Inspection on 20/06/07 for Cressage House

This inspection was carried out on 20th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 found no outstanding requirements from the previous inspection report, but made 7 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 20/02/08

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 Christine Walsh Unannounced Inspection 20th June 2007 09:30 Cressage House DS0000062441.V338700.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.V338700.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.V338700.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.V338700.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. 21st June 2006 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 £300 - £590 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.V338700.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This site visit formed part of the key inspection process and was carried over one day by Mrs C Walsh, regulatory inspector. The manager completed an Annual Quality Assurance Assessment (AQAA) document, which was returned to the Commission for Social Care Inspection prior to the visit to the home. In addition “Have Your Say” resident and relatives comment cards were sent of which five were received in total. The information obtained to inform this report was based on viewing the records of the people who use and work at the service, speaking with the residents, visitors and staff and observing care and support practices. A tour of the home took place and documents pertaining to health and safety were viewed. What the service does well: The home does well to support its residents with dedicated hardworking and skilled staff and a manager and provider 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. A resident said: “My keyworker reviews my care plans with me” Another said: “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”. 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 decisions about their daily lives. A resident said: “The staff are good, they look after me when I am unwell”. Cressage House DS0000062441.V338700.R01.S.doc Version 5.2 Page 6 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. Good relationships have been established between the home and local health care services. The residents live in a spacious Victorian house, which still boast many of its original features, it is clean, tastefully decorated and furnished throughout. Resident’s bedrooms reflect their individuality and hobbies and interests. A resident said: “I like my room and I feel safe at Cressage house”. What has improved since the last inspection? What they could do better: Identified through the body of the report are a number of areas where the home needs to improve and seven requirements and one recommendation have been made. These particularly link to the health, welfare and safety of the residents whose associated behaviours and the way they wish to live their lives potentially places others at risk. Further highlighted by the registered persons was the need for additional funding to build upon resources, especially staff. The current numbers of staff cannot appropriately meet the current needs of the residents. The staff are very hard working, but task orientated leaving little time for quality time with the residents such as social time and community based activities. There are limited numbers of staff at the weekend and evening this limits the opportunity to assist residents who require two to one support to go out if they wish. Staff have received training in understanding various types of mental health conditions and training in managing difficult people, however a number of the residents have very complex needs and at times exhibit unpredictable challenging behaviours placing other residents and staff at potential risk. Cressage House DS0000062441.V338700.R01.S.doc Version 5.2 Page 7 The managers administration time is limited as she is included daily on the duty rota, this has led to important information not being completed as required such as risk assessments on residents who pose a potential risk to others and completing important health risk assessment related to fire and smoking, and a failure to follow correct procedures when recruiting staff. 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.V338700.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cressage House DS0000062441.V338700.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents are provided with information about the home to assist them to make an informed choice of where to live. However the home must consider accessible formats of information for those prospective residents with cognitive and sensory needs. Prospective residents needs, wishes and aspirations are assessed prior to moving in, however the home must ensure it can meet fully their needs before agreeing a full term placement. EVIDENCE: The annual quality assurance assessment (AQAA) tool stated under “What we do well” Asking care coordinators to complete referral forms and provide up to date CPA documents and risk management plans and crisis intervention plans, making sure the prospective residents is the correct criteria for the homes registration and working well with all agencies involved. This was tested by viewing three residents’ assessment notes and “Have Your Say” comment cards received from residents and care managers, speaking with residents, the manager, the provider and staff. Cressage House DS0000062441.V338700.R01.S.doc Version 5.2 Page 10 Prior to moving into Cressage House each prospective resident is given a booklet that provides them with information about the home, its purpose, what they do, the referral process, the staff, confidentiality, the complaints procedure and quotes from residents about the home. The booklet provides specific detail to assist the prospective residents to make an informed choice. However the home must consider the needs of prospective residents who may have difficulty