Inspection on 02/03/04 for Crest House Care Home

Care Home For Older PeopleCrest House Care Home6-8 St Matthews Road St Leonards-on-sea East Sussex TN38 0TNAnnounced Inspection2nd March 2004 Commission for Social Care InspectionLaunched in April 2004, the Commission for Social Care Inspection (CSCI) is the single inspectorate for social care in England. The Commission combines the work formerly done by the Social Services Inspectorate (SSI), the SSI/Audit Commission Joint Review Team and the National Care Standards Commission. The role of CSCI is to: · Promote improvement in social care · Inspect all social care - for adults and children - in the public, private and voluntary sectors · Publish annual reports to Parliament on the performance of social care and on the state of the social care market · Inspect and assess `Value for Money of council social services · Hold performance statistics on social care · Publish the `star ratings for council social services · Register and inspect services against national standards · Host the Childrens Rights Director role.Inspection Methods & FindingsSECTION B of this report summarises key findings and evidence from this inspection. The following 4-point scale is used to indicate the extent to which standards have been met or not met by placing the assessed level alongside the phrase Standard met? The 4-point scale ranges from: 4 - Standard Exceeded (Commendable) 3 - Standard Met (No Shortfalls) 2 - Standard Almost Met (Minor Shortfalls) 1 - Standard Not Met (Major Shortfalls) O or blank in the Standard met? box denotes standard not assessed on this occasion. 9 in the Standard met? box denotes standard not applicable. X is used where a percentage value or numerical value is not applicable. ESTABLISHMENT INFORMATION Name of establishment Crest House Care Home Address 6-8 St Matthews Road, St Leonards-on-sea, East Sussex, TN38 0TN Email Address Name of registered provider(s)/Company (if applicable) Mrs Josephine Crawford Name of registered manager (if applicable) Mrs Josephine Crawford Type of registration Care Home No. of places registered (if applicable) 25 Tel No: 01424 436229 Fax No: 01424 436229Category(ies) of registration, with (number of places) Old age, not falling within any other category (25) Registration number H100000298 Date First registered 30th July 2002 Was the home registered under the Registered Homes Act 1984 Do additional conditions of registration apply? Date of last inspectionDate of latest registration certificate 30th July 2002 YES NO 28/7/03 If Yes Refer to Part CCrest House Care HomePage 1 Date of Inspection Visit Time of Inspection Visit Name of Inspector Name of Inspector Name of Inspector 1 2 32nd March 2004 09:30 am Caroline JohnsonID Code123200Name of Inspector 4 Name of Lay Assessor (if applicable) Lay assessors are members of the public independent of the NCSC. They accompany inspectors on some inspections and bring a different N/A perspective to the inspection process Name of Specialist (e.g. N/A Interpreter/Signer) (if applicable) Name of Establishment Representative at Mrs J Crawford, Manager the time of inspectionCrest House Care HomePage 2 CONTENTSIntroduction to Report and Inspection Inspection Visits Brief Description of the Services Provided Part A: Summary of Inspection Findings Inspection Summary Statutory Requirements/Good Practice Recommendations from last Inspection Conditions of Registration Statutory Requirements/ Good Practice Recommendations from this Inspection Part B: Inspection Findings National Minimum Standards For Older People: Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management & Administration Part C: Part D: Part E: E.1. E.2. E.3. Compliance with additional conditions of registration (if applicable) Lay Assessors Summary (where applicable) Providers Response Providers comments Action Plan Providers AgreementCrest House Care HomePage 3 INTRODUCTION TO REPORT AND INSPECTION Every establishment that falls within the jurisdiction of the National Care Standards Commission (NCSC) is subject to inspection, to establish if the establishment is meeting the National Minimum Standards relevant to that setting and the requirements of the Care Standards Act 2000. This document summarises the inspection findings of the NCSC in respect of Crest House Care Home. The inspection findings relate to the National Minimum Standards (NMS) for Care Homes for Older People published by the Secretary of State under the Care Standards Act 2000. The Regulations applicable to the inspected service are secondary legislation, with which a service provider must comply. Service providers are expected to comply fully with the National Minimum Standards. The National Minimum Standards will form the basis for judgements by the NCSC regarding registration, the imposition and variation of registration conditions and any enforcement action. The report follows the format of the NMS and the numbering shown in the report corresponds to that of the standards. The report will show the following: · Inspection methods used · Key findings and evidence · Overall ratings in relation to the standards · Compliance with the Regulations · Required actions on the part of the provider · Recommended good practice · Summary of the findings · Report of the Lay Assessor (where relevant) · Providers response and proposed action plan to address findings This report is a public document. INSPECTION VISITS Inspections are undertaken in line with the agreed regulatory framework with additional visits as required. This is in accordance with the provisions of the Care Standards Act 2000. The report is based on the findings of the specified inspection dates.Crest House Care HomePage 4 BRIEF DESCRIPTION OF THE SERVICES PROVIDED. Crest house is a detached property situated in a quiet residential area of St Leonards on Sea. Local shops are a short walk away and