Inspection on 23/03/07 for Creswick House

This inspection was carried out on 23rd March 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 15/11/05

Creswick House 10/05/05

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 Debra Allen Unannounced Inspection 23rd March 2007 10:30 Creswick House DS0000027471.V334876.R01.S.doc Version 5.2 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 Creswick House DS0000027471.V334876.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 Adults 18-65. 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. Creswick House DS0000027471.V334876.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Creswick House Address 77-79 Norwich Road Fakenham Norfolk NR21 8HH 01328 851537 NO FAX # creswick.jeesal@virgin.net www.jeesal.org Jeesal Residential Care Services Limited Mrs Sally Subramaniam Helen Carson Holmes Care Home 13 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) Category(ies) of Learning disability (13), Learning disability over registration, with number 65 years of age (7) of places Creswick House DS0000027471.V334876.R01.S.doc Version 5.2 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. 15th November 2005 Date of last inspection 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. 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. The Home is owned and managed by Jeesal Residential Care Services Ltd. Creswick House DS0000027471.V334876.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Care Services are judged against outcome groups, which assess how well a provider delivers outcomes for people using the service. The key inspection of this service has been carried out, by using information from previous inspections, information from the providers, the residents and their relatives, as well as others who work in or visit the home. This has included a recent unannounced visit to the home. This report gives a brief overview of the service and the current judgements for each outcome group. This inspection was carried out over a period of five and a half hours, during which time a tour of the premises was carried out, discussion took place with a number of people living at the home and with members of staff, including the deputy manager. Records relating to health & safety, recruitment and individuals living at Creswick House, were also inspected. Ten service user surveys and three relative/visitors comment cards were received prior to the inspection. Most of the service user surveys had been completed with assistance from staff and descriptions of communication were included to show how each person’s responses had been obtained. One recommendation has been made as a result of this inspection. What the service does well: The staff team are very enthusiastic and work very closely with the people living at Creswick House and adapt their working styles to effectively support people with very different abilities and requirements. Care plans are very person-centred and contain very detailed information about each person as an individual and how they want and need to be supported. Communication is a big issue and it is evident that a great deal of time and effort has been spent by the staff team to ensure a consistent approach is maintained, with regard to supporting each person. The organisation provides a good training programme and learning opportunities for staff. Creswick House DS0000027471.V334876.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. The summary of this inspection report can be made available in other formats on request. Creswick House DS0000027471.V334876.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Creswick House DS0000027471.V334876.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. Prospective service user’s individual aspirations and needs are assessed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All the people living at Creswick House have been there for a number of years, but the care plans looked at contained detailed needs assessments, which were completed prior to people moving in. These assessments are regularly reviewed and updated as necessary. Creswick House DS0000027471.V334876.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 & 10 Quality in this outcome area is good. Service users know their assessed and changing needs and personal goals are reflected in their individual plan. Service users are supported and encouraged to be involved in all aspects of life in the home. Service users are supported to make decisions about their lives and take risks as part of an independent lifestyle. Information about service users is stored securely so their personal details remain confidential. This judgement has been made using available evidence including a visit to this service. Creswick House DS0000027471.V334876.R01.S.doc Version 5.2 Page 10 EVIDENCE: Three care plans were looked at during the inspection and found to be very comprehensive and person centred. Each plan contained very detailed information with regard to individual needs, wants and choices and it was evident that a lot of time and effort has been taken to get to know each person and ensure they are supported to be actively involved in all aspects of life in the home. Minutes/notes were seen from tenants meetings, which are held on a daily basis - usually around teatime. There was solid evidence of service user involvement and staff confirmed that more accessible formats are currently being looked into for presenting the information gathered from these meetings. Each care plan also contained risk assessments, which were seen to have been reviewed regularly and updated or amended as necessary. Clear explanations were seen for situations where people’s choices were limited or restricted. All records and information relating to the people living at Creswick House were seen to be stored securely in lockable filing cabinets either in the manager’s office or the staff rooms, therefore ensuring confidentiality. Creswick House DS0000027471.V334876.