CARE HOME ADULTS 18-65
Crystal Hall Residential & Nursing Home Whittingham Hall Whittingham Preston Lancashire PR3 2JE Lead Inspector
Vivienne Morris Unannounced Inspection 9th May 2007 09:30 Crystal Hall Residential & Nursing Home DS0000006035.V330833.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 Crystal Hall Residential & Nursing Home DS0000006035.V330833.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. Crystal Hall Residential & Nursing Home DS0000006035.V330833.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Crystal Hall Residential & Nursing Home Address Whittingham Hall Whittingham Preston Lancashire PR3 2JE 01772 861034 01772 861661 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.V330833.R01.S.doc Version 5.2 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 9th February 2006 Date of last inspection Brief Description of the Service: Crystal Hall is a 47 bedded Care Home, offering both personal and nursing care to people aged 40 years and over, who suffer from a mental illness. The home is a period farmhouse with a purpose built extension and is located in a rural area of Preston. The premises are currently being further extended in order to accommodate an additional five bedrooms. Crystal Hall 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. The home provides a range of services and activities for the people living there and staff are able to meet a diverse range of needs, led by a team of experienced managers. The fees at the time of the site visit ranged from £360.50 to £550 per week. Additional charges were being incurred for hairdressing. Crystal Hall Residential & Nursing Home DS0000006035.V330833.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced site visit to this service was conducted over one day in May 2007, which formed part of the key inspection process. During the course of the site visit, discussions took place with 9 people living at the home, as well as 1 relative and 5 staff members. Relevant records and documents were examined and a tour of the premises took place, when a random selection of private accommodation was viewed and all communal areas were seen. Comment cards were received from 24 people involved with the service and their feedback is reflected throughout this report. The information provided by the home on the pre-inspection questionnaire has also been taken into consideration when writing this report. The inspector ‘tracked’ the care of three people during the site visit, not to the exclusion of other residents. The total key inspection process focused on the outcomes for people living at Crystal Hall and involved gathering information about the service from a wide range of sources over a period of time. The Commission for Social Care Inspection had not received any complaints about this service since the last inspection. What the service does well:
The information gathered before admission to the home was detailed, providing staff with a clear picture of each individual, so that they were confident that the staff team could adequately meet the assessed needs of people moving into Crystal Hall. The plans of care were very well written documents, providing staff with clear guidance about how the assessed needs of people living at the home were to be met and how people were to be supported to maintain their privacy and dignity. Residents had been involved in the care planning process and a review of care provided was conducted on a monthly basis to ensure that current needs were accurately reflected in the plan of care. People living at the home were individually respected and all were offered the same opportunities, showing that equality and diversity was an important aspect of life at Crystal Hall. Residents were able to make decisions about their lives, with support as required, including being able to take everyday risks, enabling them to live as full a life as possible. The routine of the home was seen to be flexible and freedom of movement was evident. One person living at the home said, “I get up when I want and go to bed when I want’ and another said, ‘I can do whatever I like. I don’t have to join in activities if I don’t want to, but I like going to the shop”. Crystal Hall Residential & Nursing Home DS0000006035.V330833.R01.S.doc Version 5.2 Page 6 A variety of external professionals had been involved in the care of people living at Crystal Hall to ensure that their health care needs were being appropriately met. The management of medications was good and a range of detailed risk assessments were in place to ensure that systems were implemented to protect the health and welfare of the people living at the home. Sufficient information was provided to people about the use of the local advocacy services to act on their behalf, should they so require and people living at the home were able to have some control over their lives by managing their own finances, should they so wish. Activities were provided both in the home and outside, so that people were able to continue their leisure interests whilst living at the home and so that they were able to maintain links with the community. The routine of the home was flexible and aimed to allow residents their freedom and independence by enabling them to have some control over their lives. Visiting arrangements were in place to suit the needs of individual residents and advocacy services were accessed for those wishing to have an independent person to act on their behalf. Meal times were well managed and people were provided with a choice of nutritious balanced food to ensure adequate dietary intake. Meals were well presented to promote appetite and to aid in nutrition. Those requiring support with eating their meals were assisted in a gentle manner, whilst others were encouraged to eat independently. The complaints procedure was freely available within the home and it was also included within the service users guide so that people were given enough information about how did they could make a complaint should they so wish. The policies and procedures in relation to safeguarding adults were in accordance with the Department of Health guidance ‘no secrets’, so that people knew the procedure to take should an allegation of abuse be received by the home. The home was tastefully furnished and decorated to a high standard and the premises, both internally