Inspection on 20/02/08 for Cressage House

This inspection was carried out on 20th February 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cressage House 08/07/08

Cressage House 20/06/07

Cressage House 21/06/06

Cressage House 06/10/05

Cressage House 14/04/05

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

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 Edward`s Road Southsea Hampshire PO5 3DJ Lead Inspector Jan Everitt Unannounced Inspection 20th February 2008 09:30 Cressage House DS0000062441.V356811.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 Cressage House DS0000062441.V356811.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. Cressage House DS0000062441.V356811.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cressage House Address 30 St Edward`s Road Southsea Hampshire PO5 3DJ 023 9282 1486 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) Mrs Susan Ann Walker Mrs Ann Grace Care Home 13 Category(ies) of Learning disability (13), Learning disability over registration, with number 65 years of age (13), Mental disorder, excluding of places learning disability or dementia (13), Mental Disorder, excluding learning disability or dementia - over 65 years of age (13) Cressage House DS0000062441.V356811.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. All service users in the category LD(E) and MD(E) only to be admitted with a dual diagnosis. Service users in the above categories not to be admitted under 40 years of age. 20th June 2007 Date of last 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 amenities and a short distance from the town of Portsmouth. The home has a minibus and as such service users are able to access venues and activities outside of the home and local area. The home provides a range of accommodation in single and double bedrooms, with a high number of shared rooms currently. On the ground floor is a lounge, dining room and a smokers room. The home also has a domestic kitchen, accessible via a number of steps, and service users may access the kitchen to prepare snacks and drinks as they choose. The home has an enclosed rear enclosed garden that is accessible to service users. There is a large office to the front of the home on the ground floor. The current range of fees are £325 - £591 per week, and residents are responsible for paying for their own toiletries, hairdressing, chiropody and items of a personal or luxury nature. Cressage House DS0000062441.V356811.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating of this service is 1 star. This means the people who use the service experience adequate quality outcomes. The site visit to Cressage House took place on the 20th February 2008 and was carried out over one day by one regulatory inspector. The manager Mrs. Grace assisted throughout the inspection. The previous visit of June 07 identified a poor service and an improvement plan was requested by the CSCI. This visit was to monitor the improvements identified on the plan to ensure they were completed, assess other key standards and to re- evaluate the overall rating of the service. The outcome of this visit demonstrated that in the areas identified as being poor, an improvement in the standard had been achieved. Most of the service users were at home at the time of this visit and were able to be spoken with. A tour of the home took place with the assistances of the residents who were happy to allow us to view their bedrooms and communal areas. Surveys ‘Have your Say’ had been distributed to 12 service users, 8 relatives and 8 staff on this occasion. 6 service user surveys, 3 relatives and 6 staff, returned them to the CSCI and information from them is used for this report. The outcome of the surveys indicated that there was a high level of satisfaction with the service and that generally people living and working in the home are very satisfied with the service. At the time of the inspection the home was accommodating 12 residents. There were no residents from an ethnic minority group. What the service does well: The home does well to support its residents with dedicated hardworking and skilled staff and a manager who are very caring and sympathetic to the needs of people with mental health and learning difficulties. Each resident has a personal plan that identifies their strengths and needs and provides clear information for staff on how to meet these needs. The residents are supported to develop their independent living skills and are encouraged to access the community for educational, occupational and leisure pursuits. The home provides an open and inclusive environment for the residents to live, where they can express their views and are encouraged to make choices and Cressage House DS0000062441.V356811.R01.S.doc Version 5.2 Page 6 decisions about their daily lives and participate in the decision making of the home in general. The home as far as feasibly possible and when the residents will allow, assists them to maintain a healthy lifestyle and supports them when required to attend health care appointments. The residents live in a spacious Victorian house, which is clean, well decorated and furnished throughout. Resident’s bedrooms reflect their individuality and hobbies and interests. The home provides a comfortable, clean and safe environment for the people who live there and they say they enjoy living in the house. Staff are well managed and trained, and provide a good standard of care for people, many of whom have high care needs. The interactions