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Inspection on 25/05/06 for Crystal Residential Home

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

This inspection was carried out on 25th May 2006.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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

What the care home does well

As has been commented on before, service users were highly complimentary about the quality of the service that they received. None had any issues to raise, and felt that they were extremely well cared for. The two relatives, who kindly commented on the home whilst visiting a service user, supported this view.

What has improved since the last inspection?

The four requirements that were contained in the last report have now been acted upon, albeit one (Service User Guide) needs further work. These related to the need to ensure that the Statement of Purpose and the Service User Guide were up to date and accurate; the importance of abiding by registration categories and not admitting service users who fell outside the aforementioned categories; and the need to have a health and safety risk assessment of the premises carried out, recorded and periodically reviewed/updated.

What the care home could do better:

CARE HOMES FOR OLDER PEOPLE Crystal Residential Home 97 Woodcote Grove Road Coulsdon Surrey CR5 2AN Lead Inspector Margaret Lynes Key Unannounced Inspection 25th May 2006 09:15 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.V295687.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.V295687.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 020 8660 8643 Mrs Jaisree Nemchand Mrs Jaisree Nemchand Care Home 12 Category(ies) of Old age, not falling within any other category registration, with number (12) of places Crystal Residential Home DS0000025777.V295687.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. A variation has been agreed to allow one specified service user in the Mental Disorder - over 65 (MD(E)) category to be accommodated. 1st December 2005 Date of last inspection 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 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 Service Users. 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.V295687.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was conducted over the course of 6.5 hours, and consisted of examination of documentation, talking with service users and relatives, a tour of the premises, and discussions with the manager and staff. All of the aforementioned are thanked for their assistance. The last inspection visit noted that there were four outstanding requirements. Three of these have now been met, and the fourth partially met. One of those requirements related to the admission to the home of a service user who did not fall into the home’s registration category, and for whom a variation had not been granted. It should be noted that a variation was retrospectively applied for (and granted), and that as a result of this breach of Regulations the proprietor/manager was served with a final warning. This visit has resulted in fifteen new requirements being made. While some six of these relate to premises issues, the remainder are concerned with the need for better recording and documentation; and the need to ensure that any recommendations made by the London Fire and Emergency Planning Authority (LFEPA) are acted upon without delay. Evidence to support the comments below was gathered from a range of sources – the service users themselves, relatives, members of staff and inspection records. What the service does well: What has improved since the last inspection? The four requirements that were contained in the last report have now been acted upon, albeit one (Service User Guide) needs further work. These related to the need to ensure that the Statement of Purpose and the Service User Guide were up to date and accurate; the importance of abiding by registration categories and not admitting service users who fell outside the aforementioned categories; and the need to have a health and safety risk assessment of the premises carried out, recorded and periodically reviewed/updated. Crystal Residential Home DS0000025777.V295687.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Crystal Residential Home DS0000025777.V295687.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Crystal Residential Home DS0000025777.V295687.R01.S.doc Version 5.2 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 the following standard(s): 1 and 3 (6 is N/A) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although the Service User Guide has recently been revised, it still contains some inaccuracies which means that prospective clients may not have all of the information that they need to make an informed choice about where to live. The home conducts pre-admission assessments so that the needs of potential service users are identified. This means that each service user can be reassured that the home has taken into account their individual needs, and feels that it can meet them; and the staff in the home can be as familiar as possible with new service users, and have an understanding of what specific service they will need to provide. Crystal Residential Home DS0000025777.V295687.R01.S.doc Version 5.2 Page 9 EVIDENCE: The Service User Guide has been revised and now contains a lot of relevant and useful information. What it does not contain, however, is a copy of the latest inspection report, or at least reference to it and where it can be found. The manager must also take care not to state that the home caters for clients in categories other than that for which it is registered (it states that it can care for clients with a physical disability however it is not registered for this category). The files of five service users were inspected. Each one contained an in-house pre-admission assessment. In some instances these were supplemented by an assessment from the placing authority. Crystal Residential Home DS0000025777.V295687.R01.S.doc Version 5.2 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 the following standard(s): 7, 8, 9, 10 and 11 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although the general hands on care was good, the poor documentation relating to a number of these Standards means that it is possible that service users are not receiving care that is specific to them, and which should have been identified in each service user plan. EVIDENCE: Of the five files examined four contained a service user plan. The fifth had the beginnings of one, but it had not been completed. Although there is a specific proforma for care plans in place