Inspection on 01/12/05 for Crest House Care Home

This inspection was carried out on 1st December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Crest House Care Home 22/06/07

Crest House Care Home 03/05/06

Crest House Care Home 19/07/05

Crest House Care Home 23/01/05

Crest House Care Home 18/11/04

Crest House Care Home 02/03/04

Similar services:

Springfield House

The Shelley

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Crest House Care Home 6-8 St Matthews Road St Leonards-on-sea East Sussex TN38 0TN Lead Inspector Liz Daniels Unannounced Inspection 1st December 2005 10:30 X10015.doc Version 1.40 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 Crest House Care Home DS0000021080.V269890.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 Older People. 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. Crest House Care Home DS0000021080.V269890.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Crest House Care Home Address 6-8 St Matthews Road St Leonards-on-sea East Sussex TN38 0TN 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) 01424 436229 01424 436229 Mrs Josephine Crawford Mrs Josephine Crawford Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Crest House Care Home DS0000021080.V269890.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The maximum number of service users to be accommodated is twenty-five (25) Service users must be older people aged sixty-five (65) years or over on admission 19th July 2005 Date of last inspection Brief Description of the Service: Crest House is a detached property set in its own grounds in a quiet residential area of St. Leonard’s-On-Sea. Local shops are nearby and bus routes run close to the Home. The nearest railway station is approximately half a mile away. The Home provides seventeen single bedrooms and four double rooms, currently used as singles. Twenty of the rooms have en-suite facilities. The Home has steps up to the front entrance but there is also a sloped pathway and level access throughout the building, enabling wheelchair access. There is a passenger lift to all floors. Two conservatories, and a sitting room provide communal space. Crest House Care Home DS0000021080.V269890.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over a period of almost eight hours beginning at 10.30am. The Inspector met with the Registered Manager and two other staff. Although a full tour was not undertaken on this occasion, the Inspector met with several of the residents who were spending time in the lounge area and chatted with three residents in private, two of them in their bedrooms. A range of documentation and key records was then inspected. This report should be read in conjunction with the report from the first inspection this year, on 19th July 2005. What the service does well: What has improved since the last inspection? What they could do better: The Resident’s Guide needs completing although progress continues to be made. The Manager must confirm in writing that following a pre-admission assessment, the Home can meet the resident’s needs in respect of health and welfare. This was a Requirement of the last Inspection. Progress is being made in the development of Care Plans, but the health, personal and social Crest House Care Home DS0000021080.V269890.R01.S.doc Version 5.0 Page 6 needs and the care required, must be documented in a Care Plan for each resident. Progress has been made in developing effective quality assurance but the questionnaire must be distributed to residents and their relatives to meet the Requirement from the last Inspection. Radiators must be guarded, to reduce the risk of residents being burnt if they fall against them. Currently only 17 of care staff are training / trained in NVQ level 2: this will rise to 23 once the carer enrols for the course in March. All staff must be trained in Moving & Handling: similarly all staff must be trained in First Aid. All staff should have access to formal supervision at least six times a year. 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. Crest House Care Home DS0000021080.V269890.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Crest House Care Home DS0000021080.V269890.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,4 and 6 The Resident’s Guide needs completing although progress continues to be made. The pre-admission assessment pro-forma is comprehensive, providing suitable information as a basis for a care plan. The Manager must confirm in writing that following the pre-admission assessment, the Home can meet the resident’s needs in respect of health and welfare. This was a Requirement of the last Inspection. EVIDENCE: Crest House has the information for a Resident’s Guide, although this remains in loose-leaf format. It is given out to prospective residents but the Manager confirmed that she intends to change the format, and circulate it to the current residents. Although the complaints procedure and most recent inspection report from the Commission are not included, these are publicised by being on display in the main entrance of the Home. Unplanned