Inspection on 15/07/06 for Cresta Lodge

This inspection was carried out on 15th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Cresta Lodge Bungay Road Poringland Norwich Norfolk NR14 7NA Lead Inspector Ruth Hannent Unannounced Inspection 15th August 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Cresta Lodge DS0000066516.V308790.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cresta Lodge DS0000066516.V308790.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cresta Lodge Address Bungay Road Poringland Norwich Norfolk NR14 7NA 01508 492775 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Cygnet Care Limited Mrs Sally Margaret Eickert Care Home 27 Category(ies) of Old age, not falling within any other category registration, with number (27) of places Cresta Lodge DS0000066516.V308790.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Brief Description of the Service: Cresta Lodge – formerly known as Crest-A-Dene - is an extended property situated on the edge of the village of Poringland. Within the village there are the usual amenities and Norwich is some 3 miles away, to which there is a regular bus service. The home is registered as a care home and can accommodate 27 older people. There are 19 single rooms, 9 with en-suite facilities and 4 double rooms all with en-suite facilities. The service user accommodation consists of 2 lounges, with views of the garden, and a central dining room which is situated at ground floor level. The offices are on the first floor. There are extensive, accessible gardens to the rear of the property, with smaller garden areas to the front and to the side. Cars can be parked in the drive at the front of the property. The home is supported by local GP surgeries and district nursing services. Email info@chevingtonf9.co.uk Fees £325 - £435 Cresta Lodge DS0000066516.V308790.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a site visit to complete the report of a key inspection that takes into account all aspects of the Home within the National Minimum Standards since the last inspection. This home has recently been purchased with new systems and ideas being introduced. This inspection mainly reflects the three months since the new ownership. To assist the Inspector with the judgement made of this service the Commission had received a monthly quality audit undertaken by the new proprietors, a pre inspection questionnaire and comments from both residents and relatives. Records were looked at that included, health and safety, care plans, personnel records and medication recording. A tour of the building took place with residents, relatives and staff spoken to throughout. A meal and conversation was enjoyed with observation taken and interactions heard as staff and residents went about their daily activities. Overall this home offers a caring, homely environment that is safe and comfortable. What the service does well: The home is warm and friendly. The staff, carry out their tasks unhurried and with a smile. It is evident that the new owners of Cresta Lodge wish to be actively involved and spend time checking and re checking the quality of the service offered. The Home is clean, well decorated and furnished. The gardens are well kept and invite the residents to sit in them. The Manager and Owners are acting very sensitively to the reaction from some residents and staff of change and handling each situation carefully and considerately. The Home plans with the residents what they would like to have as there social enjoyment and activities. Cresta Lodge DS0000066516.V308790.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Cresta Lodge DS0000066516.V308790.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cresta Lodge DS0000066516.V308790.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The quality outcome for this group of standards is good. This judgement has been made using available evidence including a visit to this service. No potential resident is offered a place at Cresta Lodge without as assessment of need being completed. EVIDENCE: A full discussion and records of assessment were shown of a resident about to be admitted. The Manager had already contacted the Commission prior to agreeing to permit this lady due to her illness being outside the registered category. Seen were clear detailed records that also included a scoring system to help measure the kinds of needs this person would require which enabled the Home to make the decision that the needs of this person could be met. On talking to the Manager the Home feel confident the needs can be met. On walking and talking to other residents it was evident that the care needs of the twenty two people living there are met Cresta Lodge DS0000066516.V308790.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 The quality outcome for this group of standards is good. This judgement has been made using available evidence including a visit to this service. The residents do have a comprehensive care plan that meets their needs. Resident’s health care needs are met. The Home adheres to the medication policy and the procedures are safe. Residents are treated with respect and their privacy is upheld. EVIDENCE: The care plans are all stored in a filing cabinet within the upstairs office. In total three care plans were looked at. All except the most recent residents had a photograph on the front of this file with clear details of each persons needs. Within this file is a comprehensive care plan review/checking sheet that had been completed in July by a senior staff member. On discussing any changes that occur the Manager was able to show examples of how any item of need change is written in the communication book and handed over to the next shift. Residents were able to say how they are involved with their care at Cresta Lodge DS0000066516.V308790.R01.S.doc Version 5.2 Page 10 Cresta and would happily talk to staff if they felt they needed to change something. In each care plan there are recording sheets to record any visit from a health professional including GP, DN and Chiropodist. Noted in one plan was a recent visit from the GP this was also copied into the communication book and highlighted in red as urgent action required by all staff attending this resident. On talking to one staff member on duty she gave clear details about the instructions for this person and daily records were reflecting the outcome of these instructions. The medication was administered at lunchtime and observed from a distance. The trolley was within sight at all times, each resident was offered their medication correctly with liquid doses measured at eye level. The senior staff member later showed all the MAR charts to the Inspector that were clearly marked. (It was noted that prior to the inspection staff had discussed the need to be clearer with signatures and Boots had given up-to-date training in June). (Certificates seen). Throughout the day it was evident how polite and courteous staff were. Doors were knocked upon, with resident asked if they could enter, before actually walking into the room. Each person was dressed smartly and wearing their own clothes. All care was offered behind closed doors with staff interacting with residents appropriately. On talking to a resident she was able to explain how her care needs are given to her and how caring the staff carry out these tasks. Cresta Lodge DS0000066516.V308790.