Inspection on 12/09/07 for Crystal Residential Home

This inspection was carried out on 12th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Crystal Residential Home 07/07/08

Crystal Residential Home 30/04/07

Crystal Residential Home 25/05/06

Crystal Residential Home 01/12/05

Crystal Residential Home 22/08/05

Crystal Residential Home 02/02/05

Crystal Residential Home 27/09/04

Similar services:

Clovelly House Residential Home Ltd

Cherry Orchard Nursing Home

Coppermill Care Centre

Fountains Care Centre (The)

Eleanor Palmer Trust Home

Elmstead House

Bridgeside Lodge Care Centre

Dalemead

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

CARE HOMES FOR OLDER PEOPLE Crystal Residential Home 97 Woodcote Grove Road Coulsdon Surrey CR5 2AN Lead Inspector Janet Pitt Key Unannounced Inspection 21st September 2007 10:00 X10015.doc Version 1.40 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 Residential Home DS0000025777.V350300.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 Older People. 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 Residential Home DS0000025777.V350300.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Crystal Residential Home Address 97 Woodcote Grove Road Coulsdon Surrey CR5 2AN 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) 020 8660 8643 F/P 020 8660 8643 Mrs Jaisree Nemchand Mrs Jaisree Nemchand Care Home 12 Category(ies) of Dementia (12) registration, with number of places Crystal Residential Home DS0000025777.V350300.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following categories of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Dementia - Code DE The maximum number of service users who can be accommodated is: 12 30th April 2007 Date of last inspection Brief Description of the Service: Crystal residential home is registered to care for up to twelve people in the older person category. The house is a large detached residence set in the attractive suburb of Coulsdon. The home provides eight single bedrooms and two double rooms arranged over two floors. All bedrooms have a wash hand basin, while one is en-suite. There is a passenger lift allowing easy access to both floors for all people. The home has a large garden to the rear of the building and off road parking to the front. The parking area has been resurfaced, and a new wheelchair ramp installed to the front of the house. The home provides information about its services in a Service User Guide, which is made available to current and potential persons. Additional information can be found in the home’s Statement of Purpose. The current weekly fees (as provided at the time of this inspection) range from £373.60 £430. Crystal Residential Home DS0000025777.V350300.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors undertook this unannounced inspection. Staff files, care documentation and a tour of the premises was undertaken. A Short Observational Observation was made of activities and lunchtime. The inspectors spoke with the manager. The site visit lasted a total of five hours. 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. The summary of this inspection report can be made available in other formats on request. Crystal Residential Home DS0000025777.V350300.R01.S.doc Version 5.2 Page 6 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Crystal Residential Home DS0000025777.V350300.R01.S.doc Version 5.2 Page 7 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who live in the home need to be confident that their needs will be appropriately assessed prior to moving into the home. Some improvement has been made in the assessment of need, this should be continued. EVIDENCE: People who live in the home are assessed prior to admission. It was noted that there has been some improvement on the information gathered since the previous inspection. The assessment, which were person centred, had good information on behaviour patterns and what triggered distress in a person. More information on social and relationship needs would make sure that people are treated as individuals. People who live in the home are able to be involved in the assessment process, but this needs to be consistent for all persons. Some assessments had no evidence of the person or their representative being involved. Crystal Residential Home DS0000025777.V350300.R01.S.doc Version 5.2 Page 8 Specific details in assessments are needed to make sure that needs are fully identified, i.e. ‘good’ elimination’ does not indicate normal routine. The process of including information from pre-admission assessments by other health professionals has begun. Crystal Residential Home DS0000025777.V350300.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People’s care plans are starting to become person centred. If specific details are included then this process will improve outcomes for people living in the home. Risk assessments must show a process of how risk is minimised. EVIDENCE: Care plans for people who live in the home are drawn up from assessments. Basic details of how to meet needs were in the plans. The manager reported that work on making plans person centred has commenced. These files were compared with the existing files and it was noted that there was improvement in the specific details. It is important that this is continued and is consistent, as this will make sure that people’s needs are met appropriately. Information on how needs are to be met is still needed e.g. ‘needs help with washing’, but there were no details of what sort of assistance is needed. People care plans were seen to be evaluated monthly and reviews by care managers had been carried out. However, reviews and evaluations of care Crystal Residential Home DS0000025777.V350300.R01.S.doc Version 5.2 Page 10 plans by the home need to be achieved regularly, to make sure that the person’s condition is monitored appropriately. Again, there has been improvement in involving the person or their