reading or understanding the concept of the information. This was recommended following the last visit to the home. A resident said: “ I was given information about the home and visited before making a decision to move in” The assessment documentation recorded for all three residents was comprehensive and identified their strengths, their needs, their clinical diagnosis and their complex behaviours, which are associated with their illness. Positive comments were received from placing care managers who feel the home is very good at meeting the needs of service users with complex needs and behaviours. A care manager said: “When a service user moved into the home recently the home sought the appropriate information from the service user and myself in order to assess and plan for the person moving in and any adjustments required”. The care manager went onto say: “I feel that this service is a very good in responding to the needs of the service users and is a very valued resource” Staff said they felt well equipped and skilled to meet the needs of the residents. However the manager must consider the residents’ compatibilities and their complex behaviours before making a final decision to continue to support someone following their trial period. Cressage House DS0000062441.V338700.R01.S.doc Version 5.2 Page 11 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, and 9 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 assessed needs and personal goals reflected in an individual personal plan. However the home must ensure personal plans are developed as soon as possible after the person moves in, in order to provide a consistency of care. The people who use the service are supported and where required assisted to make choices and decisions about their everyday lives. The people who use the service are support to take risks as part of an independent lifestyle however the home must ensure this is not of the detriment of others living in the home. EVIDENCE: Cressage House DS0000062441.V338700.R01.S.doc Version 5.2 Page 12 The annual quality assurance assessment (AQAA) tool stated under “What we do well” We do well to ensure all service users have completed profiles/care assessments and individual plans of care incorporating mental, physical health, personal care, daily living skills, social and community, leisure, education and training as per individual needs and wishes and all risks are highlighted. This was tested by viewing three residents personal plans and meeting with one of them, viewing comment cards received from residents and care managers and speaking with other residents, staff and the managers. Each resident has a personal plan that describes their strengths and needs and provides staff with clear and specific guidance on how to support them. The residents who were met with said they were aware of their personal plans and one said that his keyworker met with him regularly to review his care plans. Another said he was aware he had personal plans but had chosen not to be involved in their review. The staff said they felt the resident’s personal plans gave them a good understanding of the needs and how to support the resident. Detailed daily records are kept and are shared confidentially with staff at handover. A resident said: The staff are very good and they make sure I am okay” A care manager said: “Staff appear very aware to each service users needs and respond appropriately”. However the manager must ensure that care plans and risk assessments are in place as soon as possible following admission to the home especially if the resident presents with challenges. The home supports many residents who in their lives have lived in large institutional environments; the manager and provider spoke of how they have, and continue to support the residents to have their say and make choices and decision about their daily lives. The manager admits this to be ongoing and for some residents a very difficult and slow transition. The residents spoke of how they are asked what they would like to do, what they would like to eat and how they are encouraged to participate in activities and residents meetings. This was observed during various activities during the day and through discussion with the staff and the managers it was established that they are aware of the importance of supporting the residents to make choices about their lives. Cressage House DS0000062441.V338700.R01.S.doc Version 5.2 Page 13 A resident said: “I can come and go as I please and get up and go to bed when I want”. Another said: “If I don’t like what’s on the menu the staff will offer me something different”. Residents are supported to take part in daily life activities and in most cases these activities are risked assessed and provide clear guidelines for staff on how to minimise the risk to the individual and others. However the managers must seriously consider the risk posed by certain behaviours and habits and how these could be detrimental to the health and safety of others living in the home. This must be considered in respect of smoking and residents smoking in their bedrooms. The managers were fully aware of the new legislation coming into place on the first of July 2007 but had failed to complete individual risk assessments on the residents concerned. A requirement will be made in respect of this. Cressage House DS0000062441.V338700.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17. 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 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. However the lack of resources such as suffient staffing levels and funding comprises this. 