bus routes run close to the home. The nearest railway station is approximately half a mile away. The home is registered to accommodate twenty-five older people. Service users accommodation is provided on three floors, with a shaft lift installed to assist service users who may have mobility problems. The home has a front garden laid to lawn and a pleasant patio at the rear of the building.Crest House Care HomePage 5 PART A SUMMARY OF INSPECTION FINDINGSINSPECTORS SUMMARY (This is an overview of the inspectors findings, which includes good practice, quality issues, areas to be addressed or developed and any other concerns.) This report follows the announced inspection of Crest house. The home is well maintained and there was a warm and relaxed atmosphere in the home on the day of inspection. Staff spoken with were clear about their duties and responsibilities. Service users spoke highly of the support and care they receive. The inspector spoke with relatives of two of the service users during the inspection and they were very happy with the care provided and spoke very positively of the manager and her staff team. A number of requirements made following this inspection are repeated from the previous inspection. This in part is due to problems experienced by the home with their computer system. However, attention should be given to ensuring that all requirements made are addressed within the timescales given. Choice of Home (Standards 1 ­ 6) Three of the five standards assessed were met. One standard was not applicable to the home. The service user guide needs to be produced. In addition a good practice recommendation was made to make a minor amendment to the homes admission documentation and that more detailed notes be taken when assessing prospective service users. Health and Personal Care (Standards 7 ­ 11) Four of the five standards assessed were met. The home is to be commended for the sensitive and supportive way in which they deal with death. Care plans are kept up to date and include basic information to meet the needs of the service users accommodated. A requirement was made in respect of one of the care plans seen to include an additional risk assessment. Daily Life and Social Activities (Standards 12 ­ 15) All of the standards were met. The home is particularly good at ensuring that service users are kept stimulated and they offer a varied choice of activities to ensure that there is something for everyone. Complaints and Protection (Standards 16 ­ 18) Two of the three standards assessed were met. The one requirement not met is in relation to providing staff with training on adult protection. Environment (Standards 19 - 26) Six of the eight standards assessed were met. The home is well maintained providing a warm and comfortable environment. Requirements in this section relate to producing a fire risk assessment, replacing the locks on two bedroom doors and producing a programme of routine maintenance. Staffing (Standards 27 ­ 30) Crest House Care Home Page 6 Three of the four standards assessed were met. Good recruitment procedures are followed and generally there has been a very stable staff team with a low turnover. The one requirement is that staff should receive contracts of employment. Management and Administration (Standards 31 ­ 38) Five of the eight standards assessed were met. Requirements in this section relate to introducing formal supervision for all care staff and ensuring that care staff are provided with training on first aid and moving and handling.Crest House Care HomePage 7 Requirements from last Inspection visit fully actioned? If No please list belowNOSTATUTORY REQUIREMENTS Identified below are areas not addressed from the last inspection report, which indicate a non-compliance with the Care Standards Act 2000 and accompanying Regulations. No. Regulation Standard Required actions Timescale for action 1 2 3 5(1) 13(6) 23(2)(b) OP1 OP18 OP19 That a service user guide is produced. Staff should receive training on adult protection. That a programme of routine maintenance and renewal of the fabric and decoration of the premises is produced. In respect of fire safety, the home should produce a detailed risk assessment. That contracts of employment are produced and issued to all staff. That formal supervision is introduced for all staff. That first aid training is provided for untrained staff. Staff who have not yet received training in moving and handling should receive training. 18/9/03 15/10/03 18/9/034 5 6 7 823(4) 18(1)(a) 18(1)(a) 18(1)(a) 13(5)OP19 OP29 OP36 OP38 OP3815/10/03 18/6/03 18/9/03 18/9/03 15/11/03Action is being taken by the National Care Standards Commission to ensure compliance in regard to the above requirements.Crest House Care HomePage 8 RECOMMENDATIONS Identified below are recommendations from the last inspection that have not been implemented No. Refer to Good Practice Recommendations StandardCONDITIONS OF REGISTRATION THAT APPLY (OTHER THAN NUMBERS AND CATEGORY OF SERVICE USERS).Met (Yes / No)Crest House Care HomePage 9 STATUTORY REQUIREMENTS IDENTIFIED DURING THE INSPECTION Action Plan: The Registered Person is requested to provide the Commission with an Action Plan, which indicates how requirements and recommendations are to be addressed with the time scale within which such actions will be taken. This action plan will be made available on request to the Area Office.STATUTORY REQUIREMENTS Identified below are areas addressed in the main body of the report, which indicate noncompliance with the Care Standards Act 2000, and accompanying Regulations 2001 and the National Minimum Standards. The Registered Provider(s) is/are required to comply within the given time scales. No. Regulation Standard * Requirement Timescale for action 1 5(1) OP1 That a service user guide is produced. [This was a requirement of the previous inspection]. In respect of one of the care plans seen a risk assessment should be carried out in respect of the use of a hot water bottle. Staff should receive training on adult protection. [This was a requirement of the previous inspection]. That a programme of routine maintenance and renewal of the fabric and decoration of the premises is produced. [This was a requirement of the previous inspection]. 