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15 & 17 Quality in this outcome area is good. Service users have opportunities for personal development, are part of the local community and engage in appropriate leisure activities. Service users are supported to have appropriate personal relationships. Service users are offered a healthy diet and enjoy their meals and mealtimes. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staff team were seen to work very closely and consistently with the people living at Creswick House and adapted to accommodate very different abilities and requirements. A separate area, upstairs, is used as a day-care room and this was seen to contain a wide selection of activity facilities and materials. There are plans to develop a sensory room in the old sleep-in room. Creswick House DS0000027471.V334876.R01.S.doc Version 5.2 Page 12 The care plans looked at contained individual activity schedules and evidence was seen, through daily notes and other information on file, of involvement in areas such as art & craft, knitting & sewing, music & movement, cooking & kitchen skills, karaoke, board games & puzzles & letter writing. The service user surveys returned included comments, under the heading ‘what’s good about living at your home’ such as: cooking, bus rides, television and shopping. On the day of inspection one person was observed listening to music of their choice and they told me how they enjoy going to church. Another person was seen assisting with some lunch preparation and helping to clear up. One person’s care plan contained a learning plan/programme which was made up of three parts: (1) Care need = What (2) Care objective = purpose (3) Care plan = How. In this particular case daily living skills were being focussed on and progress information was seen with regard to making drinks, setting the table, tidying own room, doing own laundry and hoovering. Holidays and external activities are also very person centred and evidence was seen of events such as bowling, shopping, sailing, horse-riding, Gateway Club, country & wildlife parks and local pubs and restaurants. Recent holidays have included Centerparcs, Holiday Camp, Forest Lodge, Oulton Broad, hiring a car for days out and day trips to London. The menus were seen to offer a varied diet, which was wholesome and nutritious. Care plans included information relating to individual’s dietary requirements and input was also noted from the speech and language therapist. Creswick House DS0000027471.V334876.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 & 21 Quality in this outcome area is excellent. Service users receive personal support in the way they prefer and their physical and emotional healthcare needs are met. Service users are protected by the home’s policies and procedures for dealing with medication. Service users are treated with dignity and respect with regard to ageing, illness and death. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans looked at were found to contain very detailed information about each person as an individual and how they needed and wanted to be supported. Communication is a big issue and it was evident that a great deal of time and effort has been spent ensuring a consistent approach is maintained, with regard to supporting each person. Creswick House DS0000027471.V334876.R01.S.doc Version 5.2 Page 14 The contents of one person’s care plan included an ‘approach to meet needs’ which explained how this person liked and needed to be supported in areas such as foot care, hair & scalp, dental, nails, going to the toilet, mobility, diet (including food allergies), epilepsy, well person issues, pain, illness and infection. A communication assessment was also seen which explained how this person communicated their understanding and how staff should communicate with them. A comprehensive but clear description of emotions was also included and this explained how to recognise when the person is bored, tired, hungry, thirsty, angry, sad or happy. A ‘daily living schedule’ detailed likes and dislikes and included food, activities and situations. Evidence was seen, in the care plans, of involvement and support from external professionals such as GP, community nurse, psychiatrist, chiropodist, dentist, optician, dietician and speech & language therapist. None of the people living at Creswick House are currently self-medicating, but they are protected by the home’s policies and procedures for dealing with medication and staff are well trained in this area. The home uses a Monitored Dosage System (MDS) and the Medication Administration Records (MAR) that were seen were all in order with no omissions or errors noted. An audit for one person showed all medication to be accounted for. Discussions with staff and information seen in the care plans confirmed that each person is individually supported and treated with dignity and respect as their needs change due to age or illness. This was particularly evident with regard to one person’s recent illness and hospital admission, with staff providing round-the-clock support to ensure consistency of care. Information was also noted, which explained how the service users are also supported to deal with and understand death and bereavement. One person was recently supported to attend their parent’s funeral. Creswick House DS0000027471.V334876.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. Service users feel their views are listened to and acted on and they are protected from abuse, neglect and self harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s complaints procedure and record keeping was seen to be robust. ‘Tenant meetings’ take place on a regular basis and notes from these meetings were seen, including action taken if necessary, which confirmed that people’s views are taken seriously. A keyworker system is in place to enable people to discuss any concerns with a named member of staff and the home’s complaints procedure explains that ‘the keyworker system is also designed to enable tenants with communication difficulties to be advocated for by trying to understand their own individual communication systems’. Financial records were looked at for some of the people living at Creswick house and another robust system was seen to be in place. Records of all transactions are maintained and two staff are required to sign on each occasion if dealing with finances on behalf of the service user. Discussions with staff members and training records confirmed that all staff have received training in, and understand abuse, adult protection and whistleblowing. Creswick House DS0000027471.V334876.