CARE HOME ADULTS 18-65
Crescent Nursing Home 12 The Crescent Bedford Bedfordshire MK40 2RU Lead Inspector
Katrina Derbyshire Unannounced Inspection 3rd November 2005 12:20 Crescent Nursing Home DS0000017671.V263955.R01.S.doc Version 5.0 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.V263955.R01.S.doc Version 5.0 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.V263955.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Crescent Nursing Home Address 12 The Crescent Bedford Bedfordshire MK40 2RU 01234 266933 01234 342557 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 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.V263955.R01.S.doc Version 5.0 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). 22nd June 2005 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. Crescent Nursing Home DS0000017671.V263955.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out on 3rd November 2005. The Acting Manager, Mr Wammala was present throughout. During the inspection several areas of the home were visited and the inspector spent time with many of the residents in lounge area, day centre and their own individual rooms. The care of three residents was examined in depth by looking at their records and interviewing the residents and staff who look after them. What the service does well: What has improved since the last inspection?
The home has replaced the corridor and stair carpet at the front of the home since the last inspection, as the old one was very worn and did not smell very nice. The new carpet means that this area of the home looks a lot better and it has improved the overall décor in this area. They have also decorated other areas in the home and have recently redecorated the large lounge; this is now a lot brighter and nicer for the residents to sit in. The manager at the home has also been checking the kitchen to make sure that all the food is checked and when passed its use by date it is thrown away. He records all his checks to the kitchen and this is very good because the catering staff then know exactly what they have to do to make things better for the residents. Crescent Nursing Home DS0000017671.V263955.R01.S.doc Version 5.0 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. Crescent Nursing Home DS0000017671.V263955.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Crescent Nursing Home DS0000017671.V263955.R01.S.doc Version 5.0 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 the following standard(s): EVIDENCE: These standards were not assessed. Crescent Nursing Home DS0000017671.V263955.R01.S.doc Version 5.0 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 & 10 The storage of confidential information is good so the privacy and confidentiality of the residents is maintained. EVIDENCE: Written information on all residents was noted to be kept in locked areas throughout the home. Care plans and individual records were stored within the office areas and it was observed that access was restricted to these rooms. Staff during their induction had been informed of the importance of confidentiality and one staff member was able to explain fully the obligations that the home has for maintaining the privacy of all residents. Residents spoke of the choices available to them whilst living at the home. One resident said “ l go out when l want to, they don’t restrict me the only thing l have to do is let them know when l am going out, so they know l am safe”. Other choices available to residents were choice of meals, clothing and social activities, written evidence of these were seen in the care records.
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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 the following standard(s): 12, 15, 16 & 17 Activities within the home are good and provide residents with an opportunity to receive a varied and supportive social life. EVIDENCE: 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; Arts and crafts alongside word games are available for example. One resident said, “We have sky television, that means l can watch my cricket”. Within the individual care records residents had a plan or information on resident’s families or friends. It was noted that these plans did not contain sufficient information or guidance to staff on what and how they should support the resident in maintaining contact with their family. One example was that an entry had been made that said ‘ encourage family members to visit, there was no information on how staff should do this or who the family members were. Crescent Nursing Home DS0000017671.V263955.R01.S.doc Version 5.0 Page 11 Residents spoken to were all clear on their own individual rights and the responsibilities that they had when living in the home. One resident said “ l know what l am entitled to, when l moved in here l was told and l know the home has a contract with me”. It was noted that the presentation of liquidised meals was not appropriate. The meat, potatoes and vegetables were all mixed together this did not look very nice and the resident was not able to distinguish what they were eating. Food that is liquidised needs to be done separately so that that the meal is set out in the same way as those meals that have not been blended. Crescent Nursing Home DS0000017671.V263955.R01.S.doc Version 5.0 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20 The homes system for recording the receipt of medication is not adequate to ensure checks can be made to see if residents have received all their prescribed medication. EVIDENCE: The storage, receipt and administration of medication was examined. The majority of medication and medication administration sheets were noted to be correct and the home used a monitored dosage system, however one resident who had recently been on a course of anti biotic had not received the amount of doses that they had been prescribed. In addition when new monthly supplies were delivered to the home that could not be administered through the monitored dosage system there was no system for adding this new amount to any remaining stocks; therefore it is not possible to carry out a full audit to show if the level of stock corresponded with the Medication sheets. The reasons for this were fully explained to the manager at the time of the inspection. Staff confirmed that they did receive regular updates in the administration of medicines and observations were made of medication and noted to be appropriate and follow safe practice guidelines. Crescent Nursing Home DS0000017671.V263955.R01.S.doc Version 5.0 Page 13 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 the following standard(s): 22 & 23 The home has 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 was a copy of how the resident could complain. 