representative in the care planning process and this should be continued. Daily records maintained are starting to reflect how needs have been met. This must be continued. Risk taking plans had identified the risk to individuals i.e. falling over, getting lost, burning them selves when making tea however the plans did not indicate how the risk could be reduced or eliminated or what steps the home would take to manage the risk. One person had a bed rail in place, but there was limited evidence of the process followed in order to use this particular piece of equipment. In general care plans included detailed information about people in relation to their health care and mental health needs however the home could elaborate on their social needs and how these are being met. Care plans included a record of contact with health care professionals such as general practitioners, district nurse and opticians. The home recently identified that one person had a pressure sore. The person’s general practitioner was contacted and a district nurse visited the person and set a treatment plan in place. Care plans are handwritten which is a lengthily process; it is recommended that a computer be purchased to enable plans to be updated electronically. People’s wishes on end of life care had been recorded. People who have weight loss must be monitored closely to make sure that appropriate care is given. One person had been given a food supplement, but this had not been prescribed and there was no involvement from other professionals. It was noted that people in the home had been losing weight, but there were no interventions or alterations to the menu. Crystal Residential Home DS0000025777.V350300.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People receive adequate nutrition, but more attention is needed to special dietary needs, to make sure weight loss is minimised. Mealtimes have improved, but need further improvement to make sure they are social events. Activities within the home do not reflect individual choice. EVIDENCE: During the mealtime observed, was seen that attempts had been made to make the event sociable, but there were still elements of task orientation. The meal serve was hot and looked appetising, condiments were available. However, people’s choice was not always evident. Some people were informed what the meal was, whilst others were not. There was no provision for special diet such as pureed or soft diets. This issue must be addressed to make sure that nutritional needs of people are met. Interaction between staff and people who live in the home tended to be poor. For example staff were seen talking across people and making comments such as ‘well done’. This does not show that people are being treated as adult. One staff member stood up to assist a person with their meal. It was also observed Crystal Residential Home DS0000025777.V350300.R01.S.doc Version 5.2 Page 12 that conversation during the meal tended to relate to the meal itself and not the well being of the person. Interactions between some people were positive, with engagement on both sides and laughter over something that was commented upon. One person commented in a residents satisfaction questionnaire that the cleanliness of the home and the laundry facilities where excellent but that they was getting rather tired of sandwiches. Records of activities offered to people in the home were inspected. These were the same for all and there was little evidence to suggest that people had the opportunity to choose their activities on an individual basis. In house activities offered to people include handball, skittles, cooking, bingo, and gentle exercise, TV/Video, connect 4, nail care and baking. There was little evidence to suggest that the home had planned excursions, trips to the theatre or visits into town or local places of interest. A member of staff should be delegated the role of activities co-ordinator and seek out opportunities/events in the local community and brings these to the attention of people at residents meetings. People were observed playing skittles and chatting with staff, but it was not evident that playing of skittles was their choice, as the member of staff failed to gain consent prior to starting the game. There was a pleasant atmosphere and people appeared comfortable in their surroundings. Some people were watching television. There was a lacked of evidence available to determine whether relationships needs of people had been addressed. Crystal Residential Home DS0000025777.V350300.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live in the home are protected from harm and any concerns are addressed. EVIDENCE: Information from previous inspection indicates that there are no issues with these areas. Therefore these Standards were not assessed at this inspection. Crystal Residential Home DS0000025777.V350300.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are able to personalise their rooms and attention is starting to be paid to the maintenance of the environment. Unpleasant odours within the home need to be controlled. EVIDENCE: Requirements made at the previous inspection for minor repairs had been undertaken. However a planned programme of redecoration and refurbishment is needed to make sure that people live in a safe and homely place. It was noted that the home had a strong smell of urine. There had been attempts to eliminate the odour with air fresheners this had not been successful. The manager reported that there are plans to review a toileting programme for one person and carpets had been replaced in some bedrooms. Crystal Residential Home DS0000025777.V350300.R01.S.doc Version 5.2 Page 15 A number of bedrooms had been redecorated, the hallway had also been redecorated and an upstairs toilet had been retiled. The carpeting is due to be replaced in the dining room with flooring that can be easily cleaned. Crystal Residential Home DS0000025777.V350300.