between the staff and the residents are warm and friendly and staff pay a good deal of attention to respecting peoples’ dignity and privacy. The people who use the service say: ‘I can come and go as I please, I chose’ ‘I can come and go as I please, I chose what time I get up, go to bed and what I do during the day’. ‘I go out everyday except when I have to stay in for GP or District nurse appointments’. ‘I can speak to any staff at any time they listen to me’. ‘If I want to complain I can to the staff’. ‘We have house meetings and I can talk to my key worker at any time’. Relatives’ surveys indicated that they were generally pleased with how their relative was being cared for: ‘I think there have been improvements since the present owner and manager have been in post. The staff are always friendly and helpful. ‘I know she is well looked after’. Staff say: ‘I get loads of support from the manager’. ‘I had a thorough induction’. ‘I meet with the manager regularly to talk about my role’. ‘The team communicate well between themselves’. ‘We have the support and knowledge to meet the service user’s needs’. ‘’Staff always make Cressage House a welcoming, comfortable and pleasant environment where residents feel safe and valued’. ‘Staff are trained to provide the best quality of care and involve service users in the planning of their care’. Cressage House DS0000062441.V356811.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: The Statement of Purpose and Service User Guide information should reflect any changes in policy within the home and be made available in alternative format. The staff that have not received appropriate training in Safeguarding and abuse must undertake this as soon as possible. Staff rotas must be maintained to evidence that sufficient staff are on duty throughout the whole week to meet the needs of the service users. The home must develop a quality assurance system that involves consultation with the service users and their representatives. Reports from the visiting provider must be undertaken and reports from those visit be made available for inspection. The registered manager should be allocated protected hours each week to enable her to undertake her carry out her management role effectively. Cressage House DS0000062441.V356811.R01.S.doc Version 5.2 Page 8 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. Cressage House DS0000062441.V356811.R01.S.doc Version 5.2 Page 9 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 Cressage House DS0000062441.V356811.R01.S.doc Version 5.2 Page 10 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 good. This judgement has been made using available evidence including a visit to this service. Prospective service users needs, wishes and aspirations are assessed by the manager, prior to moving into the home. Pre-admission information needs to be more user friendly. EVIDENCE: The service user information booklet, that is given to all potential service users prior to them coming to the home to live, was viewed and the information contained in the booklet has not yet been developed in formats that can be readily understood and/or explained to service users who may not have reading/literacy skills due to their special needs. This was a recommendation from the previous inspection. The information contained in the booklet was discussed with the manager and it was recommended that the new smoking policy arrangements to be amended to ensure potential residents receive up to date information, that is correct at the time of them making decisions about going to live at the home. 5 surveys were returned from the service users, all indicated that they did not have information about the home before they moved in and that three of the five said they were not asked if they wanted to move into the home. Cressage House DS0000062441.V356811.R01.S.doc Version 5.2 Page 11 A sample of pre-admission records was viewed. Assessment documentation is comprehensive and obtains holistic information about the prospective residents strengths and needs, and a history of their physical and mental health. CPA information, activity chart, personal care, life skills, welfare, monetary skills, community integration, family and friends, special dietary needs, hobbies & interests, work occupation, behaviours and associated risks. The manager reported that she would always go to assess a potential client to ensure that the home will be able to meet their needs and that she is sure they will ‘fit in’ with other clients. She acknowledged that she had made a mistake by not assessing one client who, on admission, had presented with challenging behaviour that had not been reported to her and who had been disruptive to other service users. She admitted she would not ‘make that mistake again’. Six months later, with support from the care team, this client has now settled into the home life very well and when spoken to by us, was full of praise for the home and her life style and is able to go out into the community as and when she likes and live her life with choices. There was evidence in the resident’s records that further information is received through a care needs assessment from the care managers which is sent by them before admission. The manager said she always receives these from care manager. Also evidenced was the terms and conditions of residency signed by the resident. Cressage House DS0000062441.V356811.R01.S.doc Version 5.2 Page 12 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. The people who