30 April 2004 30 March 2004 30 May 2004213(4)(c)OP7313(6)OP18423(2)(b)OP1930 May 2004523(4)OP19In respect of fire safety, the home should produce a detailed fire risk assessment. [This 15 April 2004 was a requirement of the previous inspection]. The locks on two bedroom doors should be removed and replaced with a type that conforms to NMS. That contracts of employment are produced and issued to all staff. [This was a requirement of the previous two inspections]. 30 March 2004613(4)(c)OP24718(1)(a)OP2930 April 2004Crest House Care HomePage 10 818(1)(a)OP36That formal supervision is introduced for all staff. [This was a requirement of the previous inspection]. That first aid training is provided for untrained staff. [This was a requirement of the previous inspection]. Staff who have not yet received training in moving and handling should receive training. [This was a requirement of the previous inspection].30 May 2004 30 May 2004918(1)(a)OP381013(5)OP3830 May 2004RECOMMENDATIONS Identified below are areas addressed in the main body of the report, which relate to National Minimum Standards and are seen as good practice issues which should be considered for implementation by the registered Provider(s) No. Refer to Good Practice Recommendations Standard * The homes initial assessment documentation should be amended slightly to ensure that it complies with all the headings noted in the NMS. Attention should be given to ensuring that the document is fully completed on each occasion. The timing of the drills held should be recorded. The manager should highlight to relatives of service users the location of the homes complaint procedure.11OP312 13OP19 OP33* Note: You may refer to the relevant standard in the remainder of the report by omitting the 2-letter prefix e.g. OP10 refers to Standard 10.Crest House Care HomePage 11 PART BINSPECTION METHODS & FINDINGSThe following inspection methods have been used in the production of this report Direct Observation Indirect Observation Sampling · Pre-inspection Questionnaire · Records · Care Plans / Care Pathways · Meals · Activities · Other (Specify) `Tracking care and support Group discussion with service users Individual discussion with service users Group discussion with staff Individual discussion with staff Discussion with management Service user survey Relatives/significant others survey/feedback Visiting Professionals survey / feedback Tour of Premises Formal Interviews Document reading Additional Inspection Information: Number of Service Users spoken to at time of inspection Number of Relatives/significant others the inspectors had contact with Number of letters received in respect of the service CRB check for the Responsible Individual seen CRB check for the Manager seen Certificate of registration was displayed at the time of the inspection Certificate of registration accurately reflected the situation in the service at the time of inspection Total number of care staff employed (excluding managers) Total number of staff with nursing qualifications employed Date of Inspection Time of Inspection Duration Of Inspection (hrs) YES YES YES YES YES YES YES NO YES YES YES YES NO YES YES YES NO YES YES YES 4 3 8 NA NO YES YES 14 X 02/03/04 09.30 7.5Crest House Care HomePage 12 The following pages summarise the key findings and evidence from this inspection, together with the NCSC assessment of the extent to which the National Minimum Standards for Care homes for older persons have been met. The following scale is used to indicate the extent to which standards have been met or not met by placing the assessed level alongside the phrase Standard met? The scale ranges from: 4 - Standard Exceeded 3 - Standard Met 2 - Standard Almost Met 1 - Standard Not Met (Commendable) (No shortfalls) (Minor shortfalls) (Major shortfalls)0 or blank in the Standard met? box denotes standard not assessed on this occasion. 9 in the Standard met? box denotes standard not applicable. X is used where a percentage value or numerical value is not applicable.Crest House Care HomePage 13 Choice of HomeThe intended outcomes for the following set of standards are: · · · · · · 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.Standard 1 (1.1 ­ 1.3) The registered person produces and makes available to service users an up to date statement of purpose setting out the aims, objectives, philosophy of care, services and facilities and terms and conditions of the home; and provides a service users guide to the home for current and prospective residents. The statement of purpose clearly sets out the physical environmental standards met by a home in relation to standards 20.1, 20.4, 21.3, 21.4, 22.2, 22.5, 23.3 and 23.10: a summary of this information appears in the homes service users guide Range of fees charged From (£) 350 To (£) 450Any charges for extras If yes, please state what the extras are:YESTOILETRIES, CHIROPODY AND HAIRDRESSING 2 Key findings/Evidence Standard met? There is a detailed statement of purpose in place. The deputy manager advised that the service user guide is currently being produced. The home has had a problem with their computer and a number of documentation records have been lost and cannot be retrieved.Crest House Care HomePage 14 Standard 2 (2.1 ­ 2.2) Each service user is provided with a statement of terms and conditions at the point of moving into the home (or contract if purchasing their care privately). 