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Inspection on 13/10/05 for Crystal Hall Residential & Nursing Home

Also see our care home review for Crystal Hall Residential & Nursing Home for more information

This inspection was carried out on 13th October 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home provides care to a vulnerable care group of younger adults with mental health problems. Residents at the home are long term and have a good relationship with staff and the manager. Resident`s comments included, ` it`s clean and efficient`, `it`s A1`, `staff are lovely`. One visitor wrote to the inspector saying, `all staff are approachable and friendly. The home provides a high standard of care. My relative is quite capable of making her views known to inspectors if asked.` Another relative wrote, `I am very satisfied with my sister`s care`. Finally another wrote, `I think the staff are wonderful and do a good job`.

What has improved since the last inspection?

There were some areas of improvement required at the last inspection and all have been addressed promptly and some at the time of the inspection.

What the care home could do better:

There should be some minor adjustments made to the supervision of staff so it becomes a more valuable tool for both staff members and the manager. A deputy or assistant manager could help with this task. More activities for the more abled should be looked into. A computer, library, pool table and education room are options to explore.

CARE HOME ADULTS 18-65 Crystal Hall Residential & Nursing Home Whittingham Hall Whittingham Preston Lancashire PR3 2JE Lead Inspector Elaine Clare Unannounced Inspection 13th October 2005 Crystal Hall Residential & Nursing Home DS0000006035.V252132.R01.S.doc Version 5.0 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 Crystal Hall Residential & Nursing Home DS0000006035.V252132.R01.S.doc Version 5.0 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. Crystal Hall Residential & Nursing Home DS0000006035.V252132.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Crystal Hall Residential & Nursing Home Address Whittingham Hall Whittingham Preston Lancashire PR3 2JE 01772 861034 01772 866161 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) Crystal Hall Limited Mr John Patterson Care Home 47 Category(ies) of Dementia (9), Mental disorder, excluding registration, with number learning disability or dementia (38) of places Crystal Hall Residential & Nursing Home DS0000006035.V252132.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The home must not accommodate any service user under the age of 40 years. The home is registered for a maximum of 47 service users to include: Up to 38 service users in the category of Mental Disorder (MD) Up to 9 service users in the category of DE (DE) The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection 27th January 2005 Date of last inspection Brief Description of the Service: Crystal Hall is a 41 bedded Care Home with Nursing, offering care to Service Users with a mental illness aged 40 years plus. The home is a period farmhouse with an extensive purpose built extension situated in a rural area. The home is within walking distance of shops, a public house and places of worship. The home is also on a bus route. There are well-maintained grounds surrounding the property, which include an external aviary and enclosed courtyard. Crystal Hall Residential & Nursing Home DS0000006035.V252132.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over two days and was carried out to ensure that compliance had been achieved to the requirements made at the last inspection. A tour of the premises took place and staff and care records were inspected. Four staff members were spoken with along with eight of the forty residents, lunch was spent with two gentlemen and the inspector walked with one resident to the local shops. What the service does well: 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. Crystal Hall Residential & Nursing Home DS0000006035.V252132.R01.S.doc Version 5.0 Page 6 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 Crystal Hall Residential & Nursing Home DS0000006035.V252132.R01.S.doc Version 5.0 Page 7 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 the following standard(s): 1,2,3,4,5 Residents had been assessed and had been given the opportunity to view the premises prior to admission. EVIDENCE: The home had reviewed its Statement of Purpose and was in line with current regulations. A copy of the Statement of Purpose would be available to anyone that requested it. A summary of the Statement of Purpose was included in the service users guide, which was made to everyone in the home. A number of new residents had been admitted into Crystal Hall since the last inspection. Two of the resident’s files were ‘case tracked’. This is a process whereby all the information collated about a resident is examined. One of the residents had been admitted in early September 2005 and had undergone a full assessment by the manager of the home, a qualified nurse. Evidence was seen for individuals referred through Care Management, that the manager had obtained a summary of the single Care Management (health and social services) assessment – integrated with the Care Programme Approach (CPA). The home had developed for each resident, an individual care plan based on the Care Management Assessment. The care plans had identified a number of areas of need however some areas had been left blank. It’s important that a holistic approach is taken for each individual and that all their needs are addressed and not necessarily the issues that are most evident. Crystal Hall Residential & Nursing Home DS0000006035.V252132.R01.S.doc Version 5.0 Page 8 The manager, a registered nurse, assesses rehabilitation plans and