Inspection on 23/01/05 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 Inspection23rd January 2005 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 18/11/04 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 323rd January 2005 10:00 am Alexis ReillyID Code103835Name of inspector 4 Name of specialist (e.g. Interpreter/Signer) (if applicable) Name of establishment representative at the time of inspectionNA Mrs J Crawford, managerCrest House Care HomePage 2 CONTENTSIntroduction to Report and Inspection Inspection Visits Brief Description of the Services Provided Part A: Summary of Inspection Findings Inspectors Summary Statutory Requirements/Good Practice Recommendations from last Inspection Conditions of Registration Statutory Requirements/ Good Practice Recommendations from this Inspection Part B: Inspection Methods & 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: D.1. D.2. D.3. Compliance with Conditions (if 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 Commission for Social Care Inspection (CSCI), 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 CSCI 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 CSCI 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 · 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. 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 25 older people. Service users accommodation is provided on 3 floors. There is a shaft lift to assist service users who 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 announced inspection took place on the 23rd January 2005. This inspection is the second the service has received in the year running from April 04 to April 05, this report covers a percentage of the standards, and should be read in conjunction with the previous inspection report dated 18th November 2004. THE INSPECTOR WAS ABLE TO SPEND TIME WITH THE SERVICE USERS AT THIS INSPECTION, AND RELATIVES OF SERVICE USERS PLACED. ALL REPORTED THAT THEY RECEIVED A GOOD STANDARD OF CARE. STAFF WERE FRIENDLY, WELCOMING AND PROFESSIONAL IN THEIR APPROACH. THERE IS EVIDENCE THAT THE OUTCOMES FOR SERVICE USERS AT THE HOME ARE GOOD. HOWEVER, THE HOME IS REQUIRED TO MEET THE NATIONAL MINIMUM STANDARDS WITHIN THE TIMESCALES SET. THE MANAGER WAS INFORMED AT THE LAST INSPECTION THAT THE HOME HAD UNTIL 23/1/05 TO MEET ALL OF THE OUTSTANDING REQUIREMENTS, THE DATE SET FOR THE ANNOUNCED INSPECTION. THE SERVICE HAS AGAIN FAILED TO MEET THIS TIMESCALE. THE MANAGER INFORMED THE INSPECTOR SHE DID NOT UNDERSTAND THE REQUIREMENT IN RELATION TO A SERVICE USER GUIDE, AND DIDNT UNDERSTAND WHAT ONE WAS. THE INSPECTOR DISCUSSED THIS WITH THE MANAGER IN DETAIL DURING THE INSPECTION. Choice of Home (Standards 1-6) 4 of the 6 standards were assessed. 2 were met. Requirements have been made at the previous three inspections that the home should provide a service users guide. This has not been complied with. The manager was advised that a service users guide should be made available to service users and that this is still a requirement under the present standards. There is a detailed terms and conditions of residence in place a copy of which is given to each new service user. A recommendation was made at the previous inspection that the homes initial assessment documentation should be amended to ensure that complied with the headings noted in the National Minimum Standards. It was further recommended that attention should be given to ensuring that the document is fully completed on each occasion. Service users are encouraged to visit the home prior to making a decision to move in. Health and Personal Care (Standards 7-11) 2 of the 5 standards were assessed. These were met. Medication Administration Records were checked on the day of the inspection and found to be in order. The wishes of service users in the event of terminal care, and arrangement following death have been assessed and a record is kept of the outcome. The home holds funeral services at the home, if this is requested by the relatives of the deceased. This enables residents to be part of the service. Daily Life and Social Activities (Standards 12-15) 2 of the 4 standards were assessed. These were met Crest House Care Home Page 6 On the day of the announced inspection service users were watching a war video prior to Sunday lunch. The home arranges for the local news form the Hastings Observer to be played in the mornings. There is also musical entertainment, and gentle music and movement. In addition activities include quizzes, a knit and natter group, which is run by St Lukes church. There is a newly formed horticultural society. A number of service users plant seeds and when they are ready they will plant them in the raised beds in the garden. The daughter of one of the residents does weekly floral arrangements, raffle tickets are given to service users to win the arrangements. The service offers a choice for the main menu and a choice for the set meal in the evenings. Alternative can always be accommodated. Service users talked positively with regard to the food in the home. Complaints and Protection (Standards 16-18) 2 of the 3 standards were assessed. Neither were met Service users right to vote is upheld in the home. The conservative political member had recently visited the home. Requirements have been at the previous two inspections that all staff should receive training on Adult Protection. This has not been complied with at the present time. The manager stated that she would obtain a suitable video and ensure that all staff receive this training by the announced inspection on 23/1/05. This has not been done. There is a detailed procedure in place on adult protection and the prevention of abuse. This is the third time this requirement has been made. Environment (Standards 19-26) 3 of the 8 standards were assessed. 