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Inspection on 22/08/05 for Crystal Residential Home

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

This inspection was carried out on 22nd August 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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

Service users and relatives expressed their satisfaction with the service being provided. All thought it was of a high quality, and that the home was well managed. The home is relatively small, and as such has a homely comfortable feel, which is sometimes lost in larger establishments. Staff are welcoming, and they too expressed their satisfaction in the way the home was run and managed.

What has improved since the last inspection?

The manager has taken steps to meet most of the requirements that were made following the last inspection visit. This means that the quality of the overall service provided to service users can only have got better.

What the care home could do better:

This visit resulted in an additional eight requirements being made. This clearly indicates that although the service has got better in a number of areas there is still room for improvement. Most of these new requirements are minor and the home should be able to meet them with minimal effort. Of most concern was the shortfall of staff on duty at weekends, as the rota indicated that there was only one carer on the afternoon/evening shift on Saturdays. This must be rectified as a matter of urgency.

CARE HOMES FOR OLDER PEOPLE Crystal Residential Home 97 Woodcote Grove Road Coulsdon Surrey CR5 2AN Lead Inspector Margaret Lynes Unannounced 22 August 2005 1015-1615 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 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 G53 G53 S25777 crystal V203556 180705 stage 4.doc Version 1.40 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 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 Mrs Jaisree Nemchand Mrs Jaisree Nemchand Care Home 12 Category(ies) of Old age registration, with number of places Crystal Residential Home G53 G53 S25777 crystal V203556 180705 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2/2/05 Brief Description of the Service: Crystal residential home is registered to care for up to twelve service users 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 service users. The home has a large l the rear of the building and off road parking to the front. The parking area has recently been resurfaced, and a new wheelchair ramp installed to the front of the house. Crystal Residential Home G53 G53 S25777 crystal V203556 180705 stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced, and was conducted over one day. During that time a number of records were examined, a tour was made of the premises and time was spent talking with service users, their relatives and staff. The last inspection had resulted in 11 requirements being made. Eight of these have now been met, two partially met while one remains outstanding. This visit resulted in a further eight requirements being made. They should not be difficult to meet and in doing so the home will further improve the overall quality of the service being provided, and thereby improve the well-being of the service users. What the service does well: What has improved since the last inspection? What they could do better: This visit resulted in an additional eight requirements being made. This clearly indicates that although the service has got better in a number of areas there is still room for improvement. Most of these new requirements are minor and the home should be able to meet them with minimal effort. Of most concern was the shortfall of staff on duty at weekends, as the rota indicated that there was only one carer on the afternoon/evening shift on Saturdays. This must be rectified as a matter of urgency. Crystal Residential Home G53 G53 S25777 crystal V203556 180705 stage 4.doc Version 1.40 Page 6 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 Residential Home G53 G53 S25777 crystal V203556 180705 stage 4.doc Version 1.40 Page 7 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 Standards Statutory Requirements Identified During the Inspection Crystal Residential Home G53 G53 S25777 crystal V203556 180705 stage 4.doc Version 1.40 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 3 (6 is N/A) The Inspector was not satisfied that prospective service users had the information that they needed to make an informed decision about where they lived, as both the Statement of Purpose and the Service Guide required updating. Although there had not been any recent admissions, the Inspector was satisfied that appropriate pre-admission assessments had been carried out at the time of earlier admissions. EVIDENCE: Two requirements were made following the last inspection regarding the need for the Statement of Purpose and the Service User Guide to be revised so that they both contained the information listed in the Regulations. The former document has been updated and all that remains to be added is information pertaining to staff numbers, experience and qualifications. The latter has yet to be produced however. Crystal Residential Home G53 G53 S25777 crystal V203556 180705 stage 4.doc Version 1.40 Page 9 The home has not admitted any residents since the last inspection. Indeed, no new residents have entered the home for over a year. At the time of the last admission however, a pre-admission assessment has been carried out. Crystal Residential Home G53 G53 S25777 crystal V203556 180705 stage 4.doc Version 1.40 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10 The Inspector was not wholly satisfied that the service user plans were adequate, as there was no clear identification of need, goal and action. This means that the staff team may not be fully aware of the differing needs of their residents, or know what specific care needs to be given. Staff ensure that each resident is able to access community based health facilities as and when required. The medication administration records were examined. These were all in order, which means that the service users are protected by the home’s good practice. From observation and discussion, service users