Inspection on 10/05/05 for Creswick House

This inspection was carried out on 10th May 2005.

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

Creswick House 23/03/07

Creswick House 15/11/05

Creswick House 24/11/04

Creswick House 11/05/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Creswick House 77-79 Norwich Road Fakenham Norfolk NR21 8HH Lead Inspector Lella Andrews Unannounced 10 May 2005 08:50 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. Creswick House I55 s27471 Creswick House v223283 (un) 100505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Creswick House Address 77-79 Norwich Road Fakenham Norfolk NR21 8HH 01328 851537 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Jeesal Residential Care Services Limited Helen Carson Holmes Care Home 13 Category(ies) of Learning disability (13), registration, with number Learning disability over 65 years of age (7) of places Creswick House I55 s27471 Creswick House v223283 (un) 100505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. Thirteen (13) adults of either sex who have a learning disability may be accommodated. A maximum of seven (7) service users accommodated on the ground floor may be over 65 years of age and have a learning disability. Maximum number not to exceed 13. Date of last inspection 24 November 2004 Brief Description of the Service: Creswick House is a large house situated on the edge of the town of Fakenham. It provides accommodation for up to thirteen adults with a learning disability. Seven of the service users may also be over the age of 65 years. The building is divided so as to provide living accommodation for the group of older, more frail service users on the ground floor and for a group of more physically able service users on the first floor. The service users living on the first floor may have behaviours which staff may find challenging. There are currently separate staff teams working on each floor. The second floor is used as office and staff accommodation. There is a large garden to the rear of the Home which has been divided so that each floor has access to their own part of the garden. There is an activities room situated at the end of the garden. The Home is owned and managed by Jeesal Residential Care Services Ltd. Creswick House I55 s27471 Creswick House v223283 (un) 100505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Inspection was unannounced and took place between 8.50am and 1.50pm on Tuesday 10th May 2005. The Manager was present throughout the Inspection. In addition to the Manager the Inspector spoke to two members of staff on an individual basis. Due to difficulties with verbal communication or because they choose not to it was not possible to speak to tenants (service users) on an individual basis but the Inspector spent time observing the staff supporting tenants. Records were inspected and a brief tour of the majority of the communal areas in the Home was undertaken. What the service does well: What has improved since the last inspection? There are now dedicated staff teams for each of the floors. Staff have worked hard to assess the communication needs of the tenants and to put in place individual care plans with regard to these. Activities are provided on a more structured basis on the first floor which is of benefit to the tenants living there. Some minor changes to the accommodation on the first floor has provided benefits to the tenants, such as changing the lounge and the dining room into two lounge/diners therefore providing more choice to tenants about where they spend their time. Creswick House I55 s27471 Creswick House v223283 (un) 100505 Stage 4.doc Version 1.30 Page 6 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. Creswick House I55 s27471 Creswick House v223283 (un) 100505 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Creswick House I55 s27471 Creswick House v223283 (un) 100505 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2, 3 and 4 The process of assessing a prospective service users needs is thorough and enables both the service user and the organisation to make an informed decision about whether the Home is an appropriate place for the service user to live. EVIDENCE: The assessment carried out for the tenant who moved to the Home most recently is very thorough and involved gathering information from the tenant, their family as well as professionals involved in their life. Visits to the Home by the tenant and their family are encouraged as part of the decision making process. The organisation employs a Behaviour Support Manager who was very involved in the assessment process. The detailed assessment then provides the basis of a comprehensive care plan which is put together prior to the tenant moving into the Home. The care plan shows evidence of this having been reviewed and updated regularly since the tenant moved into the Home. The Manager is clear about the range of needs that can be met by the Home and is involved in the assessment process for any prospective tenants. The Home is currently split into two separate “floors” with older, more frail tenants living on the ground floor and younger, physically able tenants, with behaviours which challenge, living on the first floor. The staff and Manager are clear about the very different needs of the two groups of tenants. Creswick House I55 s27471 Creswick House v223283 (un) 100505 Stage 4.doc Version 1.30 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 8 and 9 The detailed care plans and risk assessments are regularly reviewed and, in general, provide clear guidance to staff about how to meet individual needs. The tenants are offered choices in a range of ways and are encouraged to make their own decisions. EVIDENCE: Two care plans were looked at in detail. These are detailed and contain evidence of monthly reviews and updates. The care plans contain details about how to meet individual tenants needs with regard to personal care, communication, health care, social activities, behaviour, medication, nutrition and finances. The plans include information about seemingly minor issues but which make a difference to an individuals life eg. whether a tenant likes the light on or off when going to bed. This attention to detail is particularly important when supporting tenants with communication difficulties. There were two particular issues highlighted briefly in one of the care plans without any further detail and a recommendation is made to provide further detailed guidance to staff about these issues. Creswick House I55 s27471 Creswick House v223283 (un) 100505 Stage 4.doc Version 1.30 Page 10 The monthly reviews