use the service have their assessed needs and personal goals reflected in an individual personal plan. Residents feel they are treated with dignity and respect, and that the service promotes independence. The people who use the service are support to take risks as part of an independent lifestyle. EVIDENCE: The improvement plan received in August 07 following the inspection of July 07 said that care plans were in place and that they would be regularly monitored and reviewed. A sample of 4 care plans was viewed. Each service user has a comprehensive personal profile compiled in the records. Cressage House DS0000062441.V356811.R01.S.doc Version 5.2 Page 13 Personal plans provided evidence that people who use the service are involved in the development of their care plans; some had signed their care plans. The manager said it is hard to involve some clients that are not interested. Each resident has a key-worker to assist in this process and clearly provide information on the residents’ strengths and needs and how they need to be supported. Care plans were evidenced as being reviewed appropriately. The care plans viewed were detailed and they provided all information about the service user to enable the support worker to meet the needs and described the daily routines and activities of the resident. The staff with whom we spoke with were clear of their role in respect of promoting choice and independence and gave a few examples of how this was done, in some circumstances following care plans that have been carefully written. One care worker on duty at the time of this visit was new to the home and was shadowing the other carer. She said that she had been given information about the service users before starting work but was not working alone. The surveys returned by the service users and those spoken to indicated that they are satisfied with the care and service they receive and perceive the home as their home that they can come and go as they wish within a risk framework. Service users are encouraged to be independent and to make their own decisions and those rights are only limited within a risk assessment process. The managers spoke of the institutional make up and previous practices of the home and residents, and how the staff are working with the residents to break these behaviours. Residents are encouraged to visit the kitchen when they want to make a drink and not wait for set times, and this was observed at this visit, service users were observed making tea as and when they wished baring when the mid day meal was being cooked. Service user meetings are held once a month, at which time service users are encouraged to have their say about how the home is run and what they would like to have on the menu, what activities they would like and any complaints they would like to voice. A number of requests made by the residents in meetings have been honoured. The minutes of these meetings were viewed. Surveys returned by the service users indicated that they consider the staff always listens to them. We observed a good interaction and communication between the care staff and the service users and the manager displayed a wide knowledge of how service users like to live their daily lives. Service users Cressage House DS0000062441.V356811.R01.S.doc Version 5.2 Page 14 were continually going into the office to see the manager or to just sit in the office with her Service users do manage their own finances with support. The manager was observed to be giving one service user his allowance and arranging for transport to take him out for the afternoon. The care plans evidenced that risks are assessed individually dependent on the service user’s need such as accessing the community, behaviours, personal care etc, However the previous inspection identified that the smoking policy needed to be reviewed in light of some residents smoking in their rooms and a requirement was made to risk assess those who smoke in their rooms. The improvement plan stated that individual risk assessments are in place for all service users who smoke to safeguard other service users. It was written into the risk assessment that if they continue to smoke in their rooms and not in the designated smoking area, they may put their tenancy at risk. The service users have signed this risk assessment as evidence they understand this. This was completed in June 07. These agreements were evidenced in the care records. Those service users who smoke were spoken with. They mainly smoke outside or in the designated smoking room but there is one service user who admitted that he does understand that he should not smoke anywhere other than the garden or designated room, but he continues to smoke in the bathroom. Cressage House DS0000062441.V356811.R01.S.doc Version 5.2 Page 15 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, 14 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who use the service are encouraged and supported to join in daily, social and community based activities, maintain relationships with friends and family and contribute to the decision making and planning of menus and mealtimes. EVIDENCE: The annual quality assurance assessment (AQAA) tool stated under “What we do well” Most residents pursue meaningful activities in the community and are encouraged to pursue their hobbies and interests and participate in organised trips. Some residents attend college and work and contact with family and friends either by phone or visiting is encouraged. The personal plans