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who live in the home need to be confident that they are supported by trained and competent staff. The home’s recruitment process needs to be evidence that staff are recruited safely and all necessary checks are carried out. EVIDENCE: People in the home need to be confident that they are protected from harm by the homes recruitment procedures within the home. A number of staff personnel files were examined. The files included a recent photograph, application forms, job description, two references, employment contract and a criminal record check. One person’s file included a birth certificate as proof of identity; another person’s file had no proof of identity. The application form included the person’s last 10 years employment history; this needs to include all employment history. Staff files also included induction checklists, terms and conditions of employment, staff supervision, appraisal records and training certificates. Staff had attended training on adult protection, moving and handling, medication, first aid and food hygiene. Some of these areas required refresher training. Crystal Residential Home DS0000025777.V350300.R01.S.doc Version 5.2 Page 17 On the day of the site visit there were sufficient numbers of staff available to assist people who live in the home. Care must be taken to make sure that needs are not met in a task orientated way. This will make sure that people are treated as individuals. Crystal Residential Home DS0000025777.V350300.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who live in the home are support by a manager who is aware of their responsibilities. Requirements from the previous inspection are in the process of being addressed. EVIDENCE: The manager demonstrated awareness of compliance with the Regulations. She has done a significant amount of work on the requirements made at the previous inspection. Further work is needed, but CSCI is now confident that the requirements will be met. Therefore requirements made in this section at the previous inspection have had their timescales extended and will be examined at the next inspection. Crystal Residential Home DS0000025777.V350300.R01.S.doc Version 5.2 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 Crystal Residential Home DS0000025777.V350300.R01.S.doc Version 5.2 Page 20 Are there any outstanding requirements from the last inspection? Yes 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 OP3 Regulation 12 (1) (a) Requirement Specific details of needs must be recorded in assessments; to make sure people receive appropriate care. (previous timescale of 30/08/07 not met) Social activities, religious needs and relationship needs must be recorded on admission. This will make sure that people are able to lead fulfilling lives. (previous timescale of 30/08/07 not met) Assessments of people must be fully completed and identify all needs. This will make sure that care planned is appropriate. (previous timescale of 30/08/07 not met) Timescale for action 30/01/08 2 OP3 12 (4) (a) & (b) 30/01/08 3 OP3 14 30/01/08 4 OP7 15 5 OP8 13 (4) A detailed service user plan must 30/01/08 be in place for each person, which covers health, personal and social care needs. (previous timescale of 30/08/07 not met) Risk assessments must be in 30/01/08 place and contain an auditable trail to make sure risk to a person is minimised. DS0000025777.V350300.R01.S.doc Version 5.2 Page 21 Crystal Residential Home 6 OP12 16 (2) (m) & (n) 7 OP13 16 (2) (m) 8 OP15 16 (2) (i) 9 OP19 23 (2) (b) & (d) There must be a suitable range of activities for people to participate in. These should reflect their personal interests. This will make sure that people are able to maintain or develop interests. (previous timescale of 30/08/07 not met) People must be able to develop or maintain personal relationships. This will make sure they are able lead fulfilling lives. (previous timescale of 30/08/07 not met) Meal times must be a social occasion and there should be evidence of choice. Alternative diets must be available. This will make sure that people’s nutritional needs are met. (previous timescale of 30/08/07 not met) There must be a programme of redecoration and refurbishment in place to maintain a safe environment for people who live in the home. (previous timescale of 30/08/07 not met) 30/01/08 30/01/08 30/01/08 30/01/08 10 OP26 16 (2) (k) 11 OP29 19 12 OP30 18 (c) The home must be free from 30/01/08 offensive odours. This will make sure that people live in a pleasant environment. (previous timescale of 30/08/07 not met) There must be a thorough 30/01/08 recruitment procedure in place and all necessary checks are carried out prior to a person commencing employment. This will make sure that people can be confident that they are in safe hands. (previous timescale of 30/08/07 not met) An appropriate training 30/01/08 programme must be in place, which enables staff to maintain and update their skills. This will make sure that competent staff DS0000025777.V350300.R01.S.doc Version 5.2 Page 22 Crystal Residential Home 13 OP38 13 (4) (c) 14 OP38 13 (4) (a) & (c) supports people. (previous timescale extended) Weekly checks of fire alarms and 30/01/08 hot water temperatures must be carried out and recorded. This will make sure that people are protected from harm. (previous timescale extended) A Health and Safety audit of the 30/01/08 home must be undertaken and issues rectified, to make sure the environment is safe for people to live in. (previous timescale extended) 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 Residential Home DS0000025777.V350300.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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 © 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 Crystal Residential Home DS0000025777.V350300.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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