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. Cressage House DS0000062441.V338700.R01.S.doc Version 5.2 Page 15 This was tested by observing activities during the day, interactions between staff and residents, speaking with residents and staff and viewing comment cards from residents and care managers. The evidence demonstrated that each resident has listed in their personal plans their individual hobbies and interests which include work, college attending religious services and in house activities such as listening to music and watching television. The manager spoke of how she was introducing indoor activities such as arts and crafts but how this has proved difficult for some to engage. Photographs on the dining room wall provided evidence that residents had enjoyed day trips last year and one resident spoke of how he enjoyed these trips. A number of the residents are independent and can access the community safely but some require support by staff and in some cases require two staff to assist them safely, however the numbers of staff in the evening and especially at weekends do not allow for them to engage in activites of their choice. This places the residents at risk of continuously not having their needs met unless steps are taken to assess staffing levels against the needs of the residents. A resident spoke of how he would like to go on holiday and it was recommended following the previous visit to the home that the residents be offered a seven day holiday at least once a year. The AQAA in improvements for the next twelve months stated they would like to take residents on short holidays, however staff and funding permitting. The manager and owner said they would speak with the resident concerned and establish where he would like to go and if he could do this safely by himself. Visitors are made welcome and contact with family and friends is` encouraged and supported where deemed safe to do so. The manager 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. A resident spoke of how he would like to invite some of his friends to the home and when put to the manager and owner they confirmed that this had happened but that they would remind the resident that he is welcome to invite his friends to the home. The manager and staff appear to be aware of the importance of respecting the residents needs, wishes, desires and their individuality, including their diverse and complex needs. And the manager recorded in the AQAA how the home has challenged racist and sexual remarks, discrimination of people who live in the home with learning disabilities and how they have encouraged all to have an equal say in how the home is run. Cressage House DS0000062441.V338700.R01.S.doc Version 5.2 Page 16 A care manager said: “I have observed staff knocking on service users doors and waiting to be asked in and leaving the office when a resident wishes to make a phone call”. Staff were observed at the time of the visit engaging respectfully with the residents and knocking on bedroom doors before entering. A resident said: “The staff are very kind and listen to me”. The AQAA states that the home provides nutritionally varied and balanced meals, which the residents are encouraged to plan and develop their skills in this area. Although there was evidence of nutritious meals being made 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 manager spoke of how she has tried to change this routine but residents requested that they eat their main meal at lunchtime. Residents are now restricted on using knives in the preparation of mealtimes as these are now only accessible under supervision following a recent incident where a resident threatened another with a knife, this is expanded upon in standard 23 protection. The manager must ensure those deemed at risk have risk assessments in place. Cressage House DS0000062441.V338700.R01.S.doc Version 5.2 Page 17 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, and 20 Quality in this outcome area is good. 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. However the home must carefully consider their responsibilities when the resident’s choice conflicts with duty of care. 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. This was tested by viewing personal plans and medication records, speaking with residents, staff and the managers and viewing “have your say” comment cards completed by residents and care managers. Cressage House DS0000062441.V338700.R01.S.doc Version 5.2 Page 18 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. Staff are provided with reminders to ensure they are supporting the residents with respect, dignity and privacy. 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 is clearly monitored and recorded. A resident said: The staff are alright, they make sure we are okay and make sure I go to the Dr’s when I need to.” The staff appeared aware of their roles and responsibilities and the importance of promoting independence and making sure personal care is carried out sensitivity. When asked what does the home do well? A member of staff said: “We care for the residents very well, its important to be patient and supportive”. 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. A resident said: “The staff look after me if I am unwell and call a doctor if I need one” A care manager said: “The home is very good at ensuring and supporting the residents to attend hospital appointments, both for their mental health and physical health” The managers spoke of a number of situations where they have struggled to support and encourage residents to attend health care appointments and recognise that this is their choice, however if the illness is detrimental to their health or others the home must consider their duty of care to ensure the resident/s receive the help they need. Cressage House DS0000062441.V338700.R01.S.doc Version 5.2 Page 19 The home support residents to take their medication and for those who are able to self-administer a risk assessment is in place and a record is kept of what the residents is taking and has taken. The home has recently changed is pharmacy supplier and are now using a blister pack system that has been deemed by the manager and staff as easier to follow, however at the time of the visit the staff had not received training in the new system and the manager was hoping that this would be undertaken by the end of July 2007. 