Inspection on 14/04/05 for Cressage House

This inspection was carried out on 14th April 2005.

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

Cressage House 08/07/08

Cressage House 20/02/08

Cressage House 20/06/07

Cressage House 21/06/06

Cressage House 06/10/05

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

CARE HOME ADULTS 18-65 Cressage House 30 St Edwards Road Southsea Hampshire PO5 3DJ Lead Inspector Lorraine Parton Unannounced 14th April 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. Cressage House H55 HO3 S62441 Cressage House v217718 140405.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Cressage House Address 30 St Edwards Road Southsea PO5 3DJ 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) 02392 821486 Mrs Susan Ann Walker Mrs Ann Grace CRH Care Home 13 Category(ies) of Learning Disability (LD) 13 registration, with number Mental Disorder, excluding learning disability or of places dementia (MD) 13 Cressage House H55 HO3 S62441 Cressage House v217718 140405.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Two service users currently residing over the age of 65 may remain in the home Date of last inspection First inspection Brief Description of the Service: Cressage House is a small care home situated in a residential area of Southsea, Portsmouth. The home is registered for thirteen service users within the category of younger adults, however, the home also accommodates two service users within the older persons category as they have lived at the home for many years. The home is situated close to local ammenities and a short distance from the town of Portsmouth. The home has a minibus and as such service users are able to access venues afield. The home provides a range of accommodation in single and double bedrooms and on the ground floor is a lounge, dining room and a smokers room. The home also has a domestic kitchen and service users who are able can access the kitchen to prepare snacks and drinks as they choose. The home has a rear enclosed garden that is accessable through the home. Cressage House H55 HO3 S62441 Cressage House v217718 140405.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place over 6.25 hours and was the first inspection since registration. The inspection assessed 18 of the 43 standards only and the other standards will be assessed at the next inspection if necessary. The inspector was assisted by both the proprietor and the registered manager and throughout the inspection and the inspector had the opportunity to speak to service users, staff and one visitor to the home. The homes staff were found to be professional and helpful throughout the inspection. The inspection also involved a walk around the home and audit of some of the homes documentation relevant to the provision of care for the service users living at the home. The inspector received eight comment cards from service users, which were found to contain positive comments about living in the home. Service users confirmed that they were happy living at the home and many of the service users commented on how the home is improving and providing a service that is led by service users. What the service does well: What has improved since the last inspection? This was the first inspection undertaken since the registration of both the new proprietor and the manager and as such the inspector was unable to assess this part of the report. The new proprietor has undertaken some environmental work in decoration of the home and improvements in the kitchen since taking over has the proprietor. Cressage House H55 HO3 S62441 Cressage House v217718 140405.doc Version 1.40 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. Cressage House H55 HO3 S62441 Cressage House v217718 140405.doc Version 1.40 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 Cressage House H55 HO3 S62441 Cressage House v217718 140405.doc Version 1.40 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) 1,2,3,4,5 The home has not got an up to date service user guide that will enable prospective service users to understand the service they may expect. The home has not got a suitable assessment and visiting procedure for prospective service users who may wish to live at the home. All service user have a up to date contract but these were found in need of amending to take into account the rooms to be occupied. EVIDENCE: The inspector was able to see a copy of the home’s statement of purpose and service user guide, however, this was found to be out of date because it was for the previous proprietor of the home. Service users confirmed that they had been given a copy of the old one and these copies were found in service user files and bedrooms. The home has agreed to complete a new statement of purpose and service user guide in line with the home’s new ethos and policies and procedures. The home has had no new admissions since 2004 and since the new proprietor has been registered. On discussion with the owner and manager of the home it was evident that currently they have no documentation in place with which to record assessments. The manager advised the inspector that they had documentation available and this would need developing to suit the home. The Cressage House H55 HO3 S62441 Cressage House v217718 140405.doc Version 1.40 Page 9 manager agreed to implement a suitable admission procedure that would enable the home to admit service users whose needs can be met and that wishes of service users can be taken into account. This will be audited at the next inspection. The home has a visiting policy that affords prospective service users to visit the home prior to agreeing to move in, however, this needs reviewing in line with the new ownership of the home. All service users have been issued with a contract from the new owner, however, this needs up dating to include the room to be occupied. Service users confirmed that they had a contract of tenancy and that they keep them in their rooms or in their files. All contracts seen had been signed by service users or their representatives. A copy of the home’s complaints procedure is included in the contracts. Cressage House H55 HO3 S62441 Cressage House v217718 140405.