3 Key findings/Evidence Standard met? There is a detailed terms and conditions of residence in place a copy of which is given to each new service user.Standard 3 (3.1 ­ 3.5) New service users are admitted only on the basis of a full assessment undertaken by people trained to do so, and to which the prospective service user, his/her representatives (if any) and relevant professionals have been party. 2 Key findings/Evidence Standard met? The homes policy is to carry out an assessment of abilities and needs of prospective service users. Records were examined in respect of a newly admitted service user. On this occasion the initial assessment was not located. However other initial assessments were examined. The inspector recommended that the form used be adapted slightly to include all the headings listed in the NMS and that more detailed notes are recorded. Standard 4 (4.1 - 4.4) The registered person is able to demonstrate the homes capacity to meet the assessed needs (including specialist needs) of individuals admitted to the home. 3 Key findings/Evidence Standard met? The manager and her deputy were able to demonstrate over the course of the inspection that the home is able to meet the needs of the service users accommodated.Standard 5 (5.1 ­ 5.3) The registered person ensures that prospective service users are invited to visit the home and to move in on a trial basis, before they and / or their representatives make a decision to stay; unplanned admissions are avoided where possible. 3 Key findings/Evidence Standard met? Service users are encouraged to visit the home prior to making a decision to move in.Crest House Care HomePage 15 Standard 6 (6.1 - 6.5) Where service users are admitted only for intermediate care, dedicated accommodation is provided together with specialised facilities, equipment and staff to deliver short-term intensive rehabilitation and enable service users to return home. 9 Key findings/Evidence Standard met? The home does not cater for intermediate care.Crest House Care HomePage 16 Health and Personal CareThe intended outcomes for the following set of standards are: · · · · · The service users health, personal and social care needs are set out in an individual plan of care. Service users make decisions about their lives with assistance as needed. Service users, where appropriate, are responsible for their own medication, and are protected by the homes 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.Standard 7 (7.1 ­ 7.6) A service user plan of care generated from a comprehensive assessment (see Standard 3) is drawn up with each service user and provides the basis for the care to be delivered. 2 Key findings/Evidence Standard met? The inspector examined two care plans on this occasion. There was basic information recorded about the needs and abilities of each service user. Service users and their relative/representative are encouraged to sign the care plan. A day/night report book is kept highlighting issues of significance. The inspector recommended that a risk assessment be carried out in respect of any service user who uses a hot water bottle. Standard 8 (8.1 ­ 8.13) The registered person promotes and maintains service users health and ensures access to health care services to meet assessed needs. Number of incidents where service users have been taken to Accident and Emergency during last 12 months Number of service users with pressure sores at time of inspection (from information taken from care notes)0 X3 Key findings/Evidence Standard met? The inspector was advised that staff encourage service users to be as independent as possible. Everyone is registered with general practitioners at local surgeries and there are good links with the community nursing services and with the Continence Advisor.Crest House Care HomePage 17 Standard 9 (9.1 ­ 9.11) The registered person ensures that there is a policy and staff adhere to the procedures for the receipt, recording, storage, handling administration and disposal of medicines, and service users are able to take responsibility for their own medication if they wish, within a risk management framework. 3 Key findings/Evidence Standard Met? The arrangements in place for the recording, storage, handling, administration and disposal of medicines are satisfactory. The pharmacist visits every few months to monitor the homes systems.Standard 10 (10.1 ­ 10.7) The arrangements for health and personal care ensure that service users privacy and dignity are respected at all times, and with particular regard to: personal care giving, including nursing, bathing, washing, using the toilet or commode, consultation with and examination by health and social care professionals, consultation with legal and financial advisors, maintaining social contacts with relatives and friends, entering bedrooms, toilets and bathrooms, and following death. 3 Key findings/Evidence Standard met? Staff observed in the course of their duties were courteous and friendly and service users spoken with held the staff team in high regard. There is a private telephone in every bedroom, which can also be used as an internal call system. This is in addition to the nurse call system.Standard 11 (11.1 ­ 11.12). Care and comfort are given to service users who are dying, their death is handled with dignity and propriety, and their spiritual needs, rites and functions observed. 4 Key findings/Evidence Standard met? The wishes of service users in the event of terminal care and arrangements following death have been assessed and a record is kept of the outcome. In the last couple of years the home has held a few funeral services at the home. The subject was discussed in depth with the inspector who formed the view that the services were carried out with sensitivity and great care.Crest House Care HomePage 18 Daily Life and Social ActivitiesThe intended outcomes for the following set of standards are: · · · · 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.Standard 12 (12.1 ­ 12.4) The routines of daily living and activities made available are flexible and varied to suit service users expectations, preferences and capacities. 