admissions to Crest House are avoided where possible. When an enquiry is made to the Home, prospective residents and their relatives are invited to visit, to spend time meeting staff and fellow residents and enjoy a meal. They can also view the available rooms and discuss the Home’s suitability. If they wish to pursue an admission, the Manager of the Home undertakes an assessment and completes the pre-admission Crest House Care Home DS0000021080.V269890.R01.S.doc Version 5.0 Page 9 assessment pro-forma that has been developed, trialled and evaluated. She currently informs the prospective resident verbally whether or not the Home is able to meet their assessed needs, although the Manager reported that a letter to confirm in writing is being developed. Residents then move in for a four-week trial period to ensure the Home’s suitability for them. Crest House does not offer intermediate care, although residents can be admitted for respite care. Crest House Care Home DS0000021080.V269890.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 and 9 Progress is being made in the development of Care Plans, but the health, personal and social needs and the care required, must be documented in a Care Plan for each resident. This was a Requirement from the last Inspection. Good processes are in place for the ordering, administration and disposal of medication. EVIDENCE: Four resident’s files were viewed. Two of those were for residents who are having respite care and assessment documentation had been completed. If the resident stays longer than 4 weeks the plan is to then develop a Care Plan for them. One resident has a Care Plan in place, which had just been developed so has not yet been reviewed. A general Risk Assessment and a Risk Assessment for Manuel Handling had been completed. A dependency profile had been completed and reviewed in September and October. Residents are asked on admission as to whether they wish to administer their own medication or wish to hand over the responsibility to the Home. If they wish to self medicate, a Risk Assessment is undertaken and the medication is stored in the individual’s room. There is informal monitoring of usage by the staff and if there is concern that medication is not being taken, as needed, a further Risk Assessment is undertaken. The medication for the Home is kept in Crest House Care Home DS0000021080.V269890.R01.S.doc Version 5.0 Page 11 a locked cupboard in the dining area. All the medication is stored in measured doses for a 4-week period. The medicine charts were seen and were correctly maintained. Photographs of all the residents are kept in a box in the medicine cupboard. This was discussed and the Home plans to include the photos with the medicine charts. A ‘Boots’ pharmacist audits the medication three monthly and all unwanted medications are collected and disposed of by ‘Boots’. New care staff are accompanied and supervised when initially administering medication and the ‘Boots’ pharmacist teaches basic principles. However, the Home has also purchased a distance learning training package of which medication is a part. The aim is that all care staff will undertake that training. Crest House Care Home DS0000021080.V269890.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 14 The staff at Crest House recognise the importance of ensuring individual needs and beliefs are met, offering choice and flexibility for the routines of daily living. A good programme of activities is in place. Good financial management of personal monies are in place. EVIDENCE: On the day of Inspection the atmosphere within the Home appeared happy and comfortable. Residents were choosing to spend time either in their own bedroom, or in the lounge. Staff confirmed that visitors are welcome at any time. There is a cat that lives at the Home and the Manager brings her little dog in each day to visit. Activities are organised most days, within the Home and trips out are arranged. The residents are told verbally about forthcoming activities and posters in the lounge and dining areas publicise any significant events. Residents of differing denominations are supported in their religious observance, dependant on their wishes and a service is held at the Home every fortnight for those who wish to join in. The residents choose their meals and the Manager confirmed that special diets can be accommodated and that residents can choose an alternative if they do not care for the choices on the menu. The Home does not act as the appointee for any resident but does collect the allowance for one resident from the Post Office then gives it to them. Residents or their relatives pay money for the chiropodist who visits 6weekly, or the hairdresser who visits fortnightly. All money is held separately Crest House Care Home DS0000021080.V269890.R01.S.doc Version 5.0 Page 13 in a locked cupboard. Alternatively, services and sundries are paid for from petty cash then the resident or their relative asked to reimburse. Records are kept of any transactions. Residents are encouraged to bring their own possessions into the Home and there was evidence during the Inspection that rooms had been personalised with furnishings and small items of furniture. Crest House Care Home DS0000021080.V269890.