and externally were well maintained providing those living at Crystal Hall with a safe, clean, comfortable and homely environment in which to live. The home was pleasant smelling and effective infection control measures were in place to ensure that the health and safety of people was adequately protected. Staffing levels were calculated in accordance with the assessed needs of people to ensure that adequate care was delivered. Crystal Hall Residential & Nursing Home DS0000006035.V330833.R01.S.doc Version 5.2 Page 7 Recruitment procedures and financial arrangements were in place at the home, which demonstrated that those living at Crystal Hall were adequately protected. A lot of training had been provided for all staff so that they were kept up to date with current policies, procedures and legislation and so that they were sufficiently trained to meet people’s assessed needs. The home was well managed by competent people and a team of skilled staff, who together had completed a wide range of training so that they were able to deliver the care required by the individual residents. The registered manager held relevant qualifications, had a lot of experience and was appropriately trained to manage the care home. Those spoken to felt supported by the management of the home. Systems were in place to ensure that the quality of service provided was closely monitored so that any shortfalls identified could be promptly addressed. The health, safety and welfare of residents were protected by the policies, procedures and practices of the home so that any hazards, which could pose a potential risk, were minimised or eliminated. What has improved since the last inspection? What they could do better:
The management of risk taking could be improved by providing clear guidance for staff, within a risk management framework, about strategies that need to be implemented, so that any potential harm to people living at the home is minimised. Any hand written entries on the Medication Administration Records could be signed, witnessed and countersigned so that the possibility of transcription errors is reduced. Staff working at the home need to receive training on safeguarding adults, so that everyone is aware of the correct procedures to follow, should any Crystal Hall Residential & Nursing Home DS0000006035.V330833.R01.S.doc Version 5.2 Page 8 safeguarding issues be raised, in order to consistently protect those living at the home. 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. Crystal Hall Residential & Nursing Home DS0000006035.V330833.R01.S.doc Version 5.2 Page 9 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.V330833.R01.S.doc Version 5.2 Page 10 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 (Adults 18 – 65) Quality in this outcome area is Excellent. This judgement has been made using available evidence including a visit to this service. The health, personal and social care needs of people had been thoroughly assessed before they moved into the home to ensure that the staff team could fully meet all their requirements . EVIDENCE: The care of three people living at Crystal Hall was ‘tracked’ during the site visit to the home. The care records showed that detailed information had been obtained prior to admission in order to determine individual requirements; so that the service was certain that the staff team could meet the assessed needs of people admitted to the home. The assessments carried out before admission were conducted by people who held appropriate qualifications and had experience in caring for people with mental disabilities, so that assessed needs were clearly identified. Information was gathered from a variety of sources before admission to the home so that external professional people were also involved in the care of people to ensure that all their assessed needs were fully met. People wishing to move into Crystal Hall were involved in the assessment process and they were able to spend some time at the home before making a
Crystal Hall Residential & Nursing Home DS0000006035.V330833.R01.S.doc Version 5.2 Page 11 final decision, so that they could meet other people living at the home and so that they could briefly experience what life was like at Crystal Hall. The assessed needs of those admitted to the home were clearly recorded within the care plans so that staff were provided with detailed guidance as to how service users’ needs were to be fully met. Records showed that periodic reviews of placements had been conducted to ensure that the home remained a suitable environment to meet the continuing needs of people living at Crystal Hall. Staff were appropriately qualified and had also received specific training in relation to the category of people living at Crystal Hall in order to widen their knowledge and improve their skills in caring for people with mental health needs. Staff spoken to had a sound understanding of the needs of the people they were looking after, showing that they were competent to deliver the care, which was required. Staff also knew how to access the care plans, policies and procedures, which showed that they were able to obtain relevant information if they needed it. Crystal Hall Residential & Nursing Home DS0000006035.V330833.R01.S.doc Version 5.2 Page 12 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 and 9. (Adults 18 – 65) Quality in this outcome area is Excellent. This judgement has been made using available evidence including a visit to this service. Service users’ needs were effectively planned, their rights were upheld and they were supported to make informed decisions about the routines of daily life. EVIDENCE: The care records of three people living at the home were examined. The plans of care had been developed with the individuals and were well written documents, providing clear, detailed guidance for staff about how individual needs could be met and how people could be supported to make decisions within their daily life. The information obtained before people were admitted to the home was transferred onto the care plans, which had been reviewed on a monthly basis or more often, if necessary, reflecting any changes in the care of service users so that staff were aware of people’s current needs. The plans of care outlined any limitations that needed to be implemented for the safety of the service user and others.