demonstrated that each resident has recorded their individual hobbies and interests, which include work, college attending Cressage House DS0000062441.V356811.R01.S.doc Version 5.2 Page 16 religious services and in house activities such as listening to music and watching television. The manager reported that she tries to encourage the service users to participate in more in-house group activities but it is difficult to engage the service users to put forward their suggestions of what they would like to participate in. The minutes of the last resident’s meeting recorded that the residents did not come forward with any suggestions as to what they would like for group activities. The home demonstrated that the people who live in this home continue to be part of the local community and all but one of the service users are able to go out into the community independently to clubs, church, coffee mornings, visiting friends and generally going out and about. It was observed that there were busy comings and goings of the residents at various times of the day. One service user told us that he attends college twice a week and was willing to show us the work he was undertaking related to nutrition. Two services user told us that she enjoys going out to meet friends every day; another goes to day services every day. The manager has procured extra support for the one service user who is unable to go out independently and he now has a befriender allocated to him who visits each week to take him to the local shops to buy ingredients to bake cakes. The manager said she hopes this will extend further and he will be able to go out more. The service user, who spends a good deal of time sitting in the office, enjoyed talking about his outing and the person who assists him with the cooking. A lady service user told us how she had enjoyed a recent holiday in Paris. She had gone with a group from the local college and been accompanied by a support worker. Another lady told us how she had enjoyed her holiday last year in the New Forest. Photographs on the dining room wall provided evidence that residents had enjoyed day trips last year in the better weather. Five surveys returned to the CSCI by service users indicated that they have the freedom and choice to spend their days as they wish within agreed parameters and say: ‘ I go out except when I have to stay in for GP and DN appointments’. There are risk assessments in place for those who leave the home and plans in place to identify the strategies if risks are identified The AQAA states that service users are encouraged and supported to maintain and develop functional relationships. Links with families, when available, are encouraged and freedom of choice and diversity is acknowledged at the home. A survey returned by a care manager said that Cressage House DS0000062441.V356811.R01.S.doc Version 5.2 Page 17 the home is very good at supporting clients to maintain their social contacts and networks. Speaking with the manager on this issue she gave scenarios of where relationships have been encouraged and welcomed and others where residents have placed themselves at risk and intervention from the home and professionals has taken place. At the time of this visit there were no visitors in the home but the manager said that visitors are welcome at all times and that the home does have visitors regularly. The visitor’s register supported this. Relatives returned surveys indicated that generally they were happy with the care their relative receives from the service and were made welcome should they visit the home. One commenting: ‘The staff I have met, or spoken to on the telephone, have always been friendly and helpful’. Service users spoken with at the time said that they could have visitors if they wish. There is a pleasant lounge to receive visitors or in the privacy of their bedroom. We observed that there were locks on all doors and service users maintain their own key. The manager said most of the service user chooses to lock their doors during the day. Service users were only too pleased to give permission for us to visit their rooms on the day of this visit. Staff were observed to be interacting well with the service users and speaking to them with respect, respecting their choices in their daily routines. The home has recently changed the smoking policy arrangements and there is a designated smoking room in the house and an outside area in the garden. Some choose to go outside to smoke; others do use the smoking room. There remains one resident who uses the bathroom, and it is suspected that one other resident continues to smoke in their room. The fire authorities visited the home recently and spoke to service users about the danger of smoking in bedrooms where there is a great deal of inflammable material. The home has subsequently written into their policy that if people continue to smoke in their rooms and put the whole house at risk, this could result in their contract of residency being at risk. The service users have signed individual agreements to say that they understand this and will endeavour to keep to the house smoking rules. All five residents who completed comment cards said they are always treated well by staff. Cressage House DS0000062441.V356811.R01.S.doc Version 5.2 Page 18 Residents’ now have access to their kitchen when they wish and Key Workers’ are supporting residents’ to get involved in developing skills in the kitchen area. The AQAA states that the home provides nutritionally varied and