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 confirmed that they had been informed on how they could complain, all those spoken to stated that they would feel happy to complain if they felt a need. The home had a copy of the local protection of vulnerable adults policy alongside their own guidance in this topic. They both gave clear guidance on how to report a suspicion of alleged abuse and gave details on the types of abuse, these included physical, emotional and financial. Training records showed that all staff had attended training workshops on protecting vulnerable adults. In addition staff were able to describe accurately the steps that they would need to take if they ever suspected abuse of any resident. Crescent Nursing Home DS0000017671.V263955.R01.S.doc Version 5.0 Page 14 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 the following standard(s): EVIDENCE: These standards were not assessed, although previous requirements made at the last inspection to replace a carpet and undertake redecoration to a lounge were noted to have been carried out. Crescent Nursing Home DS0000017671.V263955.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33 & 35 The arrangements for the training of staff are good with the staff demonstrating a clear understanding of their roles. EVIDENCE: The homes induction of new staff was seen to follow national standards for care staff, new staff on their first day of employment were also now supernumerary to the rota, which allowed them to focus on orientating themselves to the home. Individual training records are maintained and entries also showed the duration of the course so that the home could monitor the amount of training undertaken to meet this standard. Training that staff had undertaken included mental health awareness, food hygiene and national vocational qualifications in care. Registered nurses were also supported in attending further training to maintain their learning. Staff also confirmed that they had received the training detailed within their records and certificates were also maintained. Staff when questioned were able to describe the individual needs of the residents, their descriptions matched the information contained within the care plans. Observations made of the interaction between the staff and residents showed that a supportive relationship was held between them. One resident said of the staff team “they know what they are doing and they always help me if l need it”.
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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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39 & 42 The home regularly reviews aspects of its performance through a good programme of self-review and consultations, which include seeking the views of resident’s. However the home needs to show how they act upon these views. EVIDENCE: The home has a system in which it seeks the views of the residents on a regular basis and uses questionnaires within this. Residents are asked their opinion on various aspects in the home including food, entertainment and the environment. However the home was not able to demonstrate how it had used this information to make changes in the home or to influence changes in the homes policies, the manager said that the home would now attempt to undertake this. Health and safety records were examined and were all seen to be up to date and in order, areas inspected included fire safety, lifting equipment and the storage of chemicals.
Crescent Nursing Home DS0000017671.V263955.R01.S.doc Version 5.0 Page 18 Crescent Nursing Home DS0000017671.V263955.R01.S.doc Version 5.0 Page 19 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 X X X X X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X 3 X X 3 Standard No 24 25 26 27 28 29 30
STAFFING Score X X X X X X X LIFESTYLES Standard No Score 11 X 12 3 13 X 14 X 15 2 16 3 17 Standard No 31 32 33 34 35 36 Score X X 3 X 3 X CONDUCT AND MANAGEMENT OF THE HOME 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Crescent Nursing Home Score X X 2 X Standard No 37 38 39 40 41 42 43 Score X X 2 X X 3 X DS0000017671.V263955.R01.S.doc Version 5.0 Page 20 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 YA15 Regulation 12(1)(a) 16(2)(m) 12(4)(a) 16(2)(i) 12(1)(a) 13(2) 12(1)(a) 13(2) 12(3) 24(3) Requirement Records must be clear on how staff are to support resident’s in maintaining contact with their families. The presentation of liquidised meals must be the same as all other meals. Records of all medication stored at the home must be sufficient to enable an audit to be undertaken. All medication must be administered as prescribed. The home must show how it uses the views and opinions of the resident to change and influence the running of the home. Timescale for action 15/01/06 2 3 YA17 YA20 15/01/06 15/01/06 4 5 YA20 YA39 15/01/06 31/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Crescent Nursing Home DS0000017671.V263955.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Bedfordshire & Luton Area Office 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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