4 Key findings/Evidence Standard met? On the day of inspection there was a range of activities available for service users. A tape of local news from the Hastings Observer was played in the morning. Service users spoken with stated that they enjoy listening to the tape, which is updated weekly. There was also musical entertainment and the inspector noted the obvious delight of service users singing and taking part in gentle exercises. In addition activities include quizzes, a knit and natter group, which is run with St Lukes Church. Currently service users are knitting blankets for charity. St Matthews Church also hold a regular church meeting in the home. Service users spoken with talked fondly of the newly formed horticultural society. A number of service users were involved in sowing seeds which when ready they will plant in the raised beds in the garden. Standard 13 (13.1 ­ 13.6) Service users are able to have visitors at any reasonable time and links with the local community are developed and/or maintained in accordance with service users preferences 3 Key findings/Evidence Standard met? As stated above there are good links with the local community. The inspector was advised that the majority of service users receive regular contact from family and friends.Standard 14 (14.1 ­ 14.5) The registered person conducts the home so as to maximise service users capacity to exercise personal autonomy and choice. 3 Key findings/Evidence Standard met? Service users are encouraged to bring items of personal possessions on admissions to the home and many of the bedrooms seen reflected the individual tastes and personalities of the occupants.Crest House Care HomePage 19 Standard 15 (15.1 ­ 15.9) The registered person ensures that service users receive a varied, appealing, wholesome and nutritious diet, which is suited to individual, assessed and recorded requirements and that meals are taken in a congenial setting and at flexible times. 3 Key findings/Evidence Standard met? Records seen indicate that service users are offered varied and well balanced diets. There is a choice for the main meal and a set meal in the evenings. However, alternatives to the menu can always be accommodated. Whilst the inspector did not take up the offer of a full meal, all food received was appetising, well presented and tasted delicious. Service users talked very positively of the quality of the food served.Crest House Care HomePage 20 Complaints and ProtectionThe intended outcomes for the following set of standards are: · · · 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.Standard 16 (16.1 ­ 16.4) The registered person ensures that there is a simple clear and accessible complaints procedure, which includes the stages, and time-scales for the process and that complaints are dealt with promptly and effectively. No. of complaints made to the home during last 12 months No. of these complaints fully substantiated No. of these complaints partly substantiated No. of these complaints not substantiated No. of these complaints not yet resolved No. of complaints sent direct to NCSC Percentage of complaints responded to within 28 days 1 1 0 0 0 0 100 3 Key findings/Evidence Standard met? There is a detailed procedure in place to ensure that anyone wishing to make a complaint about any aspect of the care provided can do so. There was one complaint recorded since the last inspection of the home. Records indicated that the complaint was dealt with swiftly on the day the complaint was raised.Crest House Care HomePage 21 Standard 17 (17.1 ­ 17.3) Service users have their legal rights protected, are enabled to exercise their legal rights directly and participate in the civic process if they wish. 3 Key findings/Evidence Standard met? The manager advised that service users are given the choice of participating in political processes such as voting in elections, and this is enabled, by postal voting. The majority of service users have friends or family members who can act on their behalf if necessary.Standard 18 (18.1 ­ 18.6) The registered person ensures that service users are safeguarded from physical, financial, or material, psychological or sexual abuse, neglect, discriminatory abuse or self-harm, inhuman or degrading treatment through deliberate intent, negligence or ignorance, in accordance with written policies. The home has an Adult Protection procedure (including Whistle Blowing) which complies with the Public Disclosure Act 1998 and the Department of Health Guidance No Secrets No. of staff referred for inclusion on POVA lists YES X2 Key findings/Evidence Standard met? There is a detailed procedure in place on adult protection and prevention of abuse. Staff have yet to receive formal training on the subject.Crest House Care HomePage 22 EnvironmentThe intended outcomes for the following set of standards are: · · · · · · · · 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.Standard 19 (19.1 ­ 19.6) The location and layout of the home is suitable for its stated purpose; it is accessible, safe and well maintained; meets service users individual and collective needs in a comfortable and homely way and has been designed with reference to relevant guidance. 