therapeutic needs; however from the detail within the rehabilitation plans it is unclear what amount of experience, knowledge and understanding the manager has on the subject. It is recommended that some additional training be gained by the manager on the subject. The manager spoke about how the new residents were invited to view the home on an introductory basis before making a decision to move in. Residents were asked to sign a contract, which had been developed by the manager of the home. Each resident had been asked to sign the contract and this was seen within each of the case tracked files. Crystal Hall Residential & Nursing Home DS0000006035.V252132.R01.S.doc Version 5.0 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 the following standard(s): 6,7,8,9,10 Care plans reflect the aspirations and goals of the individuals, and where possible drawn up between the home and the resident. EVIDENCE: The manager of the home has developed care plans, which continue to be of a good standard. Individuals have a number of areas that have been identified as a need. The manager has recognised this need from the assessment complied by the social worker and the homes assessment. The manager has developed an individual plan, which may include treatment and rehabilitation. The manager along with other multi agency professionals has developed rehabilitation plans for those residents able to be rehabilitated. One resident spoken with said how she was looking forward to having her own flat and was clearly excited about the prospect. The plan sets out how current and anticipated specialist requirements will be met (for example through positive planned interventions; therapeutic programmes; structured environments; development of language and communication; adaptations and equipment; one-one communication support.) Crystal Hall Residential & Nursing Home DS0000006035.V252132.R01.S.doc Version 5.0 Page 10 The plan does describe any restrictions on choice or freedom (agreed with the resident) imposed by a specialist programme in accordance with the Care Programme Approach and in some instances the Mental Health Act 1993. The plan has established some individualised procedures to follow should a resident be likely to be aggressive or cause harm. Risk assessments are in place with each individual having a copy of the risk assessment on file. Approaches on how to minimise the risk identified were also evident. Risk management strategies are needed to be agreed with professionals and the resident, recorded in the individual Plan, and reviewed on a regular basis and this was seen. Crystal Hall Residential & Nursing Home DS0000006035.V252132.R01.S.doc Version 5.0 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 the following standard(s): 11,12,13,14,15,16,17 The capacity for social activity varies for each resident but residents are given special support and assistance to engage in the activities of daily life. EVIDENCE: The routine of daily living and activities are flexible and varied to suit resident’s expectations and preferences. Residents can exercise their choice in relation to leisure and social activities, food, meals and mealtimes and religious observance. Within the homes plan of care resident’s interests are recorded. The residents are given opportunities for stimulation through leisure and recreational activities. One resident spoken with stated how much he was looking forward to going to Blackpool Lights that evening and another resident spoke that the best thing about the forthcoming trip was the ‘fish and chip supper’. The home has always welcomed visitors into the home and during the inspection it was observed that a number of visitors were present. Visitors are welcomed to join their relative at meal times and spend time with the resident in the garden or ‘quiet lounge’. Crystal Hall Residential & Nursing Home DS0000006035.V252132.R01.S.doc Version 5.0 Page 12 The main meal of the day was observed and taken with the residents at the home. It was a balanced, nutritious, appealing, varied and wholesome meal. The meal was taken in a congenial setting. Any resident on a special diet was catered for by the chef who showed the inspector a number of different products he used. Crystal Hall Residential & Nursing Home DS0000006035.V252132.R01.S.doc Version 5.0 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 the following standard(s): 18,19,20,21 The health and personal care, which a resident receives, is based on the individual’s needs. EVIDENCE: Nutritional screening is undertaken on admission and subsequently on a periodic basis, a record maintained of nutrition, including weight gain or loss, and appropriate action taken was seen to be recorded in the three files looked at. Residents spoken with had no concern about having their privacy and dignity respected. The manager was observed knocking on resident’s doors and speaking with the residents in a respectful manner. Some residents had mentioned that they did not wished to be disturbed in the night on the two hourly checks. This had caused some concern to some members of night staff but if the manager puts in a risk assessment and it is felt safe for the resident not to be disturbed then this should be respected. A member of staff was observed assisting a gentleman with his meals. This was being performed in a sensitive and dignified way. Crystal Hall Residential & Nursing Home DS0000006035.V252132.R01.S.doc Version 5.0 Page 14 Medication was observed and was being distributed in the dining room. It is recommended that the clinic used for giving medication in order to give the resident a little privacy. Crystal Hall Residential & Nursing Home DS0000006035.V252132.