Inspection on 09/04/10 for Crown Rest Home

This inspection was carried out on 9th April 2010.

CQC found this care home to be providing an Excellent service.

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

Crown Rest Home 24/04/07

Crown Rest Home 20/10/05

Crown Rest Home 01/06/05

Crown Rest Home 11/01/05

Crown Rest Home 30/06/04

Crown Rest Home 21/10/03

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 18/06/2010.

Key inspection report Care homes for older people Name: Address: Crown Rest Home Station Road Little Dunham Kings Lynn Norfolk PE32 2DJ     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Dragan Cvejic     Date: 0 9 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Crown Rest Home Station Road Little Dunham Kings Lynn Norfolk PE32 2DJ 01760722039 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): info@crownresthome.co.uk Mrs Lindsey Wood,Mr Christopher Wood Name of registered manager (if applicable) Provider/Manager Type of registration: Number of places registered: care home 18 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home The Crown Rest Home provides residential care for up to eighteen older people and is able to meet a range of care needs. The home is located in the village of Little Dunham and is owned and managed by Mr C & Mrs L Wood. The home comprises of the original building (which was a public house) plus some more recent extensions. The home is well maintained and care has been taken to make access as easy as possible throughout the property. The home is situated a short distance out of the village, and there is a good bus service. 0 Over 65 18 Care Homes for Older People Page 4 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 3 stars. This means the people who use this service experience excellent quality outcomes. After revieving the service through an annual service earlier this year, the home continued to provide excellent service for people that were cared for and supported in Crown Rest Home. This was an unannounced inspection. It was carried out by the link inspector Dragan Cvejic who also provided this report. This site visit lasted for 5 hours and the inspector spoke to four case tracked service users, and one more, to the staff members, a cook and two carers and to the senior staff in charge of the home, as the manager had a day off. We observed medication process, staff supporting service users and toured the home to check the environment. We checked four bedrooms, communal areas, including bathrooms, dining room and living areas. Care Homes for Older People Page 5 of 26 Documentation related to four case tracked service users was checked. Medication storage and records were also checked. A self-assessment form, AQAA, was filled in by the home and was used to inform this report. The direct comments from service users were also considered when the evidence was collected and some are presented in this report. Care Homes for Older People Page 6 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. Care Homes for Older People Page 7 of 26 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Appropriate assessments and evidence of meeting users needs determined the excellent rating of this group of standards. Evidence: An up to date statement of purpose and Service users guide provided clear information about the home to service users, allowing them to make an informed choice. The initial assessment was excellent, as it identified all areas that needed to be addressed in care plans and risk assessments. It addressed all important information, but highlighted very important details such as allergic to penicillin in red, as seen in one file. Each file also contained an example of a filled in initial assessment form, making it easy to address all areas and giving an example of how to cleary record these details. The home was particularly good in making arrangements to meet individual needs. proudly a service users commented: I like my morning coffee in the cafeteria before breakfast and they prepare it for me every morning. Care Homes for Older People Page 10 of 26 Evidence: Another entry stated: Does not want to be distrubed at night. A user was appropriately referred first of all to a GP and then to a chiropodist for a painful corn. The daily records clearly showed the process and how she was helped to experience minimal pain and discomofort through the actions taken to resolve the problem. Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users healthcare needs were appropriately assessed, recorded and met in an organised, excellent way that promoted their well being and independence with full respect for their dignity. Evidence: All four service users files checked contained detailed and up to date care plans. Care plans were clearly related to initial assessments. Accompanying risk assessments were also detailed and up to date, demonstrating regular reviews. One service users spoken to confirmed that they knew their set goals. I get washed and dressed straight away, I dont need to wait. Another user stated: Staff are really good, I dont feel neglected in any way. I use my call bell to call staff when I am in my room. It is lovely room. A user next to her added: I had my breakfast, I choose what I like. A user was observed asking for something else on her toast and a staff member brought and offered her jam, which she happily accepted. The staff member explained that she was not well and they were closely monitoring what and how much she ate. Privacy and respect for dignity exceeded minimum standards. A users file indicated Care Homes for Older People Page 12 of 26 Evidence: that the user was very proud and independent. The staff member was observed helping her get into her room to use the commode. The staff member hung a Do not disturb sign on a door and removed it after a user came out. The whole time of the visit, the interactions between staff and users was very respectful and dignified. Staff and users were smiling and both looked relaxed. Medication records were checked for four service users. There were no gaps and all details were recorded. The amount of medication was checked for three users and all matched the records. The staff were observed giving medication