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,8,9 Service user plans were basic and did not include all identified needs and wishes. Service users are encouraged and supported to make decisions about their lives. Service users are consulted about their lives and the running of the home. Service users are able to take risks, however, this is not supported by suitable assessments and documented risk assessments. EVIDENCE: The inspector audited three service user plans, which were found to be basic and not including all relevant information. Care plans include behaviour, medication, dressing, bathing, meals, mobility and leisure. All sections were found to be basic and one service user who has challenging behaviour had nothing recorded, including how to manage such behaviour. In all three care plans it was documented that service users have no needs which cannot be met yet full assessments of needs has not been undertaken. This was Cressage House H55 HO3 S62441 Cressage House v217718 140405.doc Version 1.40 Page 11 discussed with the home and it was agreed that all care plans would be reviewed and amended in accordance with service user needs and aspirations for the future. None of the service user plans include an assessment of risks or documented risk assessments individual to service users needs and wishes. The home has agreed to undertake these. The home has implemented a daily record of events recently and it is envisaged that this will assist the home with its assessment process. The home has begun to hold service user meetings. Service users confirmed to the inspector and copies of the minutes of the meetings display that the home involves service users in the running of the home as they wish. On speaking to service users they confirmed the future plans of the home and how they had been involved in these. Service users confirmed that they are able to participate within the home and service users are able to access the homes kitchen for snacks and drinks as they choose. Service users confirmed that staff now ask them what they want to do and support their decisions in matters relating to their lifestyles. Cressage House H55 HO3 S62441 Cressage House v217718 140405.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13,14 Service users participate in the community as they wish. Service users confirmed that the home provides and supports choices in leisure activities. EVIDENCE: Service users who are able access local facilities of their choice and service users confirmed that they go out and to where, when they want. Service users confirmed that they go to the local shops, pubs, cafes and for walks to local venues. The home also has a minibus, which service users stated they enjoyed as it got them out more and to venues that they might not go to if they had to go alone. The homes staff supports service users who require assistance, to access the community. Service users advised the inspector that staff support their choices in venues, however, if its in the minibus usually its not on a one to one and often this involves other peoples choice of venues. Cressage House H55 HO3 S62441 Cressage House v217718 140405.doc Version 1.40 Page 13 Service users confirmed that the home provides a range of activities including bingo, games, reading material, and outings. The home has provided sky TV at the request of service users at a meeting. Service users confirmed that they enjoy this. The home has employed the services of a activities person to ensure service users wishes for activities are met. Service user rooms contain personal possessions to reflect choices in leisure activities including music systems, televisions and arts and craft equipment for those service users who have hobbies. One service user is supported on a weekly one to one basis for cooking within the home. The home has begun to review all service users wishes as to leisure activities and is starting to meet individual needs and wishes. Cressage House H55 HO3 S62441 Cressage House v217718 140405.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 20 Medication practices are safe, however, the recording system was found to be confusing. EVIDENCE: The home has a medication policy and procedures were in place for monitoring the receipt, administration and the return of medication to the pharmacist. The home operates a monitored dosage system provided by the local pharmacist. On auditing the medication administration sheets it was unclear as to the start dates has the sheets started in the middle of the system. It was agreed with the home that they would review with the pharmacist to ensure the medication system starts at the same time as the administration sheet. Medication levels were found to be correct. Cressage House H55 HO3 S62441 Cressage House v217718 140405.doc Version 1.40 Page 15 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) 22,23 Service users were aware of how to make a complaint and to whom. The home has a complaints procedure. Staff displayed their awareness of the Adult Protection Procedures implemented by the home. EVIDENCE: The home has a complaints procedure, which service users confirmed they were aware of. Service users confirmed that they would tell the staff if they were unhappy. Service users confirmed that the manager and proprietor had gone through the complaints procedure with them. One visitor confirmed that they were aware of the home’s complaints procedure and that if they had any concerns then they would speak to the proprietor and homes manager who they found approachable and willing to resolve any issues they have. The home holds meetings for service users who wish to participate to discuss any issues they may be experiencing. These meetings are documented and appropriate action taken to resolve any issues raised within the meetings. The minutes of these meetings demonstrated that the complaints procedure had been discussed with service users. The staff were aware of the adult protection procedures and whistle blowing policies adopted by the home. Staff have received recent training on abuse and adult protection procedures. Staff had implemented the adult protection procedures recently in accordance with local adult protection procedures. Cressage House H55 HO3 S62441 Cressage House v217718 140405.doc Version 1.40 Page 16 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) 24,25 The home was clean, homely and some communal areas decorated in accordance with service user choices. Some service user bedrooms are in need of redecoration. The home does not always provide a safe