balanced meals, which the residents are encouraged to plan and to develop their skills in this area. The staff encourage residents to get their own breakfast and drinks at alternatives times of the day. A record of the meals served in maintained and if a service user has anything different from the main menu it is recorded. The meals look to be nutritious and wholesome and service users told us that ‘They like the meals they are nice’. The lunchtime meal was observed and service users were observed to be enjoying the food. The manager said that the service users are given choice and it is discussed during the previous day what they would like for their meals the following day. There are no planned menus displayed and the manager shops for the meals after she has consulted the service users on what they would like. She is also very familiar with their likes and dislikes and shops to meet their wishes. Although there was evidence of nutritious meals being presented and chosen by the residents and residents visiting the kitchen to make drinks and snacks, there was no evidence of residents being involved in the preparation of the meal and both staff on duty were busy with the preparation of the main meal of the day, which is eaten at lunchtime. The kitchen was visited and found to be clean and tidy. One of the carers or the manager cooks the main lunchtime meal. This was discussed with the manager as to specific roles within the home. The manager reported that there is generally three staff on duty and herself and one does the cooking. There was an issue with the business not employing a specific cook and this means that the carer’s role is diverted from care when she is doing kitchen duties. The carer was observed to change her outer protective clothing to an appropriate apron for cooking duties. The manager said that this arrangement does not compromise the care of the service users. There was no evidence that it did and surveys returned by staff indicate that they consider there is enough staff to support the service users’ needs. The manager said that service users are not nutritionally assessed routinely and that they are weighed occasionally, but that most had put on weight. Likes and dislikes of foods are well known by the staff and documented in the personal profile. Cressage House DS0000062441.V356811.R01.S.doc Version 5.2 Page 19 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 adequate. This judgement has been made using available evidence including a visit to this service. The home does well to provide the people who use the service with support in a way that they prefer with their personal care, health care and medication. EVIDENCE: The annual quality assurance assessment (AQAA) tool stated under “What we do well”. We support the residents with their personal care with sensitivity, and respectfully considering their dignity and privacy at all times. Making sure all residents have access to a GP, dentist, podiatry and opticians and ensure the residents who are on daily medication have this monitored and administered by staff, one resident self medicates. Care plans viewed demonstrated details of the level of support service users need. Personal plans provide staff with clear guidelines on how to support the residents in specific activities such as bathing and grooming, providing information on whether the resident prefers to have a bath or a shower and what assistance is required. Cressage House DS0000062441.V356811.R01.S.doc Version 5.2 Page 20 Due to the complex needs of the residents some have difficulty in maintaining a good standard of hygiene and are encouraged and supported sensitively by staff to do so. This was observed when visiting service user’s rooms. The manager very gently reminded one service user that the bathroom was available and that she had requested a shower earlier. Another service user was anxious to deposit his dirty laundry is the correct place and asked for guidance from the manager. It was observed that most service users were clean and well presented. They choose what they wear and how they wear it. Service user surveys returned state that the staff supports them well. Evidence found in resident’s personal plans and by speaking with residents demonstrates that the home is good at accessing health care support including assistance from community psychiatric nurses (CPN’S) and psychiatrists. Some residents attend appointments independently where as others need support or are reluctant to attend despite being unwell. The manager said that most of the service users are accompanied on any outpatient’s appointments. The chiropodist, dentist and optician visit the home and also the GP if requested, but a number of service users are able to attend these appointments independently. The AQAA states that the service could do better to try and encourage service users to go to the dentist more frequently. Some service users when asked about their doctors said they see them when they need to. Medication is managed by the home for most service users. Good records are kept in the receipt and disposal of medications. The home is using a blister pack system that has been deemed by the manager and staff as easier to follow. At the time of this visit, training records could not evidence that all the staff had received training in the blister pack system. However the majority of the staff have received training in the safe administration of medication and the manager has developed a resource pack providing staff with