to three service users, showing respect and explaining what they were doing. The home did not record Temazepam (tablets) as a controlled drug. However, on inspectors comments the records were immediately prepared for this in a controlled drug register. The owner reported a few days after the site visit that she consulted the pharmacist and introduced the system for this medication to be treated as a controlled drug, showing high respect for recommendations. All checked files contained personal wishes of service users in case of death recorded and signed. Care Homes for Older People Page 13 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users wishes were respected and helped the home organise daily life according to users preferences, while maintaining an appropriate level of support and care which ensured the safety and well being of service users. Evidence: All service users spoken to confirmed that they were fully respected, listened to and treated with dignity. Entries in their records matched what they told us, such as having cafeteria coffee, choosing what they wanted to eat and getting help with their medication, as indicated in their care plans. The AQAA explained and provided evidence: Activity co-ordinator encourages mental stimulation and physical activity regularly within the capabilities of the service user. Records are kept.The daily routines in the home are flexible and service users are able to choose when they get up, go to bed, whether they take part in activities, when and where they take meals, what they eat, whether they socialise out of their rooms and with whom and whether they partake in religious observance. Information about forthcoming events is circulated in appropriate formats to all service users which included a large variety of entertainment. The service users decide what activities they would like via the residents committee ensuring equal opportunities for all levels of impairment and these are implemented Care Homes for Older People Page 14 of 26 Evidence: by the activities co-ordinator who has attended external training. The activities co-ordinator spends time with service users in small groups or individually as they require, organises trips out, welcomes new residents, promotes and records activities and alerts other staff of any particular interests. Activities include small theatre productions visiting the home, trips to local heritage museum, shopping, music, dancing, usual activities, families days, art school, card making, jewellery making classes, clay modelling, keep fit, a huge firework display, Christmas parties and every birthday has a party. Meal time was observed and looked dignified. Staff helped a user who needed help with feeding, patiently and sensibly. Staff knew users likes and dislikes, which improved not only respect for users but also ensured good monitoring of nutrition. Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users were well protected from abuse by clear working practices, preventative measures and a clear complaints procedure. Evidence: A complaints procedure was included in the service users guide. It had a clear time scale. The home recorded complaints in their complaints records. The senior staff on duty stated that she was not aware of any formal complaints lately. The manager reported in their AQAA: The lack of formal complaints indicates that we listen and react seriously and evidence is as follows: Complaints log C4-015, one complaint September 2005 Complaints book C4-013, no complaints. She also explained the homes approach to safeguarding and their determination to ensure the protection of service users: We take abuse seriously and have robust policies in place to make staff aware of types of abuse, what to do about it and professional reporting policies with flow charts. We actively encourage staff at this home and other care homes to whistle blow if they see any form of abuse and we educate relatives that they sometimes are committing abuse without recognising it as abuse. Staff are all required to be POVA checked prior to employment and CRB checked, need two references and to provide various documents before their induction is completed. All staff are trained in abuse recognition and actions to be taken regularly, and pick up pending signs very quickly such as noting rises in temper, agitation and quickly Care Homes for Older People Page 16 of 26 Evidence: reacting to diffuse potential incidents. A management of aggressive behaviour procedure and restraint policy and procedure is in place and service users are made aware of the conduct we expect from them to other service users, visitors and staff. Several users spoken to stated that they felt well protected, as one emphasised: I dont feel neglected in any way. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was safe, comfortable and bright and service users were free to go to any part of it, but also benefited from the layout of the home with centralised communal areas, whereby staff were constantly either present or were passing throgh. This helped interactions and especially users affected by dementia, who were able to see the staff constantly. Evidence: A tour through the home provided evidence of a comfortable, safe and homely environment. In their AQAA the manager spoke about the improvements regarding the environment and special adaptations that made the home appropriate for service users conditions: The home has been designed as a care home and meets all national minimum standards and has a high build standard with all 18 rooms being single and en-suite (one being adapted to disabled standards). A choice of assisted bath or shower was available; there were two TV rooms, a conservatory, garden room, dining room, and a multifunction room for hairdressing, medical treatment or visitors overnight accomodation was also available. The home is non-institutionalised and has a very home from home approach with residents encouraged to personalise their rooms. Access is provided to all areas with a shaftlift and stairlift to the first floor, with level thresholds and no steps. The garden has wheelchair friendly pathways, rest areas, Care Homes for Older People Page 18 of 26 Evidence: residents raised veg