were treated with respect, and their right to privacy was upheld. EVIDENCE: Although the files inspected contained care plans, and these had been written on well laid out forms, there was no clear identification of the needs of each service user, the goals or the action to be taken. The forms themselves were satisfactory however staff were not completing them appropriately. A monthly Crystal Residential Home G53 G53 S25777 crystal V203556 180705 stage 4.doc Version 1.40 Page 11 report is produced for each resident, which incorporates a review of the ‘care plan’. The reports were informative however the manager was asked to ensure that staff did complete them on a monthly basis, as several has not been carried out for almost two months. The medication administration records were all correctly completed. This is evidence that the recently completed medication administration course undertaken by many of the staff was well worthwhile. From observing the interaction between the staff and the service users, and having also talked to a number of service users and their relatives, it was evident that they felt that they were being treated with respect and that their privacy was upheld as much as was possible. Crystal Residential Home G53 G53 S25777 crystal V203556 180705 stage 4.doc Version 1.40 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 - 15 The home does not have a designated activities co-ordinator, nevertheless the relatively small size of the establishment means that staff are able to provide a sufficient amount of stimulation to satisfy the service users social and recreational interests. Visitors are encouraged to call. This means that service users are enabled to maintain contact with family and friends and the local community as they wish. A number of service users met with the Inspector and they all felt that they were enabled to exercise choice and control over their lives to the extent that it was possible. The lunchtime meal was observed and appeared to be well prepared and appetising. Service users confirmed that the food was more than satisfactory. EVIDENCE: Service users were asked if they felt that they had enough to stimulate them during the day, and all said that there were enough activities should they wish to partake in them. The opportunity was taken to speak to two relatives, both of whom were positive about the home and had no concerns. Crystal Residential Home G53 G53 S25777 crystal V203556 180705 stage 4.doc Version 1.40 Page 13 It was pleasing to see home cooked food in ample supply being served hot, and with attention to presentation. Staff were available to assist residents where needed. Crystal Residential Home G53 G53 S25777 crystal V203556 180705 stage 4.doc Version 1.40 Page 14 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 The home has a satisfactory complaints procedure in place, which is accessible to service users. There was also a satisfactory adult protection procedure in place which, if followed by staff, will offer sufficient protection to service users. EVIDENCE: No complaints have been made to the home since the last inspection. Neither have their been any adult protection issues. The manager is in the process of revising the policy and procedure manual, and it was noted that although there was a satisfactory complaints procedure within the Statement of Purpose, there was none in the aforementioned manual. Given that this is one of the procedures that has been revised recently, the manager was advised to ensure that it was available in the manual for staff to refer to it if necessary. The manager has produced a booklet for each member of staff with regard to adult protection. This is good practice however it is also important that staff are given the opportunity to attend a more formal training course. Crystal Residential Home G53 G53 S25777 crystal V203556 180705 stage 4.doc Version 1.40 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 22 and 26 While in general the premises were well-maintained, there were a number of areas that needed relatively minor attention. It was not felt, therefore, that the home was being kept as well as it could be, or that the home was as safe an environment as it should be. EVIDENCE: The two requirements that were made following the last inspection have both been met. These related to the need to have an ongoing maintenance programme, and the need to have the premises assessed by an occupational therapist. Following a walk around the home, further areas of concern were noted. This has resulted in 3 new requirements being made. It should be said that these issues are quite minor and as such can be easily dealt with. It will be recommended that the smoking room be refurbished to make it a more pleasant environment. Crystal Residential Home G53 G53 S25777 crystal V203556 180705 stage 4.doc Version 1.40 Page 16 Apart from a few cobwebs (!), the home was clean, pleasant and hygienic – albeit with the exception of the smoking room. Consideration should be given to refurbishing this area. It was noted that the door to bedroom 15 was propped open with a chair. The manager was advised to discuss this with the occupant, and that if the resident wanted to have their door open all the time, then an appropriate fire safety device needs to be fitted. Crystal Residential Home G53 G53 S25777 crystal V203556 180705 stage 4.doc Version 1.40 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 30 The Inspector did not feel that the staffing numbers were sufficient to ensure that service users needs could be met in a timely manner. New staff are expected to work through a TOPSS based induction programme, while existing staff can work through a TOPSS based foundation programme, or commence NVQ courses. This should provide them with the opportunity to improve/enhance their skills. This will then have a beneficial effect on the care being provided to service users. EVIDENCE: In a home of this size, minimum staffing levels would be to have 2 staff on each day shift, plus an additional carer to cover peak times (early morning and evening), and to have 1 sleep in and 1 waking carer on at night. The rota provided showed that while on most occasions these levels were being maintained, at