Inspection on 30/04/07 for Crystal Residential Home

This inspection was carried out on 30th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 12/09/07

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 30th April 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.V337186.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.V337186.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 - over 65 years of age (1), Old age, registration, with number not falling within any other category (12) of places Crystal Residential Home DS0000025777.V337186.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. A variation has been agreed to allow one specified service user in the Mental Disorder - over 65 (MD(E)) category to be accommodated. One (1) place for a service user over the age of 65, with dementia, can be accommodated 25th May 2006 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.V337186.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector undertook this unannounced inspection. Two site visits were made, which lasted five and a half hours in total. Two service user surveys and two relatives’ surveys were received. Staff files, care documentation, medication records and training files were examined. Observation was made of practice within the home. Discussions were held with three people who live in the service and the manager. What the service does well: What has improved since the last inspection? What they could do better: As previously stated requirements relating to care planning and individual choice are outstanding. Work is needed to make sure care planning is person centred and includes details of social needs and sexuality. People who live in the home need to be able to maintain significant relationships. Further information on requirements made relating to health and safety and infection control can be found in the main body of the report. Crystal Residential Home DS0000025777.V337186.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Crystal Residential Home DS0000025777.V337186.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.V337186.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Admission to the home is process driven. Pre admission assessments were in place, but information from them has not been utilised by the home. Care needs to be taken to make sure that people admitted are within the home’s stated categories; this could lead to an individual’s needs not being identified or met. Written contracts are provided which detail service provision. EVIDENCE: Three people who live in the home were case tracked. Pre admission information from other professionals was in place. Assessments undertaken by the home were examined. One person was recently admitted with a diagnosis of a mental health disorder. Assessments contained limited information, the nutritional section on one stated ‘good diet eats everything.’ Mood changes were not clarified, i.e. one Crystal Residential Home DS0000025777.V337186.R01.S.doc Version 5.2 Page 9 assessment stated the resident gets upset and moody at times, but with no explanation of behaviour or interventions. Residents had signed to indicate that they had been involved in the process. Sexuality and spiritual needs were not addressed consistently, this is an area, which requires development, to make sure all needs are identified. There was information on resuscitation, but not details of how to carry it out. Some social history had been included in the homes’ assessment. Contracts detailed what is included in the fees and the service provision. The contracts need to include how to contact CSCI. Crystal Residential Home DS0000025777.V337186.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. 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 who use live in the home need to be confident that their needs will be met. Health needs are monitored and appropriate action is generally taken. Care plans need to fully evidence how identified needs are to be met. There was some indication of privacy and dignity being maintained, however more input is needed to make sure care plans are person centred. Medications are generally handled safely, but the home must make sure that this is consistent. End of life wishes must be recorded and acted upon to ensure that care is holistic. EVIDENCE: A new care plan format has been implemented, this allows for detailed recording and helps to make sure that all needs are identified. However, care plans must be completed fully to make sure that all needs are identified. Care plans on social activities, religion and sexuality were not in place. Crystal Residential Home DS0000025777.V337186.R01.S.doc Version 5.2 Page 11 Some plans had information of how individuals’ needs were to be met. E.g. ‘offer brush with toothpaste on it.’ These details need to be consistent across all plans to make sure that care is given according to the person’s preferences. Regular times for care needs to be met must also be detailed to make sure that all staff are aware of how to deliver care consistently. E.g. ‘regular bath’ but no times. This does not evidence independence and choice, however some plans contained detail of personal preferences, such as staying in bed until residents wanted to get up in the morning. Residents or their representatives need to be involved consistently in the care planning process. Daily records contained bland statements such as:’ is fine’. However, there were good examples of daily recording e.g. ‘sitting in conservatory, reading paper and [enjoying] sunshine’. Medication records were examined. There was a photo of each resident and a list of staff signatures. Allergies of residents were not noted. A record of the amount of medication received was detailed. One resident was on Warfarin, but there was no yellow card in their file. At medications had been signed for when given. The majority of residents were on night sedation or other sedative medications use for mental health disorders. A review of all residents’ medications is needed to make sure that they are not being over medicated and they are receiving appropriate care. Crystal Residential Home DS0000025777.V337186.