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. Good records are kept in the receipt and disposal of medications, however some gaps were found in the signature box, the manager must ensure she is regularly checking the drug administration records to check that medications have been signed when given or a clear explanation is given when they haven’t. The manager agreed to check the records daily; this will be reviewed during the next visit to the home. Cressage House DS0000062441.V338700.R01.S.doc Version 5.2 Page 20 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 and 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: The annual quality assurance assessment (AQAA) tool stated under “What we do well” We have clear and effective complaints procedure, and residents are aware of whom they can complain to and we act on their views and concerns deal with issues before they become a formal complaint. There are policies and procedures in place to protect residents from all forms of abuse. This was tested by speaking with residents and staff and viewing comment cards received from residents and care managers. Each resident on arrival in the home is given information about the home which includes the complaints policy, this is clearly laid out and easy to read but the manager must consider how residents with cognitive and sensory difficulties are made aware of the complaints procedure. The majority of the residents said they know how to make a complaint and the staff were clear about their role if a resident complained and dependent on the seriousness of the complaint how they would deal with it, however a small Cressage House DS0000062441.V338700.R01.S.doc Version 5.2 Page 21 number of residents were not sure so therefore the manager must ensure all residents are aware. A member of staff said: “It is important to listen to what the resident is saying and if possible try and settle their concern before it becomes more serious, however I will record it and let the manager know”. A resident said: “If I am unhappy I tell my keyworker or the manager and I know they will help me” Another resident said: “I was happy to tell the manager how I was feeling and I felt she listened to me”. A residents comment card, indicated the residents didn’t know how to make a complaint. A care manager said: “The home always responds to my concerns and are very good at contacting me when they need support and/or advice”. The home supports some residents with complex behaviours and needs and in most cases staff are provided with guidance in the form of care plans and risk assessments and know how to support a resident who has become challenging. However the manager must ensure care plans and risk assessments are in place for all residents as soon as possible after their admission especially if they pose a risk to others. This was discussed with the manager who agreed to have care plans and risk assessments in place within a short stipulated timescale. Staff have received dealing with challenging people training and those spoken with said they had found the training valuable and gave them confidence to deal with challenges effectively. However limited staffing at weekends and evening places them and other residents at potential risk of harm. Therefore the manager must seriously consider if the home is sufficiently staffed to meet the current level of need and support of the residents living in the home. Following this visit and before writing this report a regulation 37 notice was received identifying a serious incident that occurred in the home it appears appropriate action was taken, but under the Commission for Social Care Cressage House DS0000062441.V338700.R01.S.doc Version 5.2 Page 22 Inspection safeguarding guidelines a referral was made to local authority for investigating. Some staff have received protection of vulnerable adults training, but new staff are still to receive it, the manager also stated in the AQAA that all staff would benefit from an update, it is clear that this is required as some staff did not appear to be fully aware of what they would do if they witnessed or suspected an abusive act taking place. Although the manager is trying to organise further training this year it is felt that this must be completed within a timescale of two months. Cressage House DS0000062441.V338700.R01.S.doc Version 5.2 Page 23 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, 25, and 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 annual quality assurance assessment (AQAA) tool stated under “What we do well” we provide a clean safe environment; all residents’ rooms are adequately furnished; bright clean with tasteful soft furnishings. This was tested by taking a tour of the building, speaking with residents and the manager and by viewing comment cards from residents and care managers. Cressage House is a large Victorian building situated in Southsea, Hampshire, it is large and spacious and has retained a lot of its unique Victorian features. Cressage House DS0000062441.V338700.R01.S.doc Version 5.2 Page 24 The home has undergone some significant changes to the environment over the last two years, it is cleaner, brighter, nicely decorated and furnished. This appeared to be appreciated by the residents who said the they liked the changes they have seen and had taken part in choosing colours and furnishings. The residents appeared to take pride in their home in the way that they spoke about it. A resident said: “I like it here very much, it is always kept clean and tidy and I like my bedroom”. A care manager said: “I feel the home is committed to improving the quality of care as well as the physical environment at Cressage House” The manager and owner said they have an ongoing works programme and had recently converted a double room into a single with en suite facilities and renewed carpets and furnishings in most of the bedrooms. The dining room is especially well decorated and furnished