weekends there was a shortfall, with only one carer on the afternoon/evening shift. At the last annual inspection it was required that the manager ensure that new staff supply all of the required documentation prior to starting work. To date, it has not been possible to determine if this requirement has been met, as no new staff have been recruited since that time. Following the last (unannounced) inspection it was required that TOPSS based induction and foundation training be made available for staff. The manager has now obtained the appropriate training manual so that staff can be provided Crystal Residential Home G53 G53 S25777 crystal V203556 180705 stage 4.doc Version 1.40 Page 18 with a programme to work through. Two of the staff have already achieved NVQ awards, while a number of others are due to commence courses shortly. Crystal Residential Home G53 G53 S25777 crystal V203556 180705 stage 4.doc Version 1.40 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 35, 36, 37 and 38 The Inspector was satisfied that the home was being run with the best interests of the service users in mind, as a new quality assurance system has been implemented, and the records examined were being appropriately maintained. The home maintains appropriate records regarding service users finances, thus ensuring that their interests are appropriately safeguarded. The home’s policies and procedures were in the process of being updated, and staff supervision was being carried out at regular intervals, thereby contributing to the safeguarding of service users rights. Due to the lack of risk assessments and infrequent fire drills the Inspector was not satisfied that the home was not being maintained to an appropriate level of safety, thus putting service users at unnecessary risk. Crystal Residential Home G53 G53 S25777 crystal V203556 180705 stage 4.doc Version 1.40 Page 20 EVIDENCE: Following on from a requirement in the last inspection report the manager has now introduced a simple but effective quality assurance system. This includes quarterly checks on the quality of the catering, housekeeping, care practice and administration. These checks are supported by additional audits of the medication records and health and safety in the home. The new system includes surveying both residents and relatives for their views. It was good practice to see feedback from both groups on record. Now that there is feedback, the manager should ensure that the results are made public – within the Service User Guide. Two service users have their monies administered by the manager. The records where examined and found to be in order. It was also previously required that the manager ensure that the required records were up to date, and that the home’s policies and procedures were regularly reviewed and updated where necessary. The records examined on this visit were satisfactory, while the manager has begun reviewing the policy and procedure manual. The last inspection report also contained a requirement re risk health and safety assessments. These have yet to be carried out, as, indeed, do risk assessments for each individual resident (these had been done for some but not all of the service users). Comprehensive maintenance records were being kept, and all of the necessary regular checks were up to date with the exception of fire drills, which were not being carried out at the recommended 3-monthly interval (just one drill in the last 6 months). Crystal Residential Home G53 G53 S25777 crystal V203556 180705 stage 4.doc Version 1.40 Page 21 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 x x 3 x x x 3 STAFFING Standard No Score 27 1 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 x x 3 x 3 x 3 1 Crystal Residential Home G53 G53 S25777 crystal V203556 180705 stage 4.doc Version 1.40 Page 22 yes 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 1 Regulation 4 Requirement The Statement of Purpose must include the number, experience and qualifications of the staff team. The previously set timescale has not been fully met. The Service User Guide must contain all of the information listed in the Regulations. The previously set timescale has not been fully met. Service user plans must clearly identify individual needs, goals and the action to be taken. Where possible they should involve consultation with resident and relatives. Staff must be enabled to attend formal Adult Protection training. A new over-sink shelf is required in bedroom14. A new handle is required for the chest of drawers in bedroom 11. The carpet in the brown bedroom must be stretched so that it does not present as a tripping hazard. Staff must also ensure that emegency cord in the en-suite is not tied up out of reach (it should be noted that the manager untied the cord immediately). Timescale for action 30/10/05 2. 1 5 30/10/05 3. 7 15 30/10/05 4. 5. 6. 7. 16 19 19 19 18 23 23 13, 23 30/11/05 31/10/05 31/10/05 30/9/05 Crystal Residential Home G53 G53 S25777 crystal V203556 180705 stage 4.doc Version 1.40 Page 23 8. 9. 10. 38 38 38 23 13 13 11. 27 18 Fire drills must be held on a quartetrly basis and at least one of these should be at night. Risk assessments must be carried out for each individual service user. A health and safety risk assessment of the premises must be carried out, recorded and regularly reviewed. The previously set timescale has not been met. The manager must ensure that there are sufficient numbers of staff on duty at all times. 22/8/05 30/9/05 30/9/05 22/8/05 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. 2. Refer to Standard 19 38 Good Practice Recommendations The smoking room would benefit from refurbishment. If the resident in bedroom 15 wishes to have their door permanently open, then an appropriate fire safety device needs to be fitted. Crystal Residential Home G53 G53 S25777 crystal V203556 180705 stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection 8th Floor, Grosvenor House 125 High Street Croydon CR0 9XP 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. Extracts may not be used or reproduced without the express permission of CSCI Crystal Residential Home G53 G53 S25777 crystal V203556 180705 stage 4.doc Version 1.40 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!