Crystal Hall Residential & Nursing Home DS0000006035.V330833.R01.S.doc Version 5.2 Page 13 The statement of purpose demonstrated that those living at the home were offered choices in relation to daily activities. The care records seen provided information about the preferences and choices of residents and the plans of care included details about individual social care needs and leisure activities with details of how people were supported to continue these interests whilst living at the home. Freedom of movement within the home was evident and those living there were able to access their own private accommodation and all communal areas as they wished. The Pre-inspection questionnaire showed that people were offered a choice of menu and the inspector noted that people were served with different meals at lunchtime. Staff were observed allowing people living at the home to make decisions about what they wanted to do during the day and the service users’ guide told people about the availability of advocacy services, so that people could be supported in making important decisions about their lives. The pre-inspection questionnaire showed that two people living at Crystal Hall used the services of an advocate to act on their behalf. All 15 comment cards received from people living at the home provided positive responses in relation to being able to do what they wished at all times. Two people spoken with said that they enjoyed attending the local church. All comment cards also indicate that staff always listened to the people living at the home and always acted upon what they said. I saw that people were able to spend their day in any part of the home they wished and I noticed that the main areas of the home were quite stimulating for people. Those living at the home were able to take responsible risks within a risk management framework, ensuring that they had enough information on which to base decisions. A wide range of risk assessments had been conducted on an individual basis and plans of care-incorporated information about potential risks to individuals. However, these could have been more detailed in order to provide clear guidance for staff about systems implemented to reduce any potential harm to people. The statement of purpose showed that people were able to retain the freedom to take personal risks, so that they continued to participate in daily activities. Crystal Hall Residential & Nursing Home DS0000006035.V330833.R01.S.doc Version 5.2 Page 14 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): 12, 13, 15, 16 and 17. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Social and recreational activities were provided in accordance with residents’ expectations and the rights of people were upheld. Residents received wholesome food and the special dietary needs of people were met. EVIDENCE: The pre-inspection questionnaire showed that a variety of activities were provided, both in and out of the home, demonstrating that people living at the home had a choice of leisure interests. The registered manager told me that people, where possible, attend college courses of their choice and the preinspection questionnaire supported this information. Comment cards received from people living in the home indicated that there were always or usually activities arranged which they could take part in. Those spoken to felt that there was enough going on for them.
Crystal Hall Residential & Nursing Home DS0000006035.V330833.R01.S.doc Version 5.2 Page 15 Care records included detailed social care plans, which showed what people enjoyed doing and from speaking with people living at the home their recorded interests were followed through in day-to-day practice. One person said, “We are doing arts and crafts this afternoon, which I enjoy”. People spoken to told me that they regularly go into the village to enjoy community activities. One lady sat with me for some time showing me the poems and letters that she had written, of which she was very proud. People were seen reading newspapers and others were sitting in groups socialising and chatting. I sat in the communal areas of the home for a long period of time, chatting to people and generally observing the daily activity. The environment was very relaxed and friendly, with residents and staff demonstrating good, trusting relationships. A computer room was available for those wishing to use the computers and a well stocked library was also provided for those wishing to either spend some quiet time reading or take out books, videos and DVD’s People spoken to said that the routine of the home was relaxed and that they were able to get up and go to bed when they wanted to. One person said that they could have their meals in their room if they wished to do so and that there was always a choice of menu offered. Staff were seen offering people a variety of choices in relation to daily living and residents spoken to said that staff were very helpful. Records were retained about people’s leisure interests and hobbies, including religious needs so that staff were aware of individual social care needs, and could therefore plan activities accordingly, showing that those who were less able to participate were given the same opportunities as others by the provision of 1:1 activities. Information about the provision of activities was included within the statement of purpose and service uses guide, so that people were aware of what activities were provided. The pre inspection questionnaire showed that policies were in place in relation to equal opportunities. This included an explanation of the six principals of care, including rights, fulfilment, independence and choice, showing that all those living at the home were given the same opportunities to make decisions and informed choices about their daily lives. A visiting policy was in place at the home and information relating to visiting was also included in the statement of purpose and service user guide to ensure that all interested parties were aware of the visiting arrangements of the home. One visitor spoken to felt that he were made to feel welcome to the home at any time and that a friendly environment was provided for both those living at the home and those visiting the home. The comment cards received supported this information. The care records showed that family links were