in the home, this document is inconsistently used. One some files it had been completed as one would expect – with a clearly identified need, the aim of the care, how the care was to be carried out and a review date. On others however, the form had just been used to record on-going health information. Lacking from all of the plans was reference to social care needs. Crystal Residential Home DS0000025777.V295687.R01.S.doc Version 5.2 Page 11 In some of the files the information recorded regarding health care was good. In others it was less so, with little to indicate that new residents had been registered with a GP for example. A number of gaps were found on the medication administration records, while the manager was reminded of the importance of ensuring that there was a photograph of each service user on file, and also that it was inappropriate to use Tippex on the medication charts. The service users spoken with were unanimous in their praise of the staff team, commenting that they found them helpful, kind, and respectful. Lack of information regarding the action residents would like staff to take in the event of their [the service users] death means that it is feasible that their wishes may not be followed. The manager has devised a suitable record sheet upon which to record this important information however it was seen on only one file, and even then had not been fully completed. Crystal Residential Home DS0000025777.V295687.R01.S.doc Version 5.2 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 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. The home provides a number of recreational activities, so as to try to satisfy the service users social and recreational needs, and individual choice and control is encouraged. This means that the lifestyle in the home aims to match residents’ expectations and preferences. Service users receive a well-cooked and appealing diet, which means that their nutritional needs are catered for. Visitors are made welcome. EVIDENCE: The service users spoken with said that they felt that they were provided with a sufficient number of activities however as commented in previous sections, more attention needs to be given to assessing each service users social needs so that specific activities can be planned for them. These assessments must also give consideration to religious needs. Visitors are made welcome in the home. The opportunity was taken to speak with two of them, and they were both highly complimentary about the home and the quality of the service. Crystal Residential Home DS0000025777.V295687.R01.S.doc Version 5.2 Page 13 The food provided for lunch during the inspection appeared well presented, appetising and hot. Although at first glance the menu may not appear to provide sufficient choice, it is based upon service users preferences. The home is small which enables the staff to gain a good understanding of the residents likes and dislikes and this is reflected in the meals offered. For example, it was pleasing to see that staff took the trouble to grill sausages for one resident who didn’t want them in a casserole, while another had boiled potatoes, as they didn’t like them mashed. These may seem like small issues, but they add to the overall quality of the service. Crystal Residential Home DS0000025777.V295687.R01.S.doc Version 5.2 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 the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints procedure in place, which is accessible to service users. There is also an adequate adult protection procedure in place which, if followed by staff, will offer sufficient protection to service users. EVIDENCE: Both of the aforementioned procedures were inspected on previous visits and found to be acceptable. The staff team have now been allocated places on the Local Authority’s adult protection training course (albeit this is not until the end of the year), which should prove beneficial. In the interim it would be good practice for the manager to hold in-house discussions around adult protection, its importance and how staff should deal with it. There have not been any recorded complaints since the last inspection visit. Crystal Residential Home DS0000025777.V295687.R01.S.doc Version 5.2 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 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. Although a number of requirements have been made with regard to the premises, overall the home was found to be clean and well maintained in most areas. This means that service users are provided with a pleasant, homely and comfortable environment. EVIDENCE: A tour was made of the bedrooms and communal areas. The entire home was clean and in general well maintained. A number of requirements have been made, however, and these relate to the need for minor repairs in the bathroom, replacement/deep cleaning of two of the bedroom carpets, the need to ensure extractor fans are regularly cleaned, the importance of ensuring emergency call bell cords are always untied and in reach, the need to fit a lock to the boiler room and one requirement relating to fire safety. Crystal Residential Home DS0000025777.V295687.R01.S.doc Version 5.2 Page 16 This latter matter is of concern as it relates to issues identified by the London Fire and Emergency Planning Authority on a visit towards the end of last year. It is imperative that all bedroom doors close fully and without force, and that this work is carried out without further delay. Crystal Residential Home DS0000025777.V295687.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected at least once during a 12 month period. 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. The rota provided indicated that staffing numbers were satisfactory. This means that the needs of service users should be attended to promptly. All staff have either an NVQ level II award or are in the process of obtaining one. This means that service users are being looked after by staff who understand their basic care needs. Gaps in staff recruitment documentation mean that service users are not being fully supported or protected by the recruitment policies and practices followed by the home. In addition to the aforementioned NVQ courses, some staff have been enabled to attend other training courses. This means that they should have the competencies necessary to provide a good level of service. EVIDENCE: The manager confirmed that all of the staff currently without an NVQ award were in the process of obtaining one. In addition some staff had attended training in manual handling, first aid, food hygiene and health and safety. Crystal Residential Home DS0000025777.V295687.R01.S.doc Version 5.2 Page 18 In a home of this size, there should be at least two staff on each shift (one of whom can be the manager) plus an additional staff member at peak times. The rota provided indicated that the home was meeting this minimum level. While most of the staff recruitment was satisfactory, the manager was advised that she must ensure that she obtained full employment histories from all staff, and to also indicate on their files whether or not a visa/work or residents permit was required. With regard to the latter, there were two files where the residents’ permits were out of date. The manager was advised that she must ensure all employees had the necessary permission to work. Crystal Residential Home DS0000025777.V295687.