comfortable’.
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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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33 & 36. Staff at the home are committed and are clear about their responsibilities so residents receive a good standard of care from the staff team. EVIDENCE: Several staff were spoken to during the day and they all had an extensive knowledge of the residents within the home as they were able to describe all the information contained within the care records. All staff were aware of their responsibilities in the home and this included understanding their own limitations and knowing when and how to seek advice and assistance. One resident said “ they know me so well and always help when l need it”. However both staff and residents commented that when a new member of staff starts at the home and is included as a number straight away; this causes difficulties as they are unable to work immediately as they are still learning and residents don’t feel as if there are enough staff. The home needs to look at ways to change this, so continuity of care is maintained at all times. Staff files contained documentary evidence that supervision was being undertaken. Staff were interviewed and they confirmed that regular supervision sessions were now taking place where they could discuss their individual performance and focus on the standard of care in the home.
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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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 41. The homes policies and procedures are of a good standard and provide staff with clear guidance. EVIDENCE: A sample of the home policies and procedures were seen. Examples examined were for the recruitment of staff, whistleblowing, confidentiality and admission to the home; these were very comprehensive and up to date. Staff were able to describe accurately the protocols that should be followed in the above areas, which matched those within the policies. They also confirmed that the need to follow the homes policies and procedures had formed part of their induction, when they commenced employment at the home. The Crescent Nursing Home I51 s17671 The Crescent v234669 220605 stage 4.doc Version 1.30 Page 16 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 x 3 x Standard No 22 23
ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 x x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 x x x 2 x 2 Standard No 11 12 13 14 15 16 17 x x 3 x x x 1 Standard No 31 32 33 34 35 36 Score 3 x 2 x x 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
The Crescent Nursing Home Score 3 3 x x Standard No 37 38 39 40 41 42 43 Score x x x x 3 x x I51 s17671 The Crescent v234669 220605 stage 4.doc Version 1.30 Page 17 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA17 Regulation 12(1),13 (3) & 13(6) 12(1),13 (3) & 13(6) 23(1)(a) &23(2)(b) 16(2)(k) & (j) Requirement Systems must be in place to prevent the keeping of food beyond its best before date. Food items must be show the date that they were opened and need to be used by. Repair or redecoration to the main lounge must be undertaken The front entrance and stair carpet needs to be replaced Timescale for action 31/10/05 2. 3. 4. YA17 YA28 YA30 31/10/05 30/11/05 31/12/05 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 YA33 Good Practice Recommendations Staff should be supernumerary to the rota during their first days of induction. The Crescent Nursing Home I51 s17671 The Crescent v234669 220605 stage 4.doc Version 1.30 Page 18 Commission for Social Care Inspection Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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