Inspection on 12/02/07 for Homecrest Residential Home

This inspection was carried out on 12th February 2007.

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.

Other inspections for this house

Homecrest Residential Home 02/10/06

Homecrest Residential Home 17/02/06

Homecrest Residential Home 15/11/05

Homecrest Residential Home 14/09/04

Homecrest Residential Home 28/04/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Homecrest Residential Home 49/55 Falkland Road Wallasey Wirral CH44 8EW Lead Inspector Les Smith Unannounced Inspection 12th February 2007 09:30 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 Homecrest Residential Home DS0000033293.V331097.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. Homecrest Residential Home DS0000033293.V331097.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Homecrest Residential Home Address 49/55 Falkland Road Wallasey Wirral CH44 8EW 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) 0151 639 7513 Norens LTD Care Home 34 Category(ies) of Dementia - over 65 years of age (34) registration, with number of places Homecrest Residential Home DS0000033293.V331097.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Thirty Four (34) adults over the age of 65 (DE/E) with dementia and may from time to time admit persons between the age of 60 and 65 years of age To accommodate one named service user under the age of 65 years Date of last inspection 2nd October 2006 Brief Description of the Service: Home crest is a detached three storey building in a residential area of Wallasey. There is off-street parking at the front of the building and a patio/garden area at the rear. Homecrest is close to local shops, amenities and public transport facