CARE HOME ADULTS 18-65
Cressage House 30 St Edward`s Road Southsea Hampshire PO5 3DJ Lead Inspector
Lorraine Parton Unannounced Inspection 7th October 2005 09:00 Cressage House DS0000062441.V255334.R01.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Cressage House DS0000062441.V255334.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cressage House DS0000062441.V255334.R01.S.doc Version 5.0 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), Mental disorder, registration, with number excluding learning disability or dementia (13) of places Cressage House DS0000062441.V255334.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Two service users currently residing over the age of 65 may remain in the home 14th April 2005 Date of last inspection Brief Description of the Service: Cressage House is a care home situated in a residential area of Southsea, Portsmouth. The home is registered for thirteen service users within the category of younger adults with learning disabilities and mental health, however, the home also accommodates two service users within the older persons category as they have lived at the home for many years. The home is situated close to local ammenities and a short distance from the town of Portsmouth. The home has a minibus and as such service users are able to access venues afield. The home provides a range of accommodation in single and double bedrooms and on the ground floor is a lounge, dining room and a smokers room. The home also has a domestic kitchen and service users who are able can access the kitchen to prepare snacks and drinks as they choose. The home has a rear enclosed garden that is accessable through the home. Cressage House DS0000062441.V255334.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the second inspection the home received this year. The purpose of the second inspection was to follow up on the legal requirements made at the last inspection in April 05 and to audit the remaining standards that were not audited in the first inspection. Due to circumstances found at the home the inspector was unable to carry out a full inspection and as such many of the standards were not audited. The inspector spent the majority of the inspection attending to issues raised by service users during the inspection. The inspector will be carrying out a third inspection of the home to ensure compliance with matters brought to the homes attention in April 05 and from this inspection report. At the time of the inspection two staff were on duty and one of the homes staff partially assisted the inspector. The inspector had the opportunity to speak to service users who were generally positive about the home, however, concerns were raised about staff which has been dealt with separate to this report. These matters have been dealt with as part of the adult protection procedures. The registered manager attended the home at the inspectors request and appropriate action was taken. The registered manager assisted the inspector with some of the inspection. The inspector undertook a walk around the home and noted that the environment has been improved since the last inspection. What the service does well:
The home is working hard to involve service users in the home and service users confirmed that they are able to participate in the home as they choose. Several service users were seen participating in the home and this included washing up, assisting with preparation of meals and in the garden. Service users confirmed that they help their selves to snacks and drinks when they choose. The home is holding service user meetings and the service users state that they are able to express their views freely. Service users confirmed that the home attempts to address their issues to a satisfactory conclusion. The home enables service users to participate within the community and many of the service users attend activities of their choice, which have been provided on an individual basis. The home has made many improvements in the
Cressage House DS0000062441.V255334.R01.S.doc Version 5.0 Page 6 activities provided in the home. Service users wishing to find work are assisted by the home. Service users confirmed that they enjoy their lifestyles and that they can go out and to venues of their choice whenever they want. The home has started to provide staff training and staff have received training in adult protection, fire, hygiene and has booked first aid and food hygiene for November and December 05. Staff are commencing the NVQ 2 in the near future, however, the home is currently waiting for a start date. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office.