show evidence of the tenants having been involved and record the questions asked of the tenant and of their responses, if any. The care plans and risk assessments show evidence of other professionals having been involved in the assessment and planning of particular areas. The tenants living on the first floor have care plans which follow the new format which the organisation are in the process of implementing. These are clearer, more easy to read and provide better information for staff than the older versions. Staff are clear about the importance of offering tenants choices and were observed doing so in a variety of situations. Communication is recognised by staff as being extremely important when supporting tenants with autism and those who have difficulty with verbal communication. Training is provided to staff with regard to autism and also communication. The use of symbols, signing and objects of reference has increased since previous Inspections and staff explained the forms of communication used with individual tenants. The process of risk assessment has identified some areas where choice may be reduced due to potential risks but the staff team work hard to find solutions to this. For example, the kitchens are kept locked due to risks to the tenants and on the first floor hot drinks are provided in the dining room via thermos tea/coffee pots therefore still offering the tenants a choice. The tenants are encouraged to take part in a tenants meetings. These take place on a daily basis on the first floor and a weekly basis on the ground floor. The minutes show that all tenants are given an opportunity to raise any issues that they may have. Staff provide information about any expected visitors, staffing, training that staff are due to attend, activities and menu choices. A representative from each floor also attend the Tenants Forum which is held at the organisations head office and attended by one of the Directors of the organisation. Creswick House I55 s27471 Creswick House v223283 (un) 100505 Stage 4.doc Version 1.30 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, 15 and 16 Tenants are supported to take part in a range of activities, both at the Home and within the local community. Tenants are supported to maintain contact with family and friends in the most appropriate way for the individual. Staff respect the tenants rights in a variety of ways and the responsibilities are negotiated and agreed on an individual basis. EVIDENCE: As part of the ongoing work with regard to communication each of the tenants has an agreed timetable of activities and these are displayed in different ways depending on the needs of the individual. There is a large board on display on the ground floor which shows the activities for the week for each person in symbol and word format. The staff are very aware of the fact that the tenants are older and plan activities which are appropriate to their needs and wishes at a pace which suits each person. The Creswick House I55 s27471 Creswick House v223283 (un) 100505 Stage 4.doc Version 1.30 Page 12 activities for the tenants who live on the first floor are much more structured due to their needs associated with autism. Individual tenants have their own programme of activities in their bedrooms or in a format that they can carry around with them. The staff are aware of the need for this structure and work hard to ensure that it is carried out after careful planning. The care plans contain information about an individuals likes and dislikes with regard to activities. Records are kept of new activities that are tried for the first time and of how the tenant enjoys them. The monthly reviews and the minutes of the tenants meetings show that activities are discussed on a regular basis. The health needs of tenants are also considered when planning activities, for example, the need for regular physical exercise as part of a healthier lifestyle. The Home has two vehicles which enable tenants to access community facilities further afield as well as in the local town. There is a building in the garden which is used for activities but the Manager advised that there are plans to adapt the rooms on the second floor to be used as activity rooms and for the Managers office to be moved to the building in the garden. The activity room is mainly used by the first floor tenants and so the change will be a positive one for them as toilets are more accessible and they will not have to go outside in poor weather to access the activity rooms. The care plans contain details about the arrangements in place to enable each person to maintain contact with friends or family. Staff gave examples of recent situations when tenants have been supported to visit family. Tenants also meet up with tenants who live in other Homes owned by the organisation, many of whom have known each other for several years. Staff are aware that Creswick House is the tenants home and that their role is to support them to live their life in as independent a way as possible. Staff spoke to tenants in a respectful and kind manner. Staff know the tenants well and are aware of the plans in place to meet individual needs. Bedroom doors are locked and the tenants have their own keys unless there is a clear risk attached to this which is recorded in the care plan. Responsibilities for any tasks are recorded within the care plans. Staff were heard to encourage tenants to consider the possible consequences of actions in particular circumstances. Creswick House I55 s27471 Creswick House v223283 (un) 100505 Stage 4.doc Version 1.30 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 20 Medication is well managed which ensures that tenants receive their medication at the correct times in a safe manner. EVIDENCE: Staff on the ground floor were observed administering medication after breakfast. The Home has a medication procedure which is available to the staff to refer to. Two staff are involved in the administration of medication and this is carried out in the kitchen with only one tenant present at a time. Staff carried out this task in a calm manner and were supportive to tenants, allowing them to take their time when taking their medication. The administration records seen were filled in correctly and there were no gaps. Records are kept of medication received at the Home and returned to the pharmacy. Care plans show that medication is reviewed on a regular basis. Creswick House I55 s27471 Creswick House v223283 (un) 100505 Stage 4.doc Version 1.30 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 23 Staff are aware of Adult Protection issues and receive appropriate