environment. The home has not undertaken risk assessments and implemented safe systems for identifiable risks. EVIDENCE: The home has redecorated and refurnished some communal areas since the proprietor has taken over. Furthermore the kitchen has been refurbished and is now accessible to service users. Service users and staff confirmed that service users had been involved in the selection of the furniture and colours of the new decoration. The home is homely in appearance and service users advised the inspector that they like their home. The proprietor advised the inspector of the plans to redecorate service user rooms, which some were found to be in need of. Cressage House H55 HO3 S62441 Cressage House v217718 140405.doc Version 1.40 Page 17 The inspector had a walk around the home and noted that the home had revamped one of its bathrooms to include a assisted bath for service users who may require this assistance in the future. The home had fitted thermostatic valves to this bath and showers, however, it was noted that not all baths and showers were fitted with failsafe thermostatic valves to prevent scalding. The proprietor advised the inspection that this had been planned to be undertaken. Several first floor windows were not fitted with restrictors to prevent service users from falling from a height. Furthermore, no risk assessments have been undertaken. The home is required to undertake risk assessments and implement suitable controls for identifiable risks. The inspector audited the serving certificates and found these to be satisfactory and up to date. Cressage House H55 HO3 S62441 Cressage House v217718 140405.doc Version 1.40 Page 18 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32,34 Staff are currently receiving training based on service user needs. The home has not implemented recruitment practices to ensure service users are protected. EVIDENCE: The home has just started to implement a training programme for its staff team and is aiming to do a training session every six weeks to ensure training needs are being met. The proprietor and manager advised the inspector that the training planned is based on mandatory courses and around service user needs. Staff have received training in adult protection and infection control, however, this requires further development and must include medication, moving and handling, food hygiene, and service user specific courses. The home is currently looking into the NVQ training for staff. Currently none of the staff are NVQ trained except the registered manager. A requirement for training has been made. The inspector audited two staff files, which did not contain all relevant information required. One file contained personal details, identification, a photo and confirmation of qualifications only. The second file contained a contract, partially completed job application form, two references and a photo. Cressage House H55 HO3 S62441 Cressage House v217718 140405.doc Version 1.40 Page 19 The inspector was informed that both staff had worked at the home for some time and that CRB had been applied for all staff working at the home. No CRB and POVA’s had been completed for any of the staff at the time of the inspection. The home is required to ensure that they implement a suitable recruitment procedure before employment of future staff and that staff files contain all required information. Cressage House H55 HO3 S62441 Cressage House v217718 140405.doc Version 1.40 Page 20 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 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) None EVIDENCE: None of the standards were assessed during the inspection, however, it was evident that the ethos of the home is changing to a service user led service. This will be fully audited at the next inspection when both the proprietor and manager have settled into the home. Cressage House H55 HO3 S62441 Cressage House v217718 140405.doc Version 1.40 Page 21 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 2 2 2 2 2 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 3 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 2 x x x x x Standard No 11 12 13 14 15 16 17 x x 3 3 x x x Standard No 31 32 33 34 35 36 Score x 2 x 2 x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Cressage House Score x x 3 x Standard No 37 38 39 40 41 42 43 Score x x x x x x x H55 HO3 S62441 Cressage House v217718 140405.doc Version 1.40 Page 22 na 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. 2. 3. 4. 5. Standard 1.2,1.4 2.3 5.2 6 9 Regulation 4,5 14 5(1)(a) 15(2) 13 Requirement Review and amend the homes statement of purpose and service user guide. Implement a documented system of assessment of potential service users. Amend the service user contracts to include the room to be occupied. Review and develop all service user plans. Review and document service user risk assessments and incorporate these into the service user plans. Review medication procedures in consultation with the pharmacist. Assess and implement suitable and sufficient risk assessments for the home. This must include the environment, equipment and individual staff roles. Following a risk assesment implement suitable controls to prevent scalding from hot water, and falls from a height. Implement a system of decoration of the home. Implement a training and supervision programme for staff. 50 of staff must be trained to Timescale for action 31/9/05 31/9/05 31/9/05 31/9/05 31/9/05 6. 7. 20.4 24.6 13(2) 13(3)(b) 31/9/05 31/9/05 8. 24.6 13(3) 31/9/05 9. 10. 25.12 32 23(2)(d) 18(1),(2) 31/9/05 31/9/05 Cressage House H55 HO3 S62441 Cressage House v217718 140405.doc Version 1.40 Page 23 NVQ level 2 by 2005. 11. 34 19 Implement a thorough recruitment programme for new employees. Current staff files must be reviewed and contain all information required. 31/9/05 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 21.5 Good Practice Recommendations It is recommended that the home supports service users in accessing an advocacy service. Cressage House H55 HO3 S62441 Cressage House v217718 140405.doc Version 1.40 Page 24 Commission for Social Care Inspection 4th Floor, Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Cressage House H55 HO3 S62441 Cressage House v217718 140405.doc Version 1.40 Page 25 - 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. 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