2 were met This service does not have in place a planned programme of routine maintenance and renewal of the fabric and decoration of the premises. Carpets downstairs were covered with carpet tape, and are in need of replacing or fixing securely. The communal areas in the home include a lounge, dining room and a conservatory, a second conservatory has been built. The rear of the building has a patio area. The home operates a no smoking policy. The home was warm and bright on the day of the inspection. Radiators are unguarded and risk assessments are in place in relation to this. Staffing (Standards 27-30) 3 of the 4 standards were assessed. 2 were met On the day of the inspection the following staff were on duty. A cook 9.30am ­ 2pm, two carers 8am ­ 2pm, a care manager 9am onwards for the duration of the inspection. A carer from 2pm ­ 7pm. A carer from 2pm ­ 8pm. A sleep in member of staff from 7pm ­ 8am, and a waking staff member from 8pm ­ 8am. On the day of the inspection two employment files were examined these were incomplete with no CRB. New staff undergo a one and half hour induction the day prior to commencing within the service. Once employed the staff watch a video on fire safety and complete statutory training as and when courses are arranged. It is an expectation that staff sign up for the Aset course in care skills. Recent training undertaken within the service is food and hygiene. Management and Administration (Standards 31-38) 8 of the 8 standards were assessed. 4 were met The Manager has run the home for a number of years. She has completed a City and guilds Advanced Management in Care course. The manager has not completed NVQ Level 4. The service has a very low staff turn over, relatives and service users commented on the approachability of the manager. The manager informed the inspector during the inspection dated 2nd March 2004, a quality assurance tool had been purchased and would be implemented. This has not been done. A requirement was made at the previous three inspections that formal supervision should be introduced for all staff. The manager stated Crest House Care Home Page 7 that staff are supervised on an informal basis as a matter of course and that time is spent with each individual staff member. However, there is no formal recording of this supervision at the present time. It was agreed that a formal process of supervision would be introduced before the announced inspection on 23/1/05. This has not been met. This is the fourth time this requirement has been made. Requirements were made at previous two inspections in relation to health and safety. A requirement was made that all staff should receive training in moving and handling techniques. The inspector saw no evidence of fire drills, or water temperature checks on the day of the inspection, Training on first aid is provided for untrained staffCrest House Care HomePage 8 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. The code in Standard is a cross-reference to the Standards described in full in the section Inspection Findings. No. Regulation Standard Required actions Timescale for actionAction is being taken by the Commission for Social Care Inspection to ensure compliance in regard to the above requirements. 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 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. The code in Standard is a cross-reference to the Standards described in full in the section Inspection Findings. 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 three inspections]. Initial assessment documentation should be amended to ensure that complied with the headings noted in the National Minimum Standards.[This was a requirement from the previous inspection] Staff should receive training on adult protection. [This was a requirement of the previous three inspections]. A programme of planned routine maintenance and renewal of the fabric and decoration of the premises is produced.[This was a previous requirement from the inspection dated 2nd March 2004]. That contracts of employment are produced and issued to all staff. [This was a requirement of the previous four inspections]. A quality assurance system must be introduced into the home That formal supervision is introduced for all staff. [This was a requirement of the previous three inspections]. 1st April 2005214OP31st April 2005313(6)OP181st April 2005423(2)(b)OP191st April 2005518(1)(a)OP291st April 2005635OP331st April 20051st April 2005 Page 10718(1)(a)OP36Crest House Care Home 817(2) Schedule 4OP37That a record is kept of all fire drills. [This is a requirement from the previous inspection]. That records are kept of all monitored water temperatures. [This is a requirement from the previous inspection]. Training on first aid is provided for untrained staff.[This is a requirement from the 2nd March 2004 inspection].1st April 2005923(4)OP381st April 2005RECOMMENDATIONS 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). The code in Standard is a cross-reference to the Standards described in full in the section Inspection Findings. No. Refer to Good Practice Recommendations Standard ** 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 NO NO NA YES YES YES NO YES YES YES YES NO NO YES YES 3 2 X NO NO YES YES 14 X 23/1/05 10.10 3.Crest House Care HomePage 12 The following pages summarise the key findings and evidence from this inspection, together with the CSCI assessment of the extent to which the National Minimum Standards for Care homes for older people 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 HAIRDRESSING 1 Key findings/Evidence Standard met? Requirements have been made at the previous three inspections that the home should provide a service users guide. This has not been complied with. The manager was advised that a service users guide should be made available to service users and that this is still a requirement under the present standards. This is the fourth time this requirement has been made.