2 Key findings/Evidence Standard met? All areas of the building seen were well decorated to a good standard. The home has yet to produce a programme of routine maintenance and renewal of the fabric and decoration of the building. The manager advised that when work is required it is attended to. The inspector recommended keeping a record of all work undertaken. Fire procedures were examined in detail. The deputy manager advise that homes fire risk assessment was one of the documents lost as a result of the computer problems and this will have to be rewritten. As good practice records should identify the time fire drills are held. Standard 20. (20.1 ­ 20.7) In all newly built homes and first time registrations the home provides sitting, recreational and dining space (referred to collectively as communal space) apart from service users private accommodation and excluding corridors and entrance hall amounting to at least 4.1 sq. metres for each service user. 3 Key findings/Evidence Standard met? Communal areas include the lounge, dining room and a conservatory. Each of the areas is decorated to a good standard. There is a patio area to the rear of the home and the inspector advised that this area is well used in the summer months. The home operates a no smoking policy and staff or visitors who smoke use the patio area.Crest House Care HomePage 23 Standard 21 (21.1 ­ 21.8) Toilet, washing and bathing facilities are provided to meet the needs of service users. 3 Key findings/Evidence Standard met? All bedrooms are fitted with ensuite facilities. In addition there is an assisted bath for use by service users that cannot manage an ordinary bath. The home has a hoist facility.Standard 22 (22.1 ­ 22.8) The registered person demonstrates that an assessment of the premises and facilities has been made by suitably qualified persons including a qualified occupational therapist, with specialist knowledge of the client groups catered for and provides evidence that the recommended disability equipment has been secured or provided and environmental adaptations made to meet the needs of service users. 3 Key findings/Evidence Standard met? A shaft lift enables easy access to both the first and second floors. A number of service users have zimmer frames and some environmental adaptations such as grab rails have been fitted to meet the needs of service users. There is a call system fitted in each of the bedrooms.Crest House Care HomePage 24 Standard 23 (23.1 ­ 23.11) The home provides accommodation for each service user which meets minimum space as prescribed Total number of single bedrooms with at least 10 sq.m usable space or additional compensatory space Pre-existing homes only (1 April 2003) - single bedrooms below 10 sq.m usable space or additional compensatory space Total number of wheelchair users accommodated for in rooms at least 12sq.m Total number of wheelchair users accommodated for in rooms at less than 12sq.m Total number of shared rooms at least 16 sq.m Total number shared rooms less than 16 sq.m Percentage of places within single rooms: 100 80 - 99 Less than 80 Total number of single bedrooms Total number of single rooms with en suite Total number of double rooms Total number of double rooms with en suite NO NO YES 17 17 4 4 17 00 0 4 03 Key findings/Evidence Standard met? Room sizes comply with national minimum standards. Whilst four of the bedrooms are registered as double rooms, at the time of inspection none of the double rooms were shared.Crest House Care HomePage 25 Standard 24 (24.1 ­ 24.8) The home provides private accommodation for each service user, which is furnished and equipped to assure comfort and privacy and meets the assessed needs of the service user. 2 Key findings/Evidence Standard met? Bedrooms seen were generally well decorated to a good standard. At the time of inspection one of the bedrooms was due to be redecorated and a problem with the carpet in another bedroom would be attended to at the same time. The inspector was advised that service users have been given the choice of having a lock fitted to their bedroom door and they have declined. There are locks fitted to two bedroom doors. The locks need to be replaced with locks that comply with NMS. Standard 25 (25.1 ­ 25 8) The heating, lighting, water supply and ventilation of service users accommodation meet the relevant environmental health and safety requirements and the needs of individual service users. 3 Key findings/Evidence Standard met? On the day of inspection the home was adequately heated. Radiators are unguarded. Risk assessments have been carried out to determine if there is a need for radiators to be guarded and it is considered that they do not. Emergency lighting is provided throughout the home. Hot water is controlled at a central source rather than at the point of delivery. Hot water temperatures tested on the day of inspection were within agreed safety limits. Standard 26 (26.1 ­ 26.9) The premises are kept clean, hygienic and free from offensive odours throughout and systems are in place to control the spread of infection in accordance with relevant legislation and published professional guidance. 3 Key findings/Evidence Standard met? All areas of the home seen were clean and free from any odours.Crest House Care HomePage 26 StaffingThe intended outcomes for the following set of standards are: · · · · 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 homes recruitment policy and practices. Staff are trained and competent to do their jobs.Standard 27 (27.1 ­ 27.7) Staffing numbers and skill mix of qualified/unqualified staff are appropriate to the assessed need of the service users, the size, the layout and purpose of the home, at all times. Number of staff /hours in respect of service user needs based on guidance recommended by Department of Health. Personal Nursing Care No. service users High No. staff hours 0 X X needs allocated No. service users Medium needs No. service users Low needs No. of staff hours required No. of full time equivalent first level registered nurses No. of care staff No. of ancillary staff 3 11 X No. staff hours allocated No. staff hours allocated No. of staff hours provided X X X X X XX 14 2Crest House Care HomePage 27 3 Key findings/Evidence Standard met? The staff rota available for inspection indicated that there are satisfactory staffing levels in the home. At the time of inspection there were fourteen