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 Good practise for the management of complaints is in place. EVIDENCE: No complaints have been forwarded to the Commission since the last Inspection. There is a complaints procedure, which the staff, when asked, said they were aware of. The procedure is publicised in the main entrance of the Home. All complaints and their outcome are recorded: there have been no complaints recorded for two years. Three residents stated that they could raise any concerns with the person-in-charge and be confident that they would be listened to and their concern acted upon. Crest House Care Home DS0000021080.V269890.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 20 The accommodation at Crest House is comfortable, safe and well maintained. A pleasant courtyard, gardens and lawns surround the Home. The current redecoration and re-furbishing programme has been well planned to cause minimal disruption to the residents. EVIDENCE: Crest House is a large detached property with steps up to the front entrance but also a sloped pathway and level access throughout the building, enabling wheelchair access. A full tour was not undertaken at this Inspection but there was the opportunity to see two bedrooms and the communal areas of the Home. Comfortable accommodation is arranged over three floors with a shaft lift to provide access for those with limited mobility. There are two conservatories, a sitting room and a dining room to provide communal space. A small courtyard garden at the back of the Home can be accessed from the conservatories, providing a pleasant seating area. The carpet in the main walkways remains worn and covered with strips of carpet tape. However as a redecoration programme had been planned to start imminently, it was agreed that the replacement of the downstairs carpeting would not be undertaken Crest House Care Home DS0000021080.V269890.R01.S.doc Version 5.0 Page 16 until the remainder of the re-decoration had been completed. The Manager has confirmed since the Inspection, that one bedroom has already been repainted and new carpet laid. The vacant rooms will be decorated initially then residents move for short periods whilst their rooms are upgraded. The Fire Alarm system and Emergency Lighting was inspected and serviced on 29th November 2005. Fire training is in place: the last session was on 18th August. However the night staff were unable to attend. One member of staff who started in May 2005 has also not had training although she had been shown where the fire alarms and extinguishers are and taught about fire procedures as part of the Induction programme. The last fire drill was during the afternoon of 27th July when five staff were present. Crest House Care Home DS0000021080.V269890.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28 and 30 Currently 17 of care staff are training / trained in NVQ level 2: this will rise to 23 once the carer enrols to start the course in March. Good progress has been made in providing formal training opportunities for the staff. EVIDENCE: There are 13 care staff, including the Care Manager, employed at Crest House. 2 of those staff started studying for their NVQ level 2 in September 2005. Another is awaiting interview (which the Manager anticipates will be in December) and hopes she will be starting the course next March (2006). The Home has now purchased a training programme, which has many modules and is studied for in house. Each module is then assessed externally before a Certificate of competence is given. The two staff who have joined the Home most recently are undertaking the Induction training and all staff will undertake the Foundation training. 3 care staff are now trained as trainers in Moving & Handling. It was agreed at the Inspection that as staff have not had their Moving and Handling training for over a year, a programme of training to train all the staff would commence in January. The Manager has endeavoured to ascertain the standard of the training package in relation to NVQ. The company supplying the package informed her that it developed an “underpinning knowledge that can be cross-referenced to NVQ level 2”. Crest House Care Home DS0000021080.V269890.R01.S.doc Version 5.0 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36 and 38 A Manager with very good experience runs the Home. A copy of City & Guild’s confirmation that the AMC equates to the RMA should be sent to the Commission. Progress has been made in developing effective quality assurance but the questionnaire must be distributed to residents and their relatives to meet the Requirement from the last Inspection. Good financial arrangements for residents’ monies are in place. Staff should have access to formal supervision at least six times per year. All staff must be trained in Moving & Handling: similarly all staff must be trained in First Aid. Radiators must be guarded, to