Crystal Hall Residential & Nursing Home DS0000006035.V330833.R01.S.doc Version 5.2 Page 16 encouraged, where appropriate to ensure that people living at the home did not loose contact with the people they cared about. The four weekly menus were examined and were found to provide a choice of well-balanced meals to ensure that those living at the home received a nutritious dietary intake. The menu of the day was clearly displayed, so that people were aware of the choices they had been given for lunch. The cook was responsible for offering people choices of meals and one resident confirmed that there were alternatives to the menu available if required. The pre-inspection questionnaire showed that residents were offered a choice of menu and that special diets were provided as required. The food served at lunchtime was wholesome and well presented, so that appetite and nutrition was promoted. People were seen being assisted with their meals in a dignified manner as required, with staff sitting with them, smiling and supporting them in a gentle manner. The dining room was found to be a relaxed area for people to eat in, with wellpresented tables and an unhurried atmosphere, so that those dining were comfortable and enjoyed having their meals in pleasant surroundings. Comments received on the day of the site visit, in relation to food were positive. Those spoken to said that the food was good. One person living at the home said, “The food is marvellous. I eat everything”. Comment cards received from people living at the home indicated that they enjoyed their meals and the pre-inspection questionnaire showed that facilities were available for people living at the home to make snacks and drinks whenever they wish. Crystal Hall Residential & Nursing Home DS0000006035.V330833.R01.S.doc Version 5.2 Page 17 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 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and personal care needs of people living at the home were being consistently met and their privacy and dignity was always respected. EVIDENCE: People living at Crystal Hall were seen to be treated well, their privacy and dignity being respected. Staff spoken to were aware of people’s rights and the need to promote their privacy and dignity. Staff were seen knocking on bedroom doors before entering, which were fitted with locks, so that people could protect their belongings and so that they could have some privacy, should they wish to do so. People spoken to stated that the staff treat them well and respect their privacy and dignity at all times. All three plans of care seen were found to be very well written documents. This enabled staff to have a clear picture of people’s assessed health, personal and social care needs and how these were to be appropriately met. One person spoken to said, “We want for nothing in this place, it is excellent”. Crystal Hall Residential & Nursing Home DS0000006035.V330833.R01.S.doc Version 5.2 Page 18 One staff member said to me, “It is good that the owners really care about the people living here. All their family know the residents by name. It is not just a business. They really do care”. The pre-inspection questionnaire showed that a wide range of external professionals were involved in the care of people living at Crystal Hall and care plans examined supported this information. All comment cards received from people living at the home showed that they were satisfied with the care provided for them and one General Practitioner indicated satisfaction with the overall care provided to his patients. One person said, “If I am not well, they (the staff) get the doctor”. A General Practitioner routinely visits the home each week, so that any health problems can be dealt with appropriately. The pre inspection questionnaire showed that medication policies and procedures were in place, so that staff were constantly aware of current regulations and guidelines in relation to the safe administration of medications. The management of medications was good. Clear medication records were maintained to ensure that a thorough audit trail was evident and photographs were retained of each resident on their Medication Administration Records for identification purposes. The pre-inspection questionnaire showed that registered nurses were responsible for the administration of medications so that those living at the home were given their medications by people trained to do so. However, hand written entries on the medication administration records should be signed, witnessed and countersigned in order to reduce the possibility of any transcription errors. Crystal Hall Residential & Nursing Home DS0000006035.V330833.R01.S.doc Version 5.2 Page 19 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 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints were well managed. The procedures in place for safeguarding adults could have been better. EVIDENCE: The Pre-inspection questionnaire showed that there had not been any changes in the policies and procedures in relation to complaints or safeguarding adults since the last inspection, showing that information provided to people remained the same. The Pre-inspection questionnaire showed that the home had not received any complaints since the last inspection and comment cards indicated that people would know how to make a complaint, should they wish to do so. A detailed complaints procedure was in place at the home, which was displayed prominently and which was included within the service users guide, showing that people were given enough information about making a complaint should they wish to do so. People spoken to at the time of the site visit said that they would know what to do if they were not happy about something at the home. A system was in place at the home so that any complaints received could be recorded and any recurring patterns identified and regularly monitored. The Commission for Social Care Inspection had not received any complaints about this service since the last inspection.