training with regard to this issue which provides protection to the tenants. EVIDENCE: Staff all receive training with regard to Adult Protection within their induction and then more detailed training within their first year of working in the organisation. Staff are aware of action to take if they have any concerns about any issues relating to the tenants and have confidence that these will be taken seriously by the Manager and the organisation. Care plans show that records are kept of any accidents and any bruises/marks noticed and of any changes in tenants behaviour. Risks are recognised and assessed with records kept. The organisation deals effectively with any concerns relating to tenants. Creswick House I55 s27471 Creswick House v223283 (un) 100505 Stage 4.doc Version 1.30 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 Tenants live in a homely, comfortable and safe environment. EVIDENCE: A tour of the majority of the communal areas of the Home was undertaken. The ground floor accommodation is more homely as there are more ornaments and pictures whereas the first floor is less so due to the needs of the tenants who live there. Individual bedrooms are decorated attractively and tenants are encouraged to personalise these. The lounge and the dining room on the first floor have been changed recently so that both are lounge/dining rooms which enables the tenants to have a choice about where they spend their time and where they have their meals. Staff advised that this has been an improvement as tenants can spend their time in smaller groups. Tenants were seen to move around their Home freely although they are not allowed to go into other tenants rooms without permission and also cannot move from the ground floor to the first floor or vice versa as these now provide very separate living accommodation. Creswick House I55 s27471 Creswick House v223283 (un) 100505 Stage 4.doc Version 1.30 Page 16 There was an unpleasant odour on the first floor accommodation but the staff are working hard with the particular tenant to address this issue. Appropriate cleaning equipment is provided and was in use on the day of the Inspection. Creswick House I55 s27471 Creswick House v223283 (un) 100505 Stage 4.doc Version 1.30 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, Tenants are supported by staff who are clear about their roles and who know the tenants well and how to meet their needs. EVIDENCE: Conversations with staff and inspection of the rotas show that there have been some difficulties with staffing recently due to staff leaving and also some staff sickness. However, staff worked hard to ensure that there were suitable staffing levels provided through that time and the Manager is now confident that recent recruitments will improve the situation. The way that the shifts are organised is different on each floor but this seems to suit the staff and the tenants on each floor. The staff on the first floor have recently started to work on a “long day” system. Whilst the staffing difficulties may have prompted this change the staff advised that they have found that this is a more effective way to work with tenants with autism as it removes the handover period which can cause difficulties with so many people in the Home. The Manager is aware of the need to monitor the situation to ensure that staff are not becoming too tired and that they are able to work effectively throughout the long day. Creswick House I55 s27471 Creswick House v223283 (un) 100505 Stage 4.doc Version 1.30 Page 18 The Home now has a waking night staff on each floor. This is a recent change and staff advised that it is a big improvement as previously there was one waking night staff and one sleep-in for the whole Home. A member of staff advised when they started work at training to undertake their supportive to the tenants. and calmly. that they had received a good induction programme the Home and that they have received appropriate role. Staff have a positive attitude and are kind and Difficult situations were dealt with appropriately Creswick House I55 s27471 Creswick House v223283 (un) 100505 Stage 4.doc Version 1.30 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, Tenants benefit from a well run Home, with a Manager who gives clear direction and sets high standards EVIDENCE: The Manager of the Home has only been in post for about eighteen months but has many years experience of working with adults with a learning disability and challenging behaviours. Approximately six months ago one of the deputy managers from another Home within the organisation came to work as the deputy at this Home. The deputy and the Manager take responsibility for a separate floor each although the Manager retains the overall responsibility for the whole Home. The Manager has high standards for herself and for the staff team. The Manager has now established herself within her role and these standards are much more clearly communicated to the team. Staff advised that they are confident that any issues taken to the Manager will be addressed and said that Creswick House I55 s27471 Creswick House v223283 (un) 100505 Stage 4.doc Version 1.30 Page 20 she is approachable. The Manager is currently undertaking the Registered Managers Award and hopes to have completed this by October 2005. Creswick House I55 s27471 Creswick House v223283 (un) 100505 Stage 4.doc Version 1.30 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 4 3 3 x Standard No 22 23 ENVIRONMENT Score x 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 3 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x x Standard No 11 12 13 14 15 16 17 x 3 3 3 3 3 x Standard No 31 32 33 34 35 36 Score 3 3 3 x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Creswick House Score x x 3 x Standard No 37 38 39 40 41 42 43 Score 3 x x x x x x I55 s27471 Creswick House v223283 (un) 100505 Stage 4.doc Version 1.30 Page 22 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard Regulation N/A Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 6 Good Practice Recommendations It is recommended that clear written guidance is available to staff for all issues highlighted in the care plan as a potential risk Creswick House I55 s27471 Creswick House v223283 (un) 100505 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection 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. Extracts may not be used or reproduced without the express permission of CSCI Creswick House I55 s27471 Creswick House v223283 (un) 100505 Stage 4.doc Version 1.30 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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