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Generally staff are aware of the need to support people who live in the home. Some people are consulted or listened to regarding the choice of daily activity, but this process could be improved. Individual’s wishes to develop or maintained personal relationships with privacy for intimate contact are not respected. Although people who use the service have no complaints about food, mealtimes are not a social occasion and menus are not available. EVIDENCE: People who live in the home are able to eat their meals in the dining room, which leads off the kitchen. Tables were laid with suitable cutlery and condiments. At mid morning staff asked individuals what they wanted for lunch; on the first site visit there was a choice of fish or pie. One resident said food was good. Examination of the food store indicated that there was little fresh produce and most foods were of the convenience type. No menus were displayed at the tables. Crystal Residential Home DS0000025777.V337186.R01.S.doc Version 5.2 Page 13 People who live in the home are able to go out, however there were limited activities within the home. On one site visit individuals were sitting around edges of lounge in their chairs. A communion service was being held on second site visit. Activities or interests of people who live in the home had been recorded inconsistently, with limited detail, e.g. watches TV, with no mention of type of programme they enjoy. A married couple live in the home, but do not share a room. There is no separate provision to enable this couple to have a shared bedroom and a lounge, which is seen as good practice. One of the couple was concerned that their partner’s room was not near to them, so they only saw each other during day. Crystal Residential Home DS0000025777.V337186.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. 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. The home enables people who use the service to express their views. The home maintains a record of complaints; policies and procedures for Safeguarding Adults are available and give specific guidance to those using them. EVIDENCE: No complaints were recorded in the complaint book. No protection of vulnerable adults investigations. All four surveys received indicated that the respondents were aware of how to raise any concerns. Crystal Residential Home DS0000025777.V337186.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home does not have an ongoing maintenance programme in place. Essential maintenance is only done when a problem has arisen. A number of the fixtures and fittings need replacing and some of the décor requires upgrading. EVIDENCE: People who live in the home are able to bring in personal possessions. However some areas of the home needed attention. The carpeting in dining area is stained and worn. The wallpaper is torn and grubby in places. Skirting boards were scuffed. The kitchen was clean and tidy. Crystal Residential Home DS0000025777.V337186.R01.S.doc Version 5.2 Page 16 Some rooms needed recarpeting and redecorating, in particular those rooms in which people who smoked lived. In one bedroom there were burn holes in the sheet. In the bathroom on ground floor the hoist chair was rusted underneath. Bars of soap and nail brushes were seen in bathrooms and toilets, which indicates that there is use of communal toiletries. This poses an infection control issue. The home was not free from odours and some carpets smelt of urine. A full redecoration programme is needed to make sure the environment is homely and safe for people to live in. Crystal Residential Home DS0000025777.V337186.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Training provided is weak and mandatory areas are not prioritised. There are no reliable records are staff training. The service has a poor recruitment procedure with shortfalls in recording and process being evident. Staff are appointed and start working without references or other important documentation being received. This places people who use the service at risk of harm. EVIDENCE: People who live in the home are supported by adequate numbers of staff, as evidenced by the duty rota. Recruitment procedures need to be improved to make sure that people are protected from harm and all necessary checks are carried out prior to staff commencing employment. Staff files were examined. The application form needs to be revamped to ensure compliance with employment law and the Care Standards Act. Personal questions, such as marital status and number of dependants, need to be separate from the main application form. Cautions as well as convictions must be asked about, to make sure that relevant information is obtained from prospective employees. Crystal Residential Home DS0000025777.V337186.R01.S.doc Version 5.2 Page 18 It was noted that one member of staff did not declare a conviction. The manager said it was nothing to do with worker; this needs to be clarified as a priority. Criminal Records Bureau checks were in place, but these had not been consistently requested by the home, one CRB had been done by a different organisation. It was seen that one member of staff did not have an enhanced disclosure, only a standard one. One staff file did not have any proof of identity. Work permits were not in place for all those that needed them One worker did not have references. Each worker had a contract, but these need to be revised to include details of the Care Standards Act 2005, and not the Registered Homes Act 1984. Each file had an induction checklist in place. Staff had received training in Adult Protection, moving and handling, food hygiene and first aid. The training received had not consistently been updated to make sure that it was current. There was evidence of fire training being undertaken. Crystal Residential Home DS0000025777.V337186.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. 