Crystal Hall Residential & Nursing Home DS0000006035.V330833.R01.S.doc Version 5.2 Page 20 The pre-inspection questionnaire showed that a range of policies and procedures were in place at the home in relation to safeguarding adults, which were in accordance with Department of Health guidance, so that people were fully aware of the action to take should an allegation of abuse be reported to the home. Staff spoken to confirmed that although they were fully aware of what to do if they felt that someone living at the home was being abused, they had not received any formal training in relation to safeguarding adults. However, they had been informed about the safeguarding adults policies and procedures at the time of employment. Crystal Hall Residential & Nursing Home DS0000006035.V330833.R01.S.doc Version 5.2 Page 21 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 and 30. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home provided a safe and well-maintained environment for people to live in, which was homely, clean and hygienic. EVIDENCE: Crystal Hall is a converted farmhouse, with a purpose built extension and is designed to meet service users’ individual and collective needs. Furnishings, fittings and decoration were of a high standard, so that people living at the home benefited from a comfortable and homely environment. The pre-inspection questionnaire showed that complete refurbishment of the dining room and kitchens had taken place. It also showed that a quiet room/day room is now a conservatory and new outdoor areas have been created. Crystal Hall Residential & Nursing Home DS0000006035.V330833.R01.S.doc Version 5.2 Page 22 The bedrooms were individually decorated and furnished, providing people with personal surroundings in which to live. Some people living at the home told me that they had been able to choose the décor of their own rooms and one person said that he had helped to decorate his bedroom, showing that people were encouraged to exercise choice. A programme of routine maintenance was in place with regular checks of the building-taking place, so that any work needed was promptly attended to. The home is situated in a rural part of Preston and therefore the village in which the home is situated is surrounded by countryside. The home offers good access to local amenities and transport links, so that people living at the home can walk freely into the village centre. Specialist equipment was available, so that the needs of everyone living at the home were being met. Bedrooms were spacious, with room for nursing and medical equipment, where necessary. All bedrooms were tastefully decorated and furnished, being individualised with people’s own belongings in order to create a homely atmosphere. The bedrooms for younger adults were based on a more modern design, so that their surroundings were in keeping with their tastes and preferences. All those spoken to were more that happy with their private accommodation. At the time of the site visit the home was found to be warm, thoroughly clean and pleasant smelling, providing people with a comfortable and homely environment in which to live. All comment cards received from those using the service stated that the home was always fresh and clean. The laundry department was well organised and fitted with equipment suitable for the needs of the home and the needs of people living there. Infection control policies and procedures were in place and staff confirmed that they received appropriate training to ensure that the risk of infection was minimised. Crystal Hall Residential & Nursing Home DS0000006035.V330833.R01.S.doc Version 5.2 Page 23 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): 32, 34 and 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff working at the home were appropriately trained and in sufficient numbers to meet changing needs of residents and the recruitment procedures adequately safeguarded those living at the home. EVIDENCE: At the time of the site visit there were 40 people living at Crystal Hall. The Pre-inspection questionnaire showed that Criminal Record Bureau disclosures had been completed for all staff employed by the home. However, it did not identify that qualified nurses were registered with their professional body. . One comment card received from a relative stated, “Very few staff have mental health skills or training”. However, the pre inspection questionnaire showed that 7 nurses were trained in mental health (including the manager) and records showed that a good skill mix of staff made up the staff team so that residents’ needs were being fully met.