information on particular medications, their uses and side effects. The home support residents to take their medication. One service user was self-medicating at the time of this visit and a risk assessment is in place with a record of what the resident is taking. The medication is maintained in their room, which is locked by the service users at all times. The manager said that she monitors this each week when the repeat prescription is delivered. It was observed that the medicine trolley was stored in the manager’s office and this door was locked whenever she was not in it. The keys were occasionally left in locks in cupboards and although she was in attendance at Cressage House DS0000062441.V356811.R01.S.doc Version 5.2 Page 21 all times, it was identified to her that this was poor practice and that she must keep the keys on her person even when in the office. The manager was observed to be administering medication at lunchtime and was doing so with safe procedures. The MAR sheets were viewed and were recorded, with no gaps identified. The policy and procedure was viewed for the management of medication. These need reviewing to reflect the practices in the home and how medication is managed and also to include a self-medication policy and procedure. This was discussed with the manager who agreed that this did need a review. The manager was given advice on how to obtain the latest publication of the Royal Pharmaceutical Society Guidance on the handling of medicines in social care settings to give her guidance on producing a policy that reflects safe practice and the practices of the home. Cressage House DS0000062441.V356811.R01.S.doc Version 5.2 Page 22 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 adequate. This judgement has been made using available evidence including a visit to this service. The people who use the service have their views listened to and acted upon and feel safe, however the home must ensure staff are trained and fully aware of the policies and procedures in recognising and reporting abuse. EVIDENCE: Each resident on arrival in the home is given information about the home, which includes the complaints policy. The previous inspection identified that the manager must consider how residents with cognitive and sensory difficulties are made aware of the complaints procedure. The manager has now produced the complaints policy in graphic format to enable all service users to understand what they should do if they have concerns. The five surveys returned by the service users indicated that they would know what to do and who to go to if they had any issues or concerns. One stating ‘I can complain to the staff’. Service users spoken to said they would go to the manager. Indeed during this visit one service user visited the manager numerous times to discuss the issue of his cigarettes and she dealt with this appropriately. Cressage House DS0000062441.V356811.R01.S.doc Version 5.2 Page 23 The manager has a log in which she records complaints. This was viewed and action outcome from any complaint was recorded. The complaints recorded had arisen out of unacceptable behaviour from another resident, which has now resolved itself. The previous report made a requirement that all staff attend adult protection training within a stated timescale. The manager has endeavoured to comply with this and training took place in August 07 but not all staff could attend. The training records demonstrate that there still remains a small number of staff that needs updates in this. This was discussed with the manager and she is endeavouring to arrange further sessions on Safeguarding for the remainder of staff to attend and also for the new member of staff. The staff on duty at the time of this visit was aware of the various nature of abuse and described the course of action they should take if they suspect or witness any form of abuse. Cressage House DS0000062441.V356811.R01.S.doc Version 5.2 Page 24 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. The people who use the service are provided with a clean, homely and welcoming environment to live in. EVIDENCE: The home has adequate numbers of bathing and toilet facilities to meet the number of residents living in the home; these are situated close to bedrooms. All toilets and wash areas have liquid soap and paper towels to guard against cross infection. The staff files demonstrated that some staff have received infection control training since the last inspection. Staff were not observed preparing to support residents with personal care as the majority of the residents are independent, however the staff on duty confirmed they are issued with disposable gloves and were aware of the risk of cross infection. Cressage House DS0000062441.V356811.R01.S.doc Version 5.2 Page 25 The kitchen was visited and it was observed that there is no extractor fan in the kitchen and therefore the kitchen becomes very warm and humid when the meals are being cooked. The manager has highlighted this to the provider. The Environmental Health Officer has visited the home and issued the ‘Safe Food’ guidance pack, which is being used to audit the standards of hygiene in the kitchen. Cressage House DS0000062441.V356811.R01.S.doc Version 5.2 Page 26 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): 33, 34 & 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A dedicated and competent staff group in sufficient numbers to meet their needs supports Service users. Service users are protected by the recruitment