making it a pleasant place for the residents to have their meals. During the tour of the building three residents allowed the inspector to view their bedrooms, one had recently been redecorated in the colours chosen by the resident and was very clean and tidy, personal items in the room reflected the residents hobbies, interests and personality. However the manager must ensure the residents privacy is respected at all times and place coverings over the windows as soon as possible. The owner agreed to do this the same day. This will be reviewed during the next visit to the home. The manager has recently obtained quotes for a new modern call bell system, which will better suit the needs of the residents and the environment. The home has a separate smoking room, which has been furnished with fire retardant materials, and has a non-slip tiled floor. Despite this facility the majority of the residents prefer to smoke in their bedrooms. 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. The manager said that the bathrooms had been redecorated and a few had been replaced. Whilst testing the hot water outlet to one of the bathroom sinks it was noted to be very hot, the sink has a temperature restrictor valve on it. The manager said she would get it reset to the correct temperature as soon as possible. The manager was advised to notify the residents who use this bathroom. Cressage House DS0000062441.V338700.R01.S.doc Version 5.2 Page 25 The re sighting of the washing facilities from the kitchen area has assisted the home in maintaining a hygienic environment for the residents to live. All toilets and wash areas have liquid soap and paper towels to guard against cross infection and the home has a clinical waste contract with the local council. Staff were not observed preparing to support residents with personal care as the majority of the residents are independent, however the staff confirmed they are issued with disposable gloves and were aware of the risk of cross infection, although they have not received training. The staff said they felt they would benefit from such training. Cressage House DS0000062441.V338700.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): 32, 33, 34 and 35 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The people who use the service are supported by dedicated, hard working and skilled staff. However their holistic needs are at potential risk of being compromised and not met by insufficient staffing levels and placed at risk by an insufficient recruitment procedure. EVIDENCE: The annual quality assurance assessment (AQAA) tool stated under “What we do well” The staff team are committed and motivated they are recruited on an equal opportunities basis and we obtain two references, CRB and POVA checks are undertaken and all staff have a development plan, induction and receive supervision. This was tested by viewing two new staff files, speaking with staff, the manager and viewing the duty rota and training records. Cressage House DS0000062441.V338700.R01.S.doc Version 5.2 Page 27 Through observation it was clear that the staff work very hard and are dedicated, filling in for shifts at short notice and supporting residents and undertaking training in their own time. The home currently has twelve residents a number of these are independent and can manage their personal care, however as stated earlier a high number of residents have complex needs and some exhibit challenging behaviours which can be time consuming and takes away quality time with others. The manager and provider both spoke of incidents where a lot of their time had been taken up supporting residents exhibiting challenges or require medical attention. Residents who require one or two one support to go out have this opportunity limited by the limited staff resources. The home currently has ten staff including the manager and the provider who also works hands on in the home. Cooking and domestic chores are undertaken by staff and at the time of the visit staff were not always visible as they were preparing the midday meal and cleaning. The recent sudden departure of a member of staff has not helped with the current staffing situation. A member of staff said: “It would be good to have more staff so we can spend quality time with the residents”. Recently a concern was raised by a visitor who reported to the Commission for Social Care Inspection that only one member of staff was on duty on a weekend day. Following the last visit to the home the inspector recommended that the home review is staffing levels as there appears to be little improvement in this area and concerns have been raised in respect of recent incidents in the home the manager will be required to reassess and improve staffing levels to meet the residents needs. The home undertakes a recruitment procedure where staff attend an interview and criminal record bureau (CRB) and protection of vulnerable people (POVA) checks on staff are obtained, and a record of the interview is kept, however staff do not complete an application and evidence in the files of the last two employed staff demonstrated that only one reference had been obtained for each. This practice places the residents at potential risk and must be improved upon. A requirement will be made in respect of recruitment. Cressage House DS0000062441.V338700.R01.S.doc Version 5.2 Page 28 Staff receive training to assist them and skill them to meet the needs of the residents. A recommendation was made following the last visit to the home that staff receive training that is specific to the needs of the residents. Through speaking with staff and viewing training records it was evident that the staff had received specific training such as understanding depression, schizophrenia and self-harm, medication training and dealing with difficult people. Some staff have also received training such as moving and handling, fire safety, first aid and food hygiene. Staff are encouraged to undertake a national vocational qualification (NVQ) and over 50 have now achieved this, however all training is undertaken in the staff’s own time. The regulations require that staff receive suitable assistance, including time off, for the purpose of obtaining further qualifications appropriate to such work. A requirement will be made in respect of this. Cressage House DS0000062441.V338700.