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? A recommendation was made at the previous inspection that the homes initial assessment documentation should be amended to ensure that complied with the headings noted in the National Minimum Standards. It was further recommended that attention should be given to ensuring that the document is fully completed on each occasion.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. 0 Key findings/Evidence Standard met? This standard was not assessed on the day of the inspection.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 service does not provide 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. 0 Key findings/Evidence Standard met? This standard was not assessed on the day of the inspection.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. No. of incidents where service users have been taken to Accident and Emergency during last 12 months No. of service users with pressure sores at time of inspection (from information taken from care notes) X 0 0Key findings/Evidence Standard met? This standard was not assessed on the day of the inspection.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? Medication Administration Records were checked on the day of the inspection and found to be in order.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. 0 Key findings/Evidence Standard met? This standard was not assessed on the day of the inspection.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 arrangement following death have been assessed and a record is kept of the outcome. The home holds funeral services at the home, if this is requested by the relatives of the deceased. This enables residents to be part of the service.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. 3 Key findings/Evidence Standard met? On the day of the announced inspection service users were watching a war video prior to Sunday lunch. The home arranges for the local news form the Hastings Observer to be played in the mornings. There is also musical entertainment, and gentle music and movement. In addition activities include quizzes, a knit and natter group, which is run by St Lukes church. There is a newly formed horticultural society. A number of service users plant seeds and when they are ready they will plant them in the raised beds in the garden. The daughter of one of the residents does weekly floral arrangements, raffle tickets are given to service users to win the arrangements. 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. 0 Key findings/Evidence Standard met? This standard was not assessed on the day of the inspection.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. 0 Key findings/Evidence Standard met? This standard was not assessed on the day of the inspection.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? The service offers a choice for the main menu and a choice for the set meal in the evenings. Alternative can always be accommodated. Service users talked positively with regard to the food in the home.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 CSCI Percentage of complaints responded to within 28 days X X X X X X 100 0Key findings/Evidence Standard met? This standard was not assessed fully on the day of the inspection. However there were no complaints recorded since the last inspection.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? Service users right to vote is upheld in the home. The conservative political member had recently visited the home.Crest House Care HomePage 21 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 X1 Key findings/Evidence Standard met? Requirements have been at the previous two inspections that all staff should receive training on Adult Protection. This has not been complied with at the present time. The manager stated that she would obtain a suitable video and ensure that all staff receive this training by the announced inspection on 23/1/05. This has not been done. There is a detailed procedure in place on adult protection and the prevention of abuse. This is the third time this requirement has been made.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. 1 Key findings/Evidence Standard met? This service does not have in place a planned programme of routine maintenance and renewal of the fabric and decoration of the premises. Carpets downstairs were covered with carpet tape, and are in need of replacing or fixing securely.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? The communal areas in the home include a lounge, dining room and a conservatory, a second conservatory has been built. The rear of the building has a patio area. The home operates a no smoking policy.Standard 21 (21.1 ­ 21.8) Toilet, washing and bathing facilities are provided to meet the needs of service users. 0 Key findings/Evidence Standard met? This standard was not assessed on the day of the inspection.Crest House Care HomePage 23 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. 0 0Key findings/Evidence Standard met? This standard was not assessed on the day of the inspection.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 16 4 4 0 17 00 0 4 0Key findings/Evidence Standard met? This standard was not assessed on the day of the inspection.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. 0 Key findings/Evidence Standard met? This standard was not assessed on the day of the inspection.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? The home was warm and bright on the day of the inspection. Radiators are unguarded and risk assessments are in place in relation to this.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. 0 Key findings/Evidence Standard met? This standard was not assessed on the day of the inspection.