Inspection on 19/07/05 for Crest House Care Home

This inspection was carried out on 19th July 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 01/12/05

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 6-8 St Matthews Road St Leonards-on-sea East Sussex TN38 0TN Lead Inspector Liz Daniels Unannounced 19 July 2005 09:40 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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 H59-H10 S21080 Crest House V232667 190705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Crest House Address 6-8 St Matthews Road St Leonards-on-sea East Sussex TN38 0TN 01424 436229 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Josephine Crawford Mrs Josephine Crawford Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (OP) 25 of places Crest House H59-H10 S21080 Crest House V232667 190705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. The maximum number of residents to be accommodated is twenty five (25) Date of last inspection 23 January 2005 Brief Description of the Service: Crest House is a detached property set in its own grounds in a quiet residential area of St. Leonards. 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 level access throughout the building, with a passenger lift to all floors. Two conservatories, and a sitting room provide communal space. Crest House H59-H10 S21080 Crest House V232667 190705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over a period of six and a half hours, beginning at 9.40am and finishing at 4.10pm. The Inspector met with the Care Manager, two carers, and another member of staff. The Inspector had a tour of the Home, and met with four residents and three visitors before inspecting a range of records and documentation. As the Manager was off-site on the day of the Inspection, some of the supporting documentation for the Inspection was not available for the Inspector to view. The Inspector therefore visited subsequently and met with the Manager for a further two hours. Four Requirements remain outstanding from previous Inspections. What the service does well: 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. Crest House H59-H10 S21080 Crest House V232667 190705 Stage 4.doc Version 1.40 Page 6 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 Standards Statutory Requirements Identified During the Inspection Crest House H59-H10 S21080 Crest House V232667 190705 Stage 4.doc Version 1.40 Page 7 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 standard(s) 1,3,4 and 5 The Service User guide needs completing although progress has been made since the last Inspection. The pre-admission assessment pro-forma that has been developed needs evaluating to ensure it provides sufficient information as a basis for a care plan. Following an assessment of a prospective resident, the Home should confirm in writing that they could meet their needs in respect of health and welfare. EVIDENCE: The Home is still developing a Service User guide. Currently some information is given to prospective residents in loose-leaf format. Photographs were taken recently to be included into the guide. The Service User guide has not yet been distributed to current residents within the Home. Following the Requirement of the last Inspection, the pre-admission assessment documentation has been developed. The Manager assesses prospective residents prior to admission and they are told verbally during their assessment whether or not the Home can meet their needs. They are offered the opportunity to visit and meet the other residents, staying for a meal where possible. The Manager also endeavours to involve the prospective resident’s relatives as much as is possible prior to admission. One resident spoken with had stayed at the Home for respite previously, so knew it. Two others had visited, but for another, relatives had been on his behalf. One resident said Crest House H59-H10 S21080 Crest House V232667 190705 Stage 4.doc Version 1.40 Page 8 her daughter had chosen her room for her. Another resident had not had the opportunity to choose initially but had been able to move when her present room became free. All are pleased with the Home. Crest House H59-H10 S21080 Crest House V232667 190705 Stage 4.doc Version 1.40 Page 9 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 standard(s) 7,8 and 10 As care appears to be based on informal verbal communication between staff, or events recorded in the ‘Report Book’, Care Plans must be developed for each resident. These must identify the health, personal and social needs of each resident, the care required and the aim of that care. There should then be an evaluation of the care provided to ensure its effectiveness for the resident. The Home has good contact with local health services. EVIDENCE: Three resident’s files were viewed during the Inspection. All contained an initial assessment, a Resident’s Risk Assessment, a Manual Handling Profile and a Dependency Profile. These were last reviewed in January 2005 for the files seen. A Daily Record sheet is also included to record any significant events. However, the residents do not have their own individual plan of care, identifying health, personal and social needs. There are no clear goals and outcomes recorded. Any changes in care are passed on verbally between shifts and are recorded in the ‘Report Book’. The Home enables residents to have access to external health professionals, including chiropodists, dentists, district nurses, and opticians. Staff accompany them to health appointments as needed. Staff confirmed the importance of promoting privacy and respect when residents are undergoing examinations or personal care. During the Inspection, staff were observed to be attentive and considerate. Crest House H59-H10 S21080 Crest House V232667 190705 Stage 4.doc Version 1.40 Page 10 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 standard(s) 13 and 15 The staff at Crest House