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): 37,39, and 42. Quality in this outcome area is poor. 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, staff team and provider, however the lack of staff and management time to ensure all areas of the home are safe places them at risk of not having their holistic needs met. EVIDENCE: The annual quality assurance assessment (AQAA) tool stated under “What we do well” We do well to have a manager who has been managing in residential care for eight years and is able to run the home to meet its stated purpose aims and objectives which is to create an open, honest, positive and inclusive atmosphere. Cressage House DS0000062441.V338700.R01.S.doc Version 5.2 Page 30 To test this the inspector met and spoke with the manager at length, the provider, staff and viewed records pertaining to the health and safety of the home. It was evident through discussion with the manager, staff and residents that the manager is dedicated, hardworking and is working well towards creating an open, honest and positive atmosphere, however the manager lacks dedicated time to complete administrative tasks that are equally as important to the needs and health and safety of the residents and staff, such as: 1. Not completing care plans and risk assessments for newly admitted residents as soon as possible after their admittance. 2. Not undertaking a robust recruitment procedure and issuing prospective staff with applications. 3. Not reviewing and completing annual health and safety risk assessments. 4. Not showing awareness of the new legislation in respect of Fire Safety. The manager works long hours and at times is filling in at short notice to cover staff absences. This is not sustainable and could place the manager, residents and staff at potential risk. It is recommended that the manager is provided with more time to undertake these important tasks. 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 re meetings and everyone is given an opportunity to share their views ideas and concerns. The home has recently purchased a music centre and computer at the request of the residents. A resident said: “We are asked what we would like to do and have meetings where we discuss what’s going on in the home”. The residents went onto say that he felt well cared for and safe at Cressage House. A member of staff said: “ I think we provide a very good standard of care at Cressage House” A care manager said: “I can not think of anything to improve the service at this time.” And went on to say it is a very valuable service. Cressage House DS0000062441.V338700.R01.S.doc Version 5.2 Page 31 Through viewing service certificates of utilities, equipment and the installation of a new fire system, checks on fire appliances and training in fire safety and health and safety it was established that the manager and provider are aware of the importance of ensuring the residents and staff are living and working in a safe environment. However the lack of awareness of the new fire regulations, the failure to complete the required fire risk assessments and annual health and safety risk assessments, failure to have individual smoking risk assessments and residents repeatedly smoking in their rooms although their contract says they mustn’t places others at potential risk. The manager is required to seek advice from the fire rescue service regarding the new legislation and advice on people smoking in their bedrooms. Cressage House DS0000062441.V338700.R01.S.doc Version 5.2 Page 32 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 2 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 1 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 2 X 2 X X 1 X Cressage House DS0000062441.V338700.R01.S.doc Version 5.2 Page 33 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15 Requirement All the people who use the service must have personal care plans in place as soon as possible after they are admitted to ensure staff can provide a consistency of care, especially if their needs are complex and challenging. Timescale for action 18/07/07 2. YA9 13(4)(a)(b)(c) To safeguard all the people who use the service individual risk assessments must be in place for residents who choose to smoke in their own rooms. 22 18/07/07 3. YA22 All people who use the service 31/08/07 must be provided with information on how to make a complaint in a format that meets their needs. To safeguard all the people who use the service all staff must receive training in adult protection by the stipulated timescale. 31/08/07 4. YA23 13(6) Cressage House DS0000062441.V338700.R01.S.doc Version 5.2 Page 34 5 YA32 18(1)(a) The home must ensure that it has suffient staff on duty to meet the current needs of the people who use the service. 30/07/07 6. YA34 19(1)(a)(b)(c) To ensure the people who use the service are safeguarded from potential risk of harm a robust recruitment procedure must be undertaken at all times. 23(4) To ensure the people who use the service are safeguarded from the potential risk of fire the home must seek advice from the Hampshire Fire and Rescue service on the new legislation and residents smoking in their bedrooms. 30/07/07 7. YA42 30/07/07 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 To ensure important administrative duties are carried out as required it is recommended the manager have more time to do so. Cressage House DS0000062441.V338700.R01.S.doc Version 5.2 Page 35 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.V338700.R01.S.doc Version 5.2 Page 36 - 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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