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The proprietor both owns and manages the home, and while she does have the necessary experience and skills required, there needs to be some tightening up of practice in some areas – particularly record keeping. The home has in place a quality assurance system, however it is some time since an audit of service user views was conducted which means that it is feasible that the home is not run in the best interests of the service users. The records relating to service users’ monies (pocket money and allowances) were not accurate, which means that residents’ monies were not as secure as they should be. Due to the failure to comply with all of the recommendations set by the LFEPA on their November 05 visit, it was not felt that the health and safety of either residents or staff was being promoted as well as it should be. Crystal Residential Home DS0000025777.V295687.R01.S.doc Version 5.2 Page 20 EVIDENCE: While, as already mentioned, the basic level of care is good, improvement is needed with regard to documentation and record keeping – which falls under the remit of the manager as in such a small home she does the vast majority of this work. There are a number of quality assurance systems in place, and they are being utilised on a regular basis – with the exception of surveying the residents, relatives, staff and other stakeholders. It is some time since such a survey was carried out, and the manager was advised that one should be conducted at least annually, and the results made public. More emphasis also needs to be put on looking at equality and diversity, and ensuring that both are an integral part of the ethos of the home. The manager looks after the pocket money for two of the service users. While the written records appeared accurate, the amount of money held for each did not match the recorded amount (in both instances it was in excess of what there should be). The manager was advised of the importance in ensuring that all records (including cash held) pertaining to service users monies must be accurately maintained. While most of the issues relating to health and safety were satisfactory (i.e. risk assessments, maintenance of equipment, gas and electrical safety) the home has not met the recommendations set out by the LFEPA. These related to the need to ensure that all bedroom doors fully closed (as detailed in the environment section of this report) and also to ensure that the external fire exit doors could easily be opened/closed. On checking the ground floor door it was immediately evident that the door could only be closed using force. The manager was advised to repair this without delay. Crystal Residential Home DS0000025777.V295687.R01.S.doc Version 5.2 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 X X 2 Crystal Residential Home DS0000025777.V295687.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No 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 OP1 Regulation 5 Requirement The Service User Guide must contain a copy of the last inspection report (or at least reference to it) and it must accurately state the category of clients that the home caters for. The registered person must ensure that there is a detailed service user plan in place for each resident and that this covers health, personal and social care needs. The registered person must ensure that all service users’ health needs are documented, including registration with a local GP. The registered person must ensure that the medication administration records are correctly completed at all times. Staff must ascertain and record the wishes of each service user in the event of their serious illness/death. A resuscitation policy & procedure also need to be established. The toilet roll holder in the first floor bathroom requires re-fitting DS0000025777.V295687.R01.S.doc Timescale for action 25/06/06 2. OP7 15 25/06/06 3. OP8 12 25/06/06 4. OP9 13 25/05/06 5. OP11 12 25/06/06 6. OP19 23 31/05/06 Crystal Residential Home Version 5.2 Page 23 7. 8. OP19 OP19 23 13, 23 9. OP19 23 10. OP19 13 11. OP19 13 12. OP29 19 13. OP33 24 14. OP35 17 15. OP38 13 to the wall. All extractor fans must be cleaned on a regular basis. The registered person must ensure that all bedroom doors fully close so as to meet fire safety regulations. The carpet in bedroom 15 requires deep cleaning, while the carpet in bedroom 1 requires replacement. A lock must be fitted to the boiler room so as to prevent any service users wandering in accidentally. All staff must ensure that emergency call bell cords are untied and accessible at all times. The registered person must ensure that new staff provide all of the required documentation prior to commencing work. The registered person must ensure that quality assurance surveys are periodically carried out and the results made public. The registered person must ensure that records pertaining to service users monies are accurate at all times. The registered person must ensure that all recommendations made by the LFEPA are followed without undue delay. 25/05/06 25/06/06 25/07/06 25/06/06 25/05/06 25/05/06 25/07/06 25/06/06 25/06/06 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 OP7 Good Practice Recommendations It would be good practice to review all service user plans DS0000025777.V295687.R01.S.doc Version 5.2 Page 24 Crystal Residential Home on a monthly basis. 2. OP18 It would be good practice for the manager to hold in-house discussions around adult protection, its importance and how staff should deal with it. It would be good practice to hold staff meetings at a more regular interval than at present. 3. OP32 Crystal Residential Home DS0000025777.V295687.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 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 DS0000025777.V295687.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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!