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 The quality outcome for this group of standards is good. This judgement has been made using available evidence including a visit to this service. Residents do experience a lifestyle that suits their needs. Relatives and friends come and go as they wish. Residents do have assistance to make choices and control over their lives. The Home offers good wholesome food with choice and it is served in nice surroundings. EVIDENCE: Residents have the opportunity to participate in various activities. On talking to some residents they gave examples of trips out they had had. (on the day of the visit six residents were off with staff and volunteers to a lake to walk around). The hairdresser had been busy trying to get the residents hair set so as not to miss the trip. One lady was eating her lunch and sitting under the dryer so as not to miss out. Entertainment comes to the Home on a regular basis and around the building it was noted papers, videos, DVD’s and games Cresta Lodge DS0000066516.V308790.R01.S.doc Version 5.2 Page 12 that could be used when required. One resident was excited about the planned trip to visit where she grew up and was keen to show her painting of the area. The Manager is to introduce life story books as part of the development of the Home to aid the staff in the person centred care approach. This will be an asset to enhance the quality of life to the individual resident and help to address the social care needs of each person. Visitors were seen coming and going with plenty of conversation and laughter. Comments on one card received from a family stated how much they were welcomed especially as they travel regularly to visit their relative by travelling over 200 miles. One resident told of her visitors calling at any time of day and that they were always welcomed and offered a drink. Some of the residents handle their own affairs. Two residents stated they knew of records held in the office and how they discuss and get involved with care details and felt if they wanted to see their own records they could ask. A meal was taken with the residents, which was chicken nuggets or scampi with chips or mash and mixed vegetables. The dessert was artic roll, ice cream or fruit. The residents spoken to and comment cards received all stated they were happy with the meals. Each resident is asked daily what choice they would like for their meal, which is recorded and then prepared. The vegetable dishes are placed on the table and residents can help themselves to the amount they prefer. One resident was noted to need assistance with eating her meal and although she was eating it there was no conversation throughout the process. This lady not aware of what was on the spoon or what was left on the plate or what the pudding was. (Recommendation) Alternatives of salad or soup is available if preferred and a bowl of fruit is in the main lounge with fresh fruit placed in residents rooms on delivery from the green grocer. On talking to three residents each one gave a different choice for their breakfasts needs from porridge with honey to weetabix and toast with marmite. Cresta Lodge DS0000066516.V308790.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 The quality outcome for this group of standards is good. This judgement has been made using available evidence including a visit to this service. Residents and relatives can be reassured that their concerns/complaints will be listened to and acted upon. Residents are protected from abuse. EVIDENCE: One complaint that had been recorded on the pre inspection questionnaire was discussed and although difficult to deal with as it was something that had been dealt with by the previous owners, had been acknowledged by the new Manager as something that needs overseeing and certain monitoring systems have been established to ensure complaints of the same nature cannot occur at Cresta Lodge. Staff are trained in the understanding of abuse and it was noted in one staff members supervision/training notes how she understood and had written examples of what is abuse. All residents spoken to had no concerns about any of the care they were given and each one said they felt safe living at this Home. Cresta Lodge DS0000066516.V308790.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,24 and 26 The quality outcome for this group of standards is good. This judgement has been made using available evidence including a visit to this service. Residents live in safe and well-maintained Home but clear records need to be available. The areas indoors and out are both comfortable and safe. Residents have comfortable bedrooms with their own possessions around them. The Home is clean, hygienic and free from offensive odours. EVIDENCE: Throughout the day the Proprietors and Manager were able to show action plans and quality documents that show what the aims are for improving and maintaining the environment. All servicing including fire equipment, Cresta Lodge DS0000066516.V308790.R01.S.doc Version 5.2 Page 15 emergency lighting and call bell systems are checked but clear records of the ongoing daily, weekly, monthly, six monthly and annual checks are not clearly recorded and although there were no problems noted and checks have been happening there was not clear evidence on record of how these checks take place. (Recommendation) The date stickers for the servicing of fire extinguishers were noted as 05/06. The call bell system is very loud, especially in the entrance to the lounge and is intrusive. One visitor was noted to hold her hands over her ears and say the noise was too much. (Recommendation) The interior of the building is homely and well decorated with suitable furniture and adequate facilities. The dining room is bright and inviting but is used at present for any visitors coming and going with an entrance to the side of the tables. This appeared intrusive during the mealtime and would certainly be draughty in the winter. (Recommendation) The garden is well tended with plenty of areas to sit and enjoy. The home had recently enjoyed a strawberry tea with all the families invited taking place in the nice garden surroundings. Each bedroom visited was slightly unique and on asking residents about their rooms they all said how they loved their room and enjoyed having their possessions around them. They were all clean, bright and well decorated. The laundry is sited in a converted garage/shed outside of the main house and has adequate laundry facilities, including a machine that has a sluice facility. The shed itself is in need of rethinking due to the fact that the cleaning chemicals are left inside and not locked away with staff travelling to and from the area and not locking the door. (See Requirement under Management Standard 38). The Home is pleasant to walk around and no odours were noted. In each bathroom/toilet there is a checklist of when and by who the facility was cleaned which is to be commended. Cresta Lodge DS0000066516.V308790.