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Residents and staff have a robust and effective complaints procedure, which they feel able to use. EVIDENCE: The registered manager has ensured that there is a simple, clear and accessible complaints procedure, which includes the stages and timescale for the process, and that complaints are dealt with promptly and effectively. There have been no complaints made to the Commission Social Care Inspection (CSCI) since the last inspection. Residents spoken with had no complaints to make about the home and the five returned questionnaires from the residents all proved positive. Residents are free to exercise their legal rights and participate in the political process should they wish. Crystal Hall Residential & Nursing Home DS0000006035.V252132.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,29,30 The home sets out to offer a family – like philosophy of care that is interwoven between the style of home; it’s size, design and layout. EVIDENCE: The location and layout of the home is suitable for its stated purpose. The home has recently undergone an extensive extension to the property, which has provided the home with a lavish rehabilitation unit. The grounds, which include a small aviary and water features is kept safe, attractive and accessible to the residents. Residents spoke how they enjoyed the quietness of the area and it’s rural setting. Residents were able to sit out in the grounds when they wished and many chose to smoke outside. The home has four lounge spaces for residents to enjoy and there are plans to build a large conservatory. There is also a separate dining facility. There are accessible toilets for residents, which are clearly marked, and close to the lounge and dining areas. Some bedrooms have ensuite facilities. The home has a number of aids, hoists and assisted toilets and baths. Crystal Hall Residential & Nursing Home DS0000006035.V252132.R01.S.doc Version 5.0 Page 17 Individual bedrooms were looked at and found to be furnished and equipped to assure comfort and privacy. Bedrooms were tastefully decorated and personal items had been brought in from the resident’s own home. Where residents had chosen to share screening is provided to ensure privacy for personal care. Crystal Hall Residential & Nursing Home DS0000006035.V252132.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36 Staff are recruited in a way that protects service users. Staff are organized in a way which meets user needs. EVIDENCE: A staff rota showed which staff are on duty at any time during the day and night. The ratios of care staff to residents must be determined according to the assessed needs of residents. Domestic staff are employed and were observed during the visit. The home has employed a number of new staff members none of which have their National Vocational Qualification level 2 in care. It is written in the Care Homes For Younger Adults Standards that a minimum ratio of 50 trained members of care staff excluding those members of the care staff who are registered nurses should be employed by January 2005. Four staff files were looked at during the inspection. All of the four files had references for the member of staff currently in employment. All four staff had a current Criminal Record Bureau (CRB) certificate, which had been sought by the registered manager. The manager had also obtained a photocopy of the registered nurses pin card. Crystal Hall Residential & Nursing Home DS0000006035.V252132.R01.S.doc Version 5.0 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,40,41,42,43 The manager has a good understanding of all the areas in the home and manages a well run, efficient home. EVIDENCE: The registered manager has been in post for a number of years and meets the required standard with regard to qualifications and experience. Currently the registered provider is not in day-to-day control of the home and therefore needs to meet the regulation to visit the care home and prepare a written report on the conduct of the care home. This is currently being done and reports are sent monthly to the Commission Social Care Inspection (CSCI). The registered manager communicates a clear sense of direction and leadership, which staff and residents understand. With the expansion of the home it is recommended that a deputy or assistant manager be employed to assist the registered manager with administrative care and supervision duties in the home. Crystal Hall Residential & Nursing Home DS0000006035.V252132.R01.S.doc Version 5.0 Page 20 Care staff have received formal supervision at least six times a year. This is an outstanding recommendation. Supervision needs to cover • • • All aspects of practise Philosophy of care in the home Career development needs It is further recommended that supervisors of the care staff attend a relevant training course to enhance their skills in this important area. The home had regularly checks on equipment and all major services. Certificates were seen that demonstrated that appliances were safe and in good working order. Fire checks were carried out regularly. Crystal Hall Residential & Nursing Home DS0000006035.V252132.R01.S.doc Version 5.0 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 3 3 3 3 3 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 3 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 4 3 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score 3 3 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 3 3 Crystal Hall Residential & Nursing Home DS0000006035.V252132.R01.S.doc Version 5.0 Page 22 No 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. 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. Refer to Standard Good Practice Recommendations Crystal Hall Residential & Nursing Home DS0000006035.V252132.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ 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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