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29 & 30 Quality in this outcome area is good. Service users live in homely, comfortable and safe environment, which is clean and hygienic. Service users bedrooms, toilets and bathrooms are individual and private and shared spaces complement their individual rooms. Specialist equipment is available and provided if required, to maximise independence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: An in-depth tour of the premises was carried out and a number of people were happy to show me their individual rooms. All the bedrooms seen were very different from each other and highly personalised, reflecting individuality. Creswick House DS0000027471.V334876.R01.S.doc Version 5.2 Page 17 Specialist and sensory equipment was observed throughout and is available and provided as needed. One person was seen walking around the house with the assistance of a walking aid and some of the individual sensory equipment included a spa bath, fish tank and colour-changing light/water feature. Although the communal areas appeared quite bland by comparison to individuals’ bedrooms, it was explained and evident that not everybody living at Creswick House likes ornaments or pictures and safety issues were an important factor. The gardens have matured well and are very attractive and inviting. A few people were observed spending time in the garden on the day of inspection. All areas seen on the day of inspection were found to be clean and hygienic with no unpleasant odours. Creswick House DS0000027471.V334876.R01.S.doc Version 5.2 Page 18 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 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35 & 36 Quality in this outcome area is good. Staff have clear roles and responsibilities, are well trained, competent and appropriately qualified. The home has robust recruitment policies and procedures. Staff are well supported and supervised. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In-depth discussions were held with two staff members and both said they felt the team worked very well together. They also spoke very highly with regard to the support and training received from the home’s manager and the organisation as a whole. The training programme/board was seen and evidence of courses attended included first aid, fire safety, health & safety, food hygiene, minimum standards, dementia, epilepsy, Autistic Spectrum Disorder (ASD) and Signalong. Creswick House DS0000027471.V334876.R01.S.doc Version 5.2 Page 19 Three personnel files were looked at and found to contain all the relevant records such as application form, contract, confirmation of identification and clear, enhanced Criminal Records Bureau (CRB) disclosures, therefore confirming that the home/organisation has robust recruitment procedures. Evidence was also seen to show that staff received one-to-one support and supervision on a regular basis. Both staff members spoken to also confirmed this fact. Creswick House DS0000027471.V334876.R01.S.doc Version 5.2 Page 20 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 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40, 41 & 42 Quality in this outcome area is good. Creswick House is a well run home and the service users benefit from the ethos, leadership and management approach. Service users’ views underpin the self-monitoring, review and development of the home. Service users’ rights and best interests are safeguarded by the home’s policies, procedures and record keeping. The health, safety and welfare of service users are promoted and protected. This judgement has been made using available evidence including a visit to this service. Creswick House DS0000027471.V334876.R01.S.doc Version 5.2 Page 21 EVIDENCE: The manager was not present on the day of inspection, but discussions with staff members confirmed that she is respected and has the best interests of the service users at heart. Staff spoken to also said they felt the management team were extremely supportive and ran a very good service. A copy of the annual development plan for 2006/2007 was seen, which contained very good evidence that the health, safety and welfare of the service users are promoted and protected and that their views play a major role in the self-monitoring, review and development of the home. Policies and procedures were looked at and found to be in good order and are regularly reviewed and updated. Health and safety is promoted within the home and records looked at confirmed that fire alarm and safety tests are carried out on a regular basis. Cleaning materials/hazardous chemicals were seen to be stored appropriately in a locked cupboard and staff training in areas relating to health and safety was seen to be up to date. Creswick House DS0000027471.V334876.R01.S.doc Version 5.2 Page 22 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 Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 4 12 3 13 3 14 3 15 3 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 3 3 3 3 3 3 3 X Creswick House DS0000027471.V334876.R01.S.doc Version 5.2 Page 23 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. Standard Regulation 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 YA42 Good Practice Recommendations When freezing fresh food, it is recommended that items are labelled with the date of freezing, to avoid confusion with use-by dates on the packaging when defrosted. 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