policies and practices of the home. Staff are supervised and training needs are identified. Although not all staff members have received training in specific courses to support them in meeting service users needs EVIDENCE: The previous report made a requirement that the home employ sufficient staff to meet the needs of the people who use the service. The improvement plan received in August 07 states that two people had been recruited full time, which increased the staffing hours by 60. This was discussed with the manager. She reported that in theory it was good but one member of staff left Cressage House DS0000062441.V356811.R01.S.doc Version 5.2 Page 27 and the amount of time it takes to recruit another made it difficult to maintain all the hours she required but the existing staff were very willing to cover hours. The manager reported that there is usually three staff and herself on during the day, this will go down to three when she leaves during the evening and night staff come on duty, which is one waking staff from 21:00 hours. At the time of this visit the manager was on duty with two carers, one being on induction and was shadowing the other carer, who had been employed for three years. The third carer usually on duty had taken annual leave. This could not be demonstrated, as the staff rotas were not available to be viewed owing to the computer that had been out of order but was at that time working again. There did not appear to be any evidence that there was not sufficient care staff, as the home was quite quiet and the two carers were not that evident as they were cleaning and cooking, and there was only the manager around the communal rooms and overseeing the clients, although many of the clients were out of the house and in the community on visits. However, it has been identified in the past report that there has been a staff shortage at week-ends, and this could not be evidenced otherwise. This was discussed with the manager and she was informed that staff rotas must be available and accurately recorded to demonstrate that sufficient staff are on duty every day of the week. It was difficult for judgements to be made without the appropriate records Staff spoken to and staff surveys say that they consider they are well supported and that there is sufficient staff on duty to meet the needs of the service users. The previous report made a requirement that a more robust recruitment procedure must be undertaken at all times to ensure the safety of the service users. The home has recently recruited new staff. The recruitment files were viewed for three staff members most recently recruited. The files demonstrated that an application form had been received and all checks were in place from the CRB, POVA with two references received. Also interview notes were being recorded. The recruitment practices have improved and are now more robust. It was discussed with the manager the level of involvement the service users have in the recruitment process. She reported that some of the service users wonder into the office and they would ask questions informally. When the applicant is taken around the home they are introduced to service users, who will have the opportunity to ask questions and who will be very frank to her as to their opinions of that person Cressage House DS0000062441.V356811.R01.S.doc Version 5.2 Page 28 A service user told us that he liked the new night carer because ‘he made him laugh’. The AQAA stated that:. Improvements for the next 12 months. More training for staff specific to the client group. All staff have a development plan and induction and receive supervision. The report of June 07 states that staff receive training to assist them and skill them to meet the needs of the residents. The manager has a programme of supervision for all staff. The supervision notes were viewed at this visit and demonstrated that training needs are identified at this time. She admits these are not up to date as with new staff and staff leaving she has not had the capacity to undertaken every member of staff supervision. The provider does not visit the home often so she does not feel well supported. The records demonstrate that a number of staff have achieved their NVQ level 2 and 3. Most staff have undertaken this in their own time and have funded this. The carer spoken to at the time of this visit said that she had achieved her NVQ level 3 and thoroughly enjoyed her job. Surveys returned from staff indicate that they consider they received sufficient training for them to meet the needs of the service users. The manager showed us examples of the induction programme new staff undertake and this evidenced that is was based on the Skills for Care induction programme. She reported that two new staff are in the process of completing this but the record/booklet was not available, as the carers had taken them home to work on. It was evident that the manager endeavours to obtain as much training as possible for her staff. The AQAA says she is working with the Skill for Care looking at obtaining as much free training as available as funding could be seen as a barrier to obtaining more client specific training for staff. At the time of this visit there was no evidence to suggest that where specific training was lacking in some areas that this had a detrimental effect on the care the service users were receiving, but would better equip the staff to meet any challenges presented to them in this client group. The staff and service users were observed