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 provider/manager has the necessary experience and qualifications to run the home, however, they need to be proactive in their approach and make sure the home is run in the best interests of the people that live there. Policies and procedures are not routinely reviewed and updated. Quality assurance monitoring is patchy and incomplete. The home is drifting and lacks purpose and direction. Health and safety is poor and there are no routine checks in place to maintain a safe environment. EVIDENCE: A tour of the premises was made. Crystal Residential Home DS0000025777.V337186.R01.S.doc Version 5.2 Page 20 Windows on the first floor could be opened more than 10cm. Bed rails were seen to be in use, but there were no risk assessments in care plans. Liquid soap and paper toilet is needed in toilets and areas where staff need to wash their hands, to make sure there is good infection control procedures. An audit of the premises is needed; to make sure it is safe. As previously mentioned soap bars and nailbrushes must be removed to prevent spread of bacteria. Personal allowances are managed for two people within the home. There were minor discrepancies on one person’s finance record. The amount of money recorded was less than the amount being held. Receipts were available for purchases. It is necessary for two people to check monies and sign when it is needed. Food temperatures need to be checked and recorded, prior to food being served, as required by the Environmental Health Officer. Hot water temperatures must be checked weekly and recorded, to prevent risk of scalds or burning. Electrical and Portable Appliance Testing was noted to be due to be carried out. Fire alarm call points testing had not been done since April 2007. Fire drills had been carried out with people who use the service. Crystal Residential Home DS0000025777.V337186.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 3 X 1 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 1 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 X X X X X X 1 STAFFING Standard No Score 27 2 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 1 X X 1 Crystal Residential Home DS0000025777.V337186.R01.S.doc Version 5.2 Page 22 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 The registered person must ensure that specific details of needs are recorded in assessments. The registered person must ensure that social activities, religious needs and relationship needs are recorded on admission. The registered must ensure that assessments of residents are fully completed and identify all needs. The registered person must ensure that information from pre admission assessments is included in the home’s assessment. The registered person must ensure that people are admitted in the categories that the home’s Statement of Purpose indicates care can be provided 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. (previous DS0000025777.V337186.R01.S.doc Timescale for action 30/08/07 2 OP3 12 (4) (a) & (b) 30/08/07 3 OP3 14 30/08/07 4 OP3 14 (1) 30/08/07 5 OP3 4 (1) (c) & Sch 1 (5) (6) & (8) 15 30/08/07 6 OP7 30/08/07 Crystal Residential Home Version 5.2 Page 23 timescale of 30/10/06 not met) 7 OP7 15 (1) The registered person must ensure that residents or their representative are involved in the care planning process. The registered person must ensure that daily records accurately reflect how needs have been met. The registered person must ensure that all residents’ medications are reviewed and sedatives are being used appropriately. Staff must ascertain and record the wishes of each service user in the event of their serious illness/death. A resuscitation policy & procedure also needs to be established. (Previous timescale of 30/10/06 not met) The registered person must ensure that there is a suitable range of activities for residents to participate in. These should reflect their personal interests. The registered person must ensure that residents are able to develop or maintain personal relationships. The registered person must ensure that meal times are a social occasion and there is evidence of choice. The registered person must ensure that there is a programme of redecoration and refurbishment in place to maintain a safe environment. The registered person must ensure that the home is free from offensive odours. The registered person must ensure that there are good infection control procedures within the home. DS0000025777.V337186.R01.S.doc 30/08/07 8 OP7 17 (1) (a) & Sch 3 13 (2) 30/08/07 9 OP9 30/08/07 10 OP11 12 30/08/07 11 OP12 16 (2) (m) & (n) 30/08/07 12 OP13 16 (2) (m) 16 (2) (i) 30/08/07 13 OP15 30/08/07 14 OP19 23 (2) (b) & (d) 30/08/07 15 16 OP26 OP26 16 (2) (k) 13 (3) 30/08/07 30/08/07 Crystal Residential Home Version 5.2 Page 24 17 OP29 19 18 OP30 18 (c) 19 OP35 17 The registered person must ensure there is a through recruitment procedure in place and all necessary checks are carried out prior to a person commencing employment. The registered person must ensure there is an appropriate training programme in place, which enables staff to maintain and update their skills. The registered person must ensure that records pertaining to service users monies are accurate at all times (this includes over-payment into their accounts as well as underpayment). (Previous timescale of 13/10/06 not met). 30/08/07 30/08/07 30/08/07 20 OP38 13 (4) (c) 21 OP38 13 (4) (c) 22 OP38 13 (4) (a) & (c) The registered person must 30/08/07 ensure that hot food temperatures are taken and recorded prior to serving. The registered person must 30/08/07 ensure that weekly checks of fire alarms and hot water temperatures are carried out and recorded. The registered person must 30/08/07 ensure that a Health and Safety audit of the home is undertaken and issues rectified, to make sure the environment is safe. 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.V337186.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: 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.V337186.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. 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