Cressage House DS0000062441.V255334.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cressage House DS0000062441.V255334.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): NONE EVIDENCE: Cressage House DS0000062441.V255334.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 8, 9 Service user plans were basic and did not include all identified needs and wishes. Service users are consulted about their lives and the running of the home. Service users are able to take risks, however, this is not supported by suitable assessments and documented risk assessments. EVIDENCE: The inspector was advised that the home had not reviewed any of the care plans since the last inspection. Care plans were found to be inadequate at the last inspection. This requirement remains outstanding from the last inspection. The home has not undertaken risk assessments for service users. This remains outstanding from the last inspection. The home is continuing to hold service user meetings, which service users state they find useful. Service users confirmed that they are able to
Cressage House DS0000062441.V255334.R01.S.doc Version 5.0 Page 10 participate within the home and service users are able to access the homes kitchen for snacks and drinks as they choose. Service users confirmed that staff ask them what they want to do and support their decisions in matters relating to their lifestyles. Cressage House DS0000062441.V255334.R01.S.doc Version 5.0 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 17 Service users confirmed that the home support their choices in activities. Service users participate in the community as they wish. Service users are able to choose whom they maintain relationship with. Service users confirmed that the home provides a range of healthy menus that are based on their wishes. EVIDENCE: Service users spoken to advised the inspector that they spend their days as they choose and that the homes staff support their wishes or encourage participation in a range of activities provided by the home. Several service users attend college for courses that they have chosen and two service users go to work. One service user is involved in their church and are actively involved on a daily basis. Some service users go out alone and therefore access the local facilities of their choice. The home has recently started to provide service users with the
Cressage House DS0000062441.V255334.R01.S.doc Version 5.0 Page 12 opportunities to go out with support. Service users confirmed that they enjoy the activities provided by the home. The home provides a range of activities in the evenings, however, these don’t appear to be organised and they are dependent on the homes staff. The inspector did not witness any activities, however, service users were seen to be participating in the home. The home welcomes visitors to the home. Service users confirmed that they are able to visit friends and family as they choose and that they are also welcome in the home. Service users stated that they are able to see their visitors in private either in the room or elsewhere in the home if not in use by other service users. The home is holding service user meetings, which are documented. Service users advised the inspector that these enabled them to voice their opinions about the home. Service users stated if they were concerned about anything they would discuss this with the homes manager who they feel would listen and act upon their wishes. On the day of the inspection the home was offering a main meal, no alternative was available. Fresh fruit was provided and service users advised the inspector that they help their selves to snacks and drinks. Service users stated that the food is always good and that they are involved in the selection of the homes menu’s. Service users were relaxed during their meal, however, only one member of staff was available during the meal and they appeared very anxious as they were trying to serve food and prepare the meal. Cressage House DS0000062441.V255334.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20 Medication practices are not always safe. EVIDENCE: At the time of the inspection the office keys had been locked in the office and the staff were waiting for a joiner to open the door. Because of this medication that should have been given at lunch time was not given until two thirty. On audit of the records it was noted that the member of staff administering medication had signed for one service user evening medication and had not signed for one service user lunch medication. Medication is stored in a monitored dosage system and there was no evidence to support that incorrect medication had been administered. The home is required to ensure all staff follow correct medication procedures and that records are maintained. The homes manager advised the inspector that staff are currently undergoing a training programme on medication. Cressage House DS0000062441.V255334.R01.S.doc Version 5.0 Page 14 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None EVIDENCE: Previous inspections display that the home meets these standards. During the inspection three service users raised concerns with the inspector relating to verbal abuse. This has been dealt with in accordance with Hampshire’s adult protection procedures. The home has taken appropriate action. Cressage House DS0000062441.V255334.R01.S.doc Version 5.0 Page 15 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 27, 30 The home was clean, homely and some communal areas decorated in accordance with service user choices. The home has not undertaken risk assessments, however, the home has implemented a range of control for identifiable risks. EVIDENCE: The home has renovated the homes bathrooms and several bedrooms since the last inspection. Service users confirmed that they had been involved in the decorating selection. This had been a previous legal requirement. At the time of the inspection the home was clean and no odours were evident throughout the building. The home has a separate kitchen and laundry and staff have received recent training in hygiene practices. The home has not undertaken risk assessments, however, the home has implemented controls for the risk of falls from first floor rooms, burns from hot surfaces and scalding from hot water. All chemicals were found to be stored in a locked area. The inspector did not audit the homes certificates and this will be audited at the next inspection. The home is required to undertake risk assessments, which remains outstanding from the last inspection.