to have a good rapport. Service users say in their comment cards returned that ‘They are treated well by staff and that staff listen to what they have to say’. Cressage House DS0000062441.V356811.R01.S.doc Version 5.2 Page 29 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 & 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people who use the service are supported by a dedicated and caring manager who would benefit from more management time being allocated for such duties to ensure the home is well run. The health and safety of the service users and staff are promoted and protected. EVIDENCE: The manager has been managing in residential care for eight years and is able to run the home to meet its stated purpose aims and objectives to create an open, honest, positive and inclusive atmosphere. She had gained her Registered Manager Award and has also attended training on the Mental Capacity Act. Cressage House DS0000062441.V356811.R01.S.doc Version 5.2 Page 30 Staff spoken to and from the surveys returned suggests that the staff think highly of the manager, who is very knowledgeable about the client group and consider she supports them well. The manager works long hours and at times is filling in at short notice to cover staff absences. It is recommended that the manager be provided with more time to undertake important management tasks such as supervision, appraisal quality assurance and organising training for staff. The manager was observed to have good relationships with the service users who felt free to visit her office and chat to her. Improvements have been made to move away from an institutional style of care and encourage the residents to have their say. The manager said the home holds regular staff and resident’s meetings and everyone is given an opportunity to share their views ideas and concerns. Minutes of theses meetings were viewed. The manager reports that she has not yet distributed any questionnaire surveys to service users and relatives to survey the level of satisfaction with the service and to measure the expected outcomes against the Statement of Purpose. She said she would be doing it this year. The manager reports that she checks on the cleanliness of the house every day and looks at MAR sheets to ensure they are fully recorded. The provider does not visit the home and undertake a Reg 26 report; therefore, she has no record of this to show us on this visit. The home has no documented evidence of a quality assurance system, which does take place but is not recorded. This must be developed further. The previous report required that the manager seek advice from the fire rescue service regarding the new legislation and advice on people smoking in their bedrooms. This she had done and the fire and rescue person visited and inspected the home and spoke to the service users about the risk of smoking in their bedrooms. The report from the fire service was viewed on this visit and most of the work recommended has been complete, with just fire door guards to be fitted. The manager is now aware of the new legislation in respect of Fire Safety and the house has been inspected to meet those regulations. A fire risk assessment is in place. Fire training took place in August 07.for all staff. The fire log was viewed this evidenced that this was not consistently recorded to say fire alarms are being tested at appropriate intervals. Evacuation of the building is practiced every three months. Cressage House DS0000062441.V356811.R01.S.doc Version 5.2 Page 31 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 2 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 2 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 X 33 2 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 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 2 X 3 X 2 X X 3 x Cressage House DS0000062441.V356811.R01.S.doc Version 5.2 Page 32 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 YA1 Regulation 4 Requirement Timescale for action 31/08/08 2. YA23 13(6) 3. YA32 18(1)(a) 4. YA39 24 The registered person must review the Statement of Purpose/Service User Guide booklet to reflect any changes made to policy in the home and make it available in alternative formats. The registered person must 31/05/08 ensure that all staff undertakes training in the Safeguarding procedures. The registered person must 31/03/08 ensure that sufficient staff are on duty at any one time to meet the needs of the service users and staff rotas are maintained to reflect named staff and hours worked. The registered person must 30/06/08 develop a quality assurance system to review the quality of care, which involves consultation with the service users and/or their representatives. The registered provider is required to make visits to the home at least once a month to monitor the standards and outcomes for service users and DS0000062441.V356811.R01.S.doc 5. YA39 26 (4) c 31/05/08 Cressage House Version 5.2 Page 33 shall supply a report that must be maintained in the home for inspection at any time. 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 YA37 Good Practice Recommendations It is strongly recommended that the registered manager be allocated protected management hours each week to enable her to carry out her management role effectively. Cressage House DS0000062441.V356811.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Cressage House DS0000062441.V356811.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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