recognise the importance of ensuring individual needs and beliefs are met and promote alternative activities for the residents, welcoming visitors to join in as they wish. The menus provided are generally varied to provide a balanced diet and specific dietary needs are met. EVIDENCE: The Inspector found the ethos of the Home to be one of encouragement for residents to join in activities and pursue interests. Outings are organised by the Home and staff confirmed that relatives and visitors are welcome to join in or to visit the Home at any time. A weekly programme of activities is organised and ladies from the local church come in and meet with the residents each week. Two residents are involved with a club and church activities. There is a visiting library and a tuck shop at the Home. Food and drinks are available throughout the 24-hour period, and a varied, nutritious menu is offered, which is rotated every four weeks. There is a main meal midday with a lighter snack or sandwiches for supper. The cook confirmed that residents can choose an alternative of their choice and that special diets can be accommodated. The four residents, who met with the Inspector, described the food as good in general and confirmed that they are given the opportunity to choose alternatives to the main meal if they wish. One resident felt the evening supper could be more varied to avoid having sandwiches as often. Another was pleased that despite not being able to eat certain foods, he receives a varied diet. The kitchen was found to be clean and plans are being made to include a hand washbasin, as recommended following the Crest House H59-H10 S21080 Crest House V232667 190705 Stage 4.doc Version 1.40 Page 11 Environmental Health Office Inspection. Meals are mainly taken in the Dining Area, which is comfortable and welcoming. Alternatively residents can choose to eat in their rooms. Crest House H59-H10 S21080 Crest House V232667 190705 Stage 4.doc Version 1.40 Page 12 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 standard(s) 18 The Home has made good progress in ensuring staff have training in Adult Protection. EVIDENCE: Following the Requirement made at the last inspections, the Home has purchased a training package in Adult Protection. All staff have had their own copy of the Training Manuel and have completed questionnaires which have been marked in-house. A further multi-choice questionnaire will be sent away and marked externally: staff will receive a Certificate if they score well. New staff will have to complete the training within two months of their start date. The Home has a procedure in place for adult protection and the prevention of abuse. Staff are aware of who to discuss any concerns with and where to find the procedure. Crest House H59-H10 S21080 Crest House V232667 190705 Stage 4.doc Version 1.40 Page 13 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 standard(s) 19,23,24,25 and 26 There should be an Annual Development Plan developed for the Home to schedule maintenance and repairs, a Requirement of the last two Inspections, that has not been met. Generally the Home appears to be well maintained and in good repair. However the carpets, which are unsafe as they have tape over them, must be replaced or repaired to avoid the long-term use of carpet tape and thereby maintain a safe environment. EVIDENCE: The Home has steps up to the front entrance but level access throughout the building, with a passenger lift to all floors. Two conservatories, a sitting room and dining area provide communal space. The carpet in the main walkways and on some of the stairs is covered with strips of carpet tape which is curling back. Although there is still no Annual Development Plan available for the Home, a Requirement of the last two Inspections, it is the Manager’s intention to replace the carpet in the front entrance this year. The bedrooms have been personalised and each room has its own telephone. The four residents who met with the Inspector all feel their rooms are homely and comfortable. A nurse call system is available in each room. The bedroom doors have no lock but the Inspector was advised that this is dependant on resident’s choice: none Crest House H59-H10 S21080 Crest House V232667 190705 Stage 4.doc Version 1.40 Page 14 of the residents who met with the Inspector wish to have their doors locked. Resident’s can choose to have a safe in their room if they wish to have lockable space. All areas seen were clean and free from odour. Water temperature checks are undertaken monthly. Crest House H59-H10 S21080 Crest House V232667 190705 Stage 4.doc Version 1.40 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29,30 The Manager must ensure the Home is staffed with an appropriate skill mix of staff in her absence. The Manager must be undertaking NVQ level 4 by the end of 2005 and the 2 carers enrolling for their NVQ level 2 in September will be insufficient to meet the National Minimum Standard of 50 staff being trained by 2005. EVIDENCE: On the day of Inspection, the Manager was off site and not available. There was no designated senior member of staff rostered for the morning, whilst the Manager was off site. Two carers were rostered for 8am-2pm, with a third from 8.30am – 11.30am. The Care Manager was due on duty at 2pm but was called in to meet with the Inspector and facilitate the Inspection. There are no carers designated as senior carers. Two carers were rostered to start work at 2pm, one to finish at 7pm and the other at 8pm. A ‘supper girl’ works from 4.30pm – 6.30pm and helps with serving supper. A cook works from 9.30am – 2pm and the care staff then prepare the evening meal. At night one carer is awake and on duty from 8pm – 8am and there is also a sleep-in carer on duty from 7pm – 8am. The Care Manager is currently undertaking her NVQ level 4, having previously completed the Assessors course and Advanced Managers Course (AMC). The Registered