garden, patios with sun protection and the car park has a solid surface with turning area and disabled parking bay. There is an internal secluded courtyard with raised fishpond and seating. Lighting is designed to be bright and dimmable in rooms and of domestic character as are the furnishings. Monthly checks are made of the fabric and condition of the home and grounds with a decorating schedule is in place and monthly maintenance schedule is in place The building conforms to the regulatory fire reform order and environmental health department regulations. Hoists, variable height beds with pressure control, various aids and equipment are available and maintained, staff being trained in the use of such equipment Residents choose from any empty room they like on admission and sometimes request to move to another room when it becomes vacant which is freely permitted The home has very good housekeeping and never has any unsavoury smells, the use of smell neutralisers is not endorsed for use on floors and furnishings. The call bell system is easy to use with all rooms used by service users having points and leads including en-suites, necklace buddy call bells are also available for immobile service users or whilst in outside areas, these link to the main system. The staff carry pagers for when they are out of earshot of the control points and all calls must be turned off at point of operation. A robust infection control policy is in place. Staff work to Norfolk Health Protection Unit Control of Infection & Communicable Disease guidance. All staff are trained in infection control annually. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Competent staff provided reassurance to service users that their needs, wishes and preferences would be respected and met. Organisation, team-work and staff effectiveness were commendable. Evidence: Staffing was a real asset to this home. Well-trained, experienced, knowledgeable and caring staff members worked as a team in an organised manner that created a supportive and caring atmosphere in the home. Staff were observed helping service during breakfast and afterward. They interacted with users each time they were passing through communal areas. There were no new staff recently employed and this very small turnover also helped service users know all the staff. A staff member spoken to stated: It is lovely to work here. We get support, regular supervision and full training. Another staff commented: We are very happy here, we get extra pay for longer service in the home. The AQAA stated: Staffing numbers are higher than required following assessed ratios needed and a good skills mix is developed in the home to meet the needs of the service users. Staff are aware of their shift patterns at least one month in advance at all times. We have achieved 72 NVQ2 or above ratio, three have NVQ3. Care Homes for Older People Page 20 of 26 Evidence: The home has never needed nor used agency staff. Staff are well trained and encouraged to take training beyond the basic requirements with ongoing internal development training in addition to the formal external training. Staff receive paid training, have individual supervision sessions and annual appraisals. Staff can request further relevant specialised training to further themselves and their career opportunities should they wish to do so. The training programme has been recognised by the University of East Anglia School of Nursing and Midwifery who place students at the home for clinical training. The College of West Anglia and Norwich City College place students for care experience. The home has also been awarded the Investor in People Award in 2005, renewed in 2008. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The effectiveness of the management team, which contributed to a high level of safety and welfare of service users, determined the excellent scoring of management, which ensured satisfaction of and respect for service users. Evidence: One of the proprietors was also the registered manager. The AQAA produced information about her: The care manager is a registered nurse with ENB certificate for Nursing the Elderly, she has NVQ 5 in Health and Social Service Management, has attended supervision skills for social service managers training, advice and guidance training and is a train the trainer in malnutrition. She also has City & Guilds 7303 teaching qualification. Quality assurance results were incorporated into AQAA and demonstrated that the home was run in an open and inclusive way and that they listened to service users. The AQAA stated: The home has had an effective quality assurance program since 2004, based on seeking the veiws of the service users and being measurable to ensure the aims and objectives of the home are being met. It also enables the annual Care Homes for Older People Page 22 of 26 Evidence: business plan to be completed effectively using a systematic cycle system. I do have money when I need. My daughter deals with my finances, stated one of the users spoken to. The information about finding an independent advocate was displayed on the board. Staff confirmed that they were regularly supervised and well supported. Safe working practices were in place. Certificates of indemnity insurance, gas safety records, water temperature records and other health and safety documents were in the health and safety folder. The records were accurate and up to date. Incidents and accidents were appropriately reported and analysed within the home in order to prevent re-occurrence and improve the safety of service users. The AQAA also explained:The managers ensure policies and procedures are followed by staff, spot checks take place and quality systems monitor and review practices. Staff have full access to all relevant procedures and information for them to carry out any of their duties to the full at all times. Full health and saftey training is regularly carried out covering a wide range and in line with relevant legislation. Comprehensive risk assessments are carried out and reviewed regularly. Accident and incident records are maintained and reported as required. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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