service users. At night there is one member of staff working a waking duty and one member of staff on a sleep-in duty. Care staff attend to domestic duties.Standard 28 (28.1 ­ 28.3) A minimum ratio of 50 trained members of care staff (NVQ Level 2 or equivalent) is achieved by 2005, excluding the registered manager and/or care manager, and in care homes providing nursing, excluding those members of care staff who are registered nurses. No. care staff (excluding registered nurses) with NVQ level 2 or equivalent of care staff with NVQ level 2 1 X 3 Key findings/Evidence Standard met? The inspector was advised that the majority of care staff have completed care skills training through the local college. Two members of staff are about to start this course and it is hoped that on completion at least one of them will go on to study for NVQ level 2.Standard 29 (29.1 ­ 29.6) The registered person operates a thorough recruitment procedure based on equal opportunities and ensuring the protection of service users. 2 Key findings/Evidence Standard met? A staff file was examined in respect of a newly recruited member of staff and the homes recruitment procedure had been followed thoroughly. The inspector was advised that all staff have been issued with a copy of the code of conduct and practice as set by the GSCC. In addition job descriptions are currently being revised. When this process is completed they will be issued to all staff along with a contract of employment.Crest House Care HomePage 28 Standard 30 (30.1 ­ 30.4) The registered person ensures that there is a staff training and development programme, which meets the National Training Organisation (NTO) workforce training targets and ensures staff fulfil the aims of the home and meet the changing needs of service users. 3 Key findings/Evidence Standard met? The inspector was advised that new staff complete a one and a half hour induction the day before they are due to start in post. Once employment has commenced staff are asked to view a video on fire safety and to complete statutory training as and when courses are arranged. It is now the expectation that all new staff sign up for the Aset course in care skills. The manager stated that the home has been advised that the Aset courses are equivalent to completing the foundation part of the Sector Skills Council specification. This should be explored further with Topps.Crest House Care HomePage 29 Management and AdministrationThe intended outcomes for the following set of standards are: · · · · · · · · 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 homes record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected.Standard 31 (31.1 ­ 31.8) The registered manager is qualified, competent and experienced to run the home and meet its stated purpose, aims and objectives. 3 Key findings/Evidence Standard met? The manager has been in the care industry for twenty-one years. Originally she was owner/manager of a home for older people with a dementia type illness and she has owned and managed Crest House for five years. She has completed a City and Guilds Advanced Management in Care course along with a number of additional short courses over the years. The manager was not totally sure that her qualification was equivalent to an NVQ level four in management and care and the inspector recommended that this be explored further. The manager is ably supported by her daughter who works as deputy manager. She has also completed the Advanced management in Care course and is an NVQ Assessor. Standard 32 (32.1 ­ 32.7) The registered manager ensures that the management approach of the home creates an open, positive and inclusive atmosphere. 3 Key findings/Evidence Standard met? Staff spoken with talked about a good team spirit where everyone is fully aware of their individual roles and responsibilities. There is a low staff turnover and clear communication between management and care staff.Crest House Care HomePage 30 Standard 33 (33.1 ­ 33.10) Effective quality assurance and quality monitoring systems, based on seeking the views of service users are in place to measure success in meeting the aims, objectives and the statement of purpose of the home. 2 Key findings/Evidence Standard met? The manager advised that the home has recently invested in a quality-monitoring tool which once introduced will enable that the home to monitor all the policies and procedures and to carry out audits on the care provided. A record is kept of all letters received from relatives of service users where comments have been made about the quality of care provided in the home. As part of the inspection process ten comment cards were received from service users and eight comment cards from relatives. All comments received were very positive in their praise of the care provided for service users. Three of the relatives cards stated that they were not aware of the homes complaint procedure. Whilst visitors can easily access the homes complaint procedure, it is recommended that the manager highlight again to relatives the location of the procedure. During the inspection the inspector welcomed the opportunity to meet with relatives of two service users. All comments received were very positive in their support for the staff team, their dedication ad commitment and their ability to keep them informed. In addition one relative in particular praised the staff for improving the quality of her mums life. This she felt was due to the activities on offer, the company of others and the security of being well cared for. Standard 34 (34.1 ­ 34.5) Suitable accounting and financial procedures are adopted to demonstrate current financial viability and to ensure that there is effective and efficient management of the business. 