Manager has similarly completed her AMC. She has not yet undertaken her NVQ level 4. It is anticipated that 2 carers will be enrolling with the College to start their NVQ level 2 in September. The training files and staff files were unavailable to be viewed in the absence of the Manager, but 2 staff files were seen at the follow-up visit. Both staff have a Contract of Employment, a Requirement of the last Inspection. On the previous inspection, two files that were examined did not contain evidence of CRB checks. When addressed during the follow-up visit, the Manager stated Crest House H59-H10 S21080 Crest House V232667 190705 Stage 4.doc Version 1.40 Page 16 that both files had been for workers helping with non-direct care, who were both under 16years old. No new staff have commenced with the Home since the last Inspection. There are records of CRB disclosures in the staff files viewed. Crest House H59-H10 S21080 Crest House V232667 190705 Stage 4.doc Version 1.40 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33,36,37 and 38 The Home must actively seek feedback from residents about the services provided and include this in the service user guide. This feedback must inform future planning and service provision. The views of family, friends and stakeholders in the community should also be sought. In general, the Home’s environment and equipment are maintained but the hoist must be serviced or removed from use to ensure its safety with residents. Training in Moving & Handling techniques and First Aid must be organised for care staff. The Home should collate its Health & Safety inspection records to ensure all checks and inspections are maintained. Staff must have the opportunity for formal supervision at least six times a year. EVIDENCE: Residents tend to meet downstairs for coffee each morning and chat. Staff stated that they are confident that over coffee, residents will discuss any concerns they may have and bring those issues to their attention. Residents when asked, stated that they feel they can raise issues with individual staff but did not specify coffee time as a time when they can express their views: a formal system of receiving feedback from residents and their relatives is not in Crest House H59-H10 S21080 Crest House V232667 190705 Stage 4.doc Version 1.40 Page 18 place. This was a Requirement of the last Inspection. The training files and staff files were unavailable to be viewed at the Inspection, in the absence of the Manager, but were seen at the follow-up visit. The Manager meets with staff daily and discusses progress with them as appropriate. However there is no record of formal supervision, a Requirement from the last four Inspections. The Manager is exploring methods of formalising training within the Home and training in First Aid and Moving & Handling is therefore not yet underway. These were also Requirements from the last Inspection. Records to promote and protect clients were inspected. The Lift was last serviced on 1st February 2005 and the last Gas service was on 1st July 2005. PAT testing was undertaken on 11th February 2005: the Care Manager stated that 112 items were tested although there was no documentation to support this. The emergency call system was last checked in January 2005. There was no evidence of a service contract for the Home’s hoist – the label on it indicated that it had last been checked on 9th October 2001. Records of fire and water checks were viewed. The fire alarm system and the emergency lighting are checked weekly and were last checked on 11th July 2005. The last fire drill was on 30th December 2004. The fire extinguishers were checked on 15th April 2005. Crest House H59-H10 S21080 Crest House V232667 190705 Stage 4.doc Version 1.40 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x 2 2 3 x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 2 x x x 3 3 3 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 3 x x 2 x x 2 2 3 Crest House H59-H10 S21080 Crest House V232667 190705 Stage 4.doc Version 1.40 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 4.1 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. Individualised Care Plans must be developed for each resident Timescale for action 30 September 05 31 October 05 30 November 05 1 October 05 31 October 05 31 October 05 2. 3. 7 19 15(1)(2)( a)(b)(c)(d ) 23(2)(b) 4. 28 5. 33 6. 36.2 7. 8. 38.2 38 The carpet which is taped must be renewed or repaired to avoid the long term use of carpet tape. [This has been a Requirement of the last two inspections]. 18(1)(a50 of care staff must be c).Schedul trained to NVQ level 2, or e 2(4) equivalent, or enrolled for the training. 24(1)(a)( A quality assurance system must b)(2)(3) be introduced into the Home. [This was a requirement of the last Inspection]. 18(2) Care staff must receive formal supervision at least six times a year. [This has been a Requirement of the last four inspections]. 13(4)(c)( The Homes hoist must be 5) serviced, or removed from use, to ensure its safety for residents. 18(c )(1) Staff must have training in health & safety including First H59-H10 S21080 Crest House V232667 190705 Stage 4.doc 31 August 05 30 November Page 21 Crest House Version 1.40 Aid. [This has been a Requirement of the last two Inspections]. Staff must have training in Moving & Handling 05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 3 38 Good Practice Recommendations The pre-admission assessment pro-forma that has been developed needs evaluating to ensure it provides sufficient information as a basis for a care plan. The Home should collate its Health & Safety inspection records to ensure all checks and inspections are maintained. Crest House H59-H10 S21080 Crest House V232667 190705 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Ivy House 3 Ivy Terrace Eastbourne East Susssex 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. 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