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29 and 30 The quality outcome for this group of standards is excellent good adequate poor. This judgement has been made using available evidence including a visit to this service. The staff at Cresta Lodge are carefully chosen and the skills and balance of staff to resident considered according to the need. Residents are supported by a robust home’s recruitment policy and procedures. Staff are trained or about to be trained to enable them to do their job competently. EVIDENCE: The Proprietors and the Manager have been looking closely at the rota’s worked within the Home and have made a decision to increase the staffing by one on each am and pm shift. The rota’s as they stand at present are difficult to cover with many split shifts. The new rota with times to be was shared with the Inspector, which will be introduced slowly as more staff are recruited. A recent advertisement had found three new staff members who are about to be interviewed. No resident appeared rushed and staff were carrying out duties throughout the day. On talking to staff and then to residents many of them choose when they have their bath, what time they like to get up and go to Cresta Lodge DS0000066516.V308790.R01.S.doc Version 5.2 Page 17 bed. One gentleman likes a daily bath and one only weekly. All this is written and offered as the person care requirements. One personnel file was picked at random from the filing cabinet. All the required paperwork is held that includes two references and as this was a member of staff from overseas all visa’s and certificates, I.D including photographs and the home country police checks, were in place. The proprietors will ensure that if a staff member is recruited from overseas they will interview them by phone as well as ensuring all the stringent checks are in place that a reputable agency has already carried out prior to the position being offered. The Home will not accept staff who cannot communicate clearly to the residents and this is checked out by conversations on the telephone. The Home has drawn up a training matrix (seen) to identify who, what and when each staff member needs training. The Home has a clear induction foundation package with extra support available for staff from overseas. The Proprietor is planning a fire training session as it was noted the last date in the home for this training was 2004. On talking to the Senior staff member training has always been available within the home and hope the new proprietors continue to give the same support. With the matrix in place and plans for training already well under way evidence of this should be available on the next inspection. Cresta Lodge DS0000066516.V308790.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 The quality outcome for this group of standards is good. This judgement has been made using available evidence including a visit to this service. Residents do live in a home, which is run by people who are fit to be in charge. Quality Assurance is very important to this home. Resident’s financial interests are safeguarded. The Home is conscious of the health and safety of residents and staff but need to look closely at some practices. EVIDENCE: The Manager of Cresta Lodge was interviewed by two Inspectors at the Commission three months ago and was deemed suitable for the Manager of Cresta Lodge DS0000066516.V308790.R01.S.doc Version 5.2 Page 19 this service. She is already part way through her Managers qualification, which she hopes to complete by the start of 2007. The Home works hard at checking and auditing the quality of care offered to residents with action plans collated from checks carried out. These are sent to the Commission and action from these plans can be seen on a site visit. The annual quality assurance check is about to take place for Cresta Lodge with the added information gleaned from other interested parties as recommended and stated in 33.7 of the National Minimum Standards. Although individual records of residents personal money was not seen on this occasion the procedure for using amenity money was noted with money removed and recorded for the ice-cream treats for the afternoons outing and receipts in place for past purchases. It was noted on the walk around that the majority of the areas were safe and work practise carried out was as risk free as possible. The mandatory training is planned and all staff should be up to date shortly Concerns shared were the lack of care over the storing of cleaning chemicals, which were placed inside the open laundry door with two bottles of bleach placed on the sink draining board. (Requirement) Noted on electrical items were the PAT stickers dated 11/07/05 and the lifting hoists were serviced on 13/04/06 No accidents had been recorded since the Home had been purchased but the Manager was able to say how recordings would take place and when and who to notify in the case of a serious incident, accident or death. One regulation 37 had been received by the commission, on the death of a resident at the beginning of August. Cresta Lodge DS0000066516.V308790.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 x x x 3 x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 2 Cresta Lodge DS0000066516.V308790.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP38 Regulation 13.4(a) Requirement The Registered Manager must ensure that all areas of the Home are safe and free from hazards and stores chemicals as recommended under COSHH regulations. Timescale for action 01/09/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard OP15 OP19 OP15 OP19 Good Practice Recommendations It is recommended that staff are reminded to assist people with meals by conversing at all times to enable choice throughout the process. It is recommended that all maintenance records are held as evidence of when and how the building is maintained safely. It is recommended that the entrance from outside into the dining room is changed to allow meals to be ate in comfort and without intrusion. It is recommended that the call bell system is reviewed and the volume altered to create a quieter environment. Cresta Lodge DS0000066516.V308790.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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