3 Key findings/Evidence Standard met? The inspector had no concerns about the financial viability of the home. An insurance certificate is on display indicating that the home is adequately insured.Crest House Care HomePage 31 Standard 35 (35.1 ­ 35.6) The registered manager ensures that service users control their own money except where they state that they do not wish to or they lack capacity and that safeguards are in place to protect the interests of the service user. Number of service users subject to Power of Attorney processes Number of service users subject to Enduring Power of Attorney processes Number of service users subject to Guardianship Orders X X X3 Key findings/Evidence Standard met? The manager advised that the home has very limited involvement in service users finances, the extent of which is drawing pensions for two service users. In both cases the personal allowances are given immediately to the relevant service users who sign receipts. Records were not seen on this occasion.Standard 36 (36.1 ­ 36.5) The registered person ensures that the employment policies and procedures adopted by the home and its induction, training and supervision arrangements are put into practice. 2 Key findings/Evidence Standard met? The deputy manager has been attending a supervisory management course during the past year. Formal supervision of care staff has not been introduced yet. However, the manager advised that there is good communication with the staff team and that she spends time with individual staff on a regular basis.Standard 37 (37.1 ­ 37.3) Records required by regulation for the protection of service users and for the effective and efficient running of the business are maintained, up to date and accurate. 3 Key findings/Evidence Standard met? Records required by regulation unless previously mentioned in this report were in order.Crest House Care HomePage 32 Standard 38 (38.1 ­ 38.9) The registered manager ensures so far as is reasonably practicable, the health, safety and welfare of service users and staff. 2 Key findings/Evidence Standard met? The deputy manager provides in-house training on the use of the hoist. Some of the staff have had training in the past on moving and handling. It is recommended that a suitably qualified person provides staff with training on moving and handling. Training in fire safety is provided six monthly. The manager advised that some of the staff team are trained in first aid but training needs to be provided for a number of staff. In addition the cooks and those staff involved in food preparation have received training in basic food hygiene. Records seen in respect of accidents were sufficiently detailed.Crest House Care HomePage 33 PART C(where applicable)COMPLIANCE WITH CONDITIONSCondition CommentsComplianceCondition CommentsComplianceCondition CommentsComplianceCondition CommentsComplianceLead Inspector Second Inspector Locality Manager DateSignature Signature SignatureCrest House Care HomePage 34 PART D(where applicable)LAY ASSESSORS SUMMARYLay Assessor Date Public reportsSignatureIt should be noted that all NCSC inspection reports are public documents.Crest House Care HomePage 35 PART EE.1PROVIDERS RESPONSE TO IDENTIFIED STATUTORY REQUIREMENTSRegistered Persons comments/confirmation relating to the content and accuracy of the report for the above inspection.We would welcome comments on the content of this report relating to the Inspection conducted on 2 March 2004 and any factual inaccuracies: Please limit your comments to one side of A4 if possibleCrest House Care HomePage 36 Action taken by the NCSC in response to provider comments: Amendments to the report were necessary NOComments were received from the provider Provider comments/factual amendments were incorporated into the final inspection reportYESNOProvider comments are available on file at the Area Office but have not YES been incorporated into the final inspection report. The inspector believes the report to be factually accurate Note: In instances where there is a major difference of view between the Inspector and the Registered Provider both views will be made available on request to the Area Office. E.2 Please provide the Commission with a written Action Plan by 23 March 2004, which indicates how requirements are to be addressed and stating a clear timescale for completion. This will be kept on file and made available on request. You will also note that the Commission has identified in the inspection report good practice recommendations and it would be useful to have some indication as to whether you intend to take any action to progress these. Status of the Providers Action Plan at time of publication of the final inspection report: Action plan was required NOAction plan was received at the point of publicationAction plan covers all the statutory requirements in a timely fashion Action plan did not cover all the statutory requirements and required further discussion Provider has declined to provide an action planOther: enter details here Crest House Care HomePage 37 E.3PROVIDERS AGREEMENT Registered Persons statement of agreement/comments: Please complete the relevant section that applies.E.3.1 I of confirm that the contents of this report are a fair and accurate representation of the facts relating to the inspection conducted on the above date(s) and that I agree with the requirements made and will seek to comply with these. Print Name Signature Designation Date Or E.3.2 I of am unable to confirm that the contents of this report are a fair and accurate representation of the facts relating to the inspection conducted on the above date(s) for the following reasons:Print Name Signature Designation Date Note: In instance where there is a profound difference of view between the Inspector and the Registered Provider both views will be reported. Please attach any extra pages, as applicable.Crest House Care HomePage 38 - 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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