reduce the risk of residents being burnt if they fall against them. EVIDENCE: The Manager has many years experience managing Crest House and caring for older people. She has attained the Advanced Managers Course (AMC). Her deputy, the Care Manager, is currently studying for her NVQ level 4 and also holds the Advanced Management Course (AMC). City & Guilds have written to Crest House Care Home DS0000021080.V269890.R01.S.doc Version 5.0 Page 19 the Care Manager to confirm that this equates to the Registered Managers Award. It was agreed that a copy of that confirmation would be forwarded to the Commission. The Inspector was shown the outline of a questionnaire to actively seek feedback from the residents and their relatives about the services provided by the Home. This has not yet been circulated but it was agreed at the inspection that this would be distributed in February and collected and analysed in March. Some of the residents handle their own financial affairs, or relatives and solicitors are appointed to act on their behalf. The Home’s management team do not act as appointees for the financial affairs of any of the residents. However, the Manager is authorised to draw the personal allowance for some residents; this is then given to the residents as cash each week. The owner for the Home invoices residents or their appointee for the fees approximately each month: sundry items or services are not included on the invoice. Any money brought in is held in the safe and separate balance books are maintained. The Manager continues to meet with staff daily and discuss their progress with them as needed. Staff feedback and observation during the Inspection was that all staff access the Manager as they need and the Manager monitors the progress and development of the staff. However this is informal, not planned and not documented as supervision. The development of formal supervision has been a Requirement from the last five inspections. Standard 38 and the health, safety and welfare of residents was not fully assessed during this inspection. However, it was observed that the radiators throughout the Home do not have guards to protect residents from the risk of being burnt. The Manager stated that these would be ordered and bought in the New Year. The Hoist, which was rarely used and had not been serviced regularly, is now being stored upstairs and is labelled as out of use. This meets the Requirement from the last Inspection. A training package has been bought for the Home and staff are undergoing training. 3 care staff are now trained as trainers in Moving & Handling. It was agreed at the Inspection that as staff have not had their Moving and Handling training for over a year, a programme of training to train all the staff would commence in January. This was a Requirement from the last inspection. Similarly 3 care staff are now trained as trainers in First Aid and will train all the staff. A programme for this has not yet been arranged. Crest House Care Home DS0000021080.V269890.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 x 3 3 X X X X X x STAFFING Standard No Score 27 x 28 1 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 3 2 x 2 Crest House Care Home DS0000021080.V269890.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? Yes 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 OP4 Regulation 14(1)(d) Requirement The Manager must confirm in writing that following the assessment the Home can meet the residents needs in respect of health & welfare. This was a Requirement from the last Inspection. Individualised Care Plans must be developed for each resident. This was a Requirement from the last Inspection. 50 of care staff must be trained to NVQ level 2, or equivalent, or enrolled for the training. This was a Requirement from the last Inspection. A quality assurance system must be introduced into the Home. This has been a Requirement from the last two Inspections. Care staff must receive formal supervision at least six times a year. This has been a Requirement of the last five inspections. Staff must have training in health & safety including First DS0000021080.V269890.R01.S.doc Timescale for action 28/02/06 2. OP7 15(1)(2(a -d) 18(1) (a-c), Sch2(4) 28/02/06 3. OP28 31/03/06 4. OP33 24(1)(a) (b)(2)(3) 31/03/06 5. OP36 18(2) 31/03/06 6. OP38 18(c)(1) 31/03/06 Crest House Care Home Version 5.0 Page 22 7. OP38 13 (4)(a)(c) Aid. Staff must have training in Moving & Handling. This has been a Requirement of the last two Inspections. Radiators must be guarded, to reduce the risk of residents being burnt if they fall against them. 28/02/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP38 Good Practice Recommendations The Home should collate its Health & Safety inspection records to ensure all checks and inspections are maintained. Crest House Care Home DS0000021080.V269890.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Crest House Care Home DS0000021080.V269890.R01.S.doc Version 5.0 Page 24 - 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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