Crystal Hall Residential & Nursing Home DS0000006035.V330833.R01.S.doc Version 5.2 Page 24 Equal opportunity policies were in place at the home to ensure that everyone applying for work was treated the same and was given the same job opportunities. Those spoken to felt that their needs were being fully met and that the staff were kind and caring. One person said, “The staff are great. We have a laugh”. Formal induction processes had been adopted by the home so that staff understood their role and were able to perform the duties expected of them. . The pre inspection questionnaire showed that a wide range of training was provided for staff so that people working at the home were competent to look after the people in their care. All staff completed a variety of mandatory coretraining courses to ensure that there was a skilled workforce and that people had the necessary knowledge to meet the needs of the people they were caring for. Staff spoken to felt that a lot of training was provided to meet their needs, including training specific to the care of people living in the home and staff training certificates available on files supported this information. The preinspection questionnaire showed that 22 care staff were employed by the home, 13 of whom had achieved a recognised care qualification, providing the home with 63 of care staff trained to look after the people living at Crystal Hall and to oversee the care provided for newer staff. Three staff files were examined at the time of the site visit. It was found that recruitment procedures were being followed in day-to-day practice and that sufficient checks had been undertaken on staff to ensure that those living at the home were adequately protected. Crystal Hall Residential & Nursing Home DS0000006035.V330833.R01.S.doc Version 5.2 Page 25 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, 39 and 42. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home was well managed by a competent person, having effective systems in place for monitoring the quality of service provided. The health, safety and welfare of people living at the home were sufficiently protected. EVIDENCE: The manager of Crystal Hall is a first level registered nurse and has had many years of relevant experience. He continues to update his own skills and competence whilst managing the care home. This demonstrated that he is competent to manage the care service and was able to educate his staff team, so that the outcome for those living at the home was positive. There were clear lines of accountability within the home so that the service was successfully managed and a good quality of life was provided for those living at
Crystal Hall Residential & Nursing Home DS0000006035.V330833.R01.S.doc Version 5.2 Page 26 the home. One person said, “This is a well run home. Mr Patterson (the manager) is excellent”. Staff spoken to confirmed this statement and told me that they feel very supported by the management of the home. One member of staff added, “When I have any concerns I feel that I can approach Mr Patterson. I feel comfortable in doing so”. There was a strong belief of being open and transparent in all areas of running the home so that people were kept informed of matters involving them. The management team were resident focused and the health, safety and welfare of those living at Crystal Hall was evidently their priority. A variety of meetings had been held for staff and for people living at the home, from which notes had been made of the discussions, which took place, so that people were kept up to date with any relevant matters. Systems were in place so that the views of people involved with the service were obtained and any issues raised were discussed at the relevant meetings, so that any problems could be rectified. The pre inspection questionnaire showed that the home acted as appointee for some people living at Crystal Hall and systems were in place to ensure that any money or valuables retained at the home on behalf of those living there was adequately protected, so that the possibility of any mishandling was reduced. The pre-inspection questionnaire showed that all systems and equipment within the home had been appropriately checked so that the health and safety of people living there was protected. This was confirmed by examination of a random selection of service certificates. Accidents occurring in the home had been accurately recorded so that the manager was able to audit and monitor the frequency of incidents. The pre-inspection questionnaire showed that 10 members of staff held current first aid certificates, so that any emergency situations could be handled appropriately. A wide range of risk assessments had been conducted, which were sufficiently detailed, showing that systems had been put in place in order to reduce the possibility of injury to people living at the home. The environment was free from any hazards, which could pose risks to those living at the home. Fire drills were conducted periodically to ensure that all staff were familiar with the fire procedure and evacuation plan within the home and a record was retained of staff attendance so that the home could ensure that all staff were involved in a fire drill at least annually. Staff spoken to confirmed that a range of mandatory training was provided, with regular up dates, showing that those working at the home were kept abreast of any changes. Crystal Hall Residential & Nursing Home DS0000006035.V330833.R01.S.doc Version 5.2 Page 27 Policies and procedures were in place at the home in relation to Health and Safety issues, moving and handling, food hygiene and Infection Control practices, so that staff were aware of the importance to ensure that the health, welfare and safety of people living at the home was consistently protected. Crystal Hall Residential & Nursing Home DS0000006035.V330833.R01.S.doc Version 5.2 Page 28 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 4 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES X 11 12 13 14 15 16 17 Score Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 4 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 3 X X 3 4 X 3 4 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 4 X 3 X X 4 X Crystal Hall Residential & Nursing Home DS0000006035.V330833.R01.S.doc Version 5.2 Page 29 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. 1 Standard YA23 Regulation 13(6) Timescale for action The registered person shall make 31/08/07 arrangements, by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. Requirement 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 YA9 Good Practice Recommendations The risk assessments should provide clear guidance for staff as to how identified risks should be appropriately managed in order to minimise any potential harm to people living at the home. Any hand written entries on the Medication Administration Records should be signed, witnessed and countersigned in order to reduce the possibility of transcription errors. 2 YA20 Crystal Hall Residential & Nursing Home DS0000006035.V330833.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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