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 X 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 X X X No. staff hours allocated No. staff hours allocated No. of staff hours provided X X X X X XX X X3 Key findings/Evidence Standard met? On the day of the inspection the following staff were on duty. A cook 9.30am ­ 2pm, 2 carers 8am ­ 2pm, a care manager 9am onwards for the duration of the inspection. A carer from 2pm ­ 7pm. A carer from 2pm ­ 8pm. A sleep in member of staff from 7pm ­ 8am, and a waking staff member from 8pm ­ 8am.Crest House Care HomePage 27 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 the 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 X X 0Key findings/Evidence Standard met? This standard was not assessed on the day of the inspection.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. 1 Key findings/Evidence Standard met? This is the fifth time a requirement with regard to this standard has been made. On the day of the inspection two employment files were examined these were incomplete with no CRB. This is the fifth time this requirement has been made.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? New staff undergo a one and half hour induction the day prior to commencing within the service. Once employed the staff watch a video on fire safety and complete statutory training as and when courses are arranged. It is an expectation that staff sign up for the Aset course in care skills. Recent training undertaken within the service is food and hygiene.Crest House Care HomePage 28 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 run the home for a number of years. She has completed a City and guilds Advanced Management in Care course. The manager has not completed NVQ Level 4.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? The service has a very low staff turn over, relatives and service users commented on the approachability of the manager.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. 1 Key findings/Evidence Standard met? nd The manager informed the inspector during the inspection dated 2 March 2004, a quality assurance tool had been purchased and would be implemented. This has not been done.Crest House Care HomePage 29 Standard 34 (34.1 ­ 34.5) Suitable accounting and financial procedures are adopted to demonstrate current financial viability and to ensure there is effective and efficient management of the business. 3 Key findings/Evidence Standard met? The inspector has no reason to have concerns about the financial viability of the home.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? Service users finances were checked on the day of the inspection and found to be in order.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. 1 Key findings/Evidence Standard met? A requirement was made at the previous three inspections that formal supervision should be introduced for all staff. The manager stated that staff are supervised on an informal basis as a matter of course and that time is spent with each individual staff member. However, there is no formal recording of this supervision at the present time. It was agreed that a formal process of supervision would be introduced before the announced inspection on 23/1/05. This has not been met. This is the fourth time this requirement has been made.Crest House Care HomePage 30 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. 1 Key findings/Evidence Standard met? On the day of the inspection a selection of records required by regulation for the protection of service users and for the effective and efficient running of the business were assessed. In general, these records are maintained, up to date and accurate. However, the following should be produced in order that Schedule 4 of the regulations is adhered to. 1. A copy of the service users guide. [See standard 1]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. 1 Key findings/Evidence Standard met? Requirements were made at previous two inspections in relation to health and safety. A requirement was made that all staff should receive training in moving and handling techniques. The inspector saw no evidence of fire drills, or water temperature checks on the day of the inspection, Training on first aid is provided for untrained staffCrest House Care HomePage 31 PART C(where applicable) Condition CommentsCOMPLIANCE WITH CONDITIONSComplianceCondition CommentsComplianceCondition CommentsComplianceCondition CommentsComplianceLead Inspector Second Inspector Regulation Manager Date Public reportsAlexis Reilly Phil HaleSignature Signature SignatureIt should be noted that all CSCI inspection reports are public documents.Crest House Care HomePage 32 PART DD.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 23rd January 2005 and any factual inaccuracies: Please limit your comments to one side of A4 if possibleCrest House Care HomePage 33 Action taken by the CSCI in response to provider comments: Amendments to the report were necessary YESComments were received from the provider Provider comments/factual amendments were incorporated into the final inspection report Provider comments are available on file at the Area Office but have not been incorporated into the final inspection report. The inspector believes the report to be factually accurateYESYESNONote: 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. D.2 Please provide the Commission with a written Action Plan by 8th March 2005, 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 YESAction plan was received at the point of publicationNOAction 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 planNOYESYESOther: enter details here NOCrest House Care HomePage 34 D.3PROVIDERS AGREEMENT Registered Persons statement of agreement/comments: Please complete the relevant section that applies.D.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 D.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 35 Crest House Care Home / 23rd January 2005Commission for Social Care Inspection 33 Greycoat Street London SW1P 2QF Telephone: 020 7979 2000 Fax: 020 7979 2111 National Enquiry Line: 0845 015 0120 www.csci.org.ukS0000021080.V195835.R01© This report may only be used in its entirety. 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