Cressage House DS0000062441.V255334.R01.S.doc Version 5.0 Page 16 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 34, 35 The home has inadequate staffing levels. Staff are currently receiving training based on service user needs. The home has not implemented suitable recruitment practices to ensure service users are protected. EVIDENCE: At the time of the inspection two care staff were on duty. One of the care staff was preparing and serving lunch and the other was cleaning a service user bedroom. The homes cleaner was not on duty. The inspector was let into the home by service users and it was several minutes before the inspector located a member of staff. On speaking to staff later on in the inspection it was ascertained that at times throughout the day two staff are inadequate to meet service user needs and that service users are unsupervised at times. On speaking to service users they advised the inspector that staff are busy and at times they do not have time to support them. Staff and service users advised the inspector that in the afternoon staff are more relaxed and can offer individual support and provide activities if service users wish. The home is required to review its staffing levels in accordance with service user needs. Cressage House DS0000062441.V255334.R01.S.doc Version 5.0 Page 17 The home is continuing to ensure staff training needs are met and have provided a range of training courses since the last inspection. Staff advised the inspector that the home has booked several staff onto the NVQ 2 training course and is awaiting start dates. Training has been based on mandatory courses and around service user needs. Training will be further audited at the next inspection. The inspector audited one new staff file, which did not contain all relevant information required. This included no confirmation of a CRB or POVA check, no application form, no interview record, only one reference had been obtained. Another member of staff had been employed for a short period to cover sickness and no checks had been undertaken. This is unacceptable. This remains outstanding from the last inspection. The home is required to ensure that they implement a suitable recruitment procedure before employment of future staff and that staff files contain all required information. Cressage House DS0000062441.V255334.R01.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 Service users do not always benefit from the way the home is run. EVIDENCE: Throughout the inspection there were several areas of concern noted by the inspector that indicated that the home is experiencing difficulties. The areas of concern have been included in the report and refer to outstanding and new items identified in the inspection including staffing levels. On speaking to the manager it was clear that managerial hours is at times minimal as the manager also needs to cover the home due to lack of staff and does not always have time to undertake the management role. Both the manager and the provider are registered with CSCI, and whilst the manager is responsible for the day to day care, the Responsible Individual is responsible overall for ensuring a safe building, and also for enabling the manager to effectively manage the day to day operation of the home. The home is required to ensure that the manager provides a minimum of thirty hours per week solely for the purpose of management of the home. Cressage House DS0000062441.V255334.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score N/A N/A N/A N/A N/A Standard No 22 23 Score N/A N/A ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 1 N/A 3 1 N/A Standard No 24 25 26 27 28 29 30
STAFFING Score 3 N/A N/A 3 N/A N/A 3 LIFESTYLES Standard No Score 11 N/A 12 3 13 3 14 3 15 3 16 N/A 17 Standard No 31 32 33 34 35 36 Score N/A N/A 2 2 1 N/A CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Cressage House Score N/A N/A 2 N/A Standard No 37 38 39 40 41 42 43 Score 2 N/A N/A N/A N/A N/A N/A DS0000062441.V255334.R01.S.doc Version 5.0 Page 20 Yes 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 4,5 Requirement Review and amend the homes statement of purpose and service user guide. This remains outstanding from the last inspection. Implement a documented system of assessment of potential service users. This remains outstanding from the last inspection. Review and develop all service user plans. This remains outstanding from the last inspection. Review and document service user risk assessments and incorporate them into the service user plans. This remains outstanding from the last inspection. Assess and implement suitable risk assessments for the home. This must include the environment, equipment and individual staff roles. This remains outstanding from the last inspection. Implement a suitable system for staff supervision. This remains outstanding from
DS0000062441.V255334.R01.S.doc Timescale for action 31/12/05 2 YA2 14 31/12/05 3 YA6 15(2) 31/12/05 4 YA9 13 31/12/05 5 YA24 13(3) 31/12/05 6 YA32 18 31/12/05 Cressage House Version 5.0 Page 21 the last inspection. 7 YA34 19 Implement a thorough recruitment programme for new staff. Current staff files must be reviewed and all relevant information be obtained. This remains outstanding from the last inspection. Review staffing levels in accordance with service user needs. The home must provide a minimum of two carers during the day. None care duties must be separate to care hours. Ensure the management hours are a minimum of thirty hours per week. Ensure all staff follow correct medication procedures in accordance with the homes medication policy and procedures. 31/12/05 8 YA33 18(1) 31/12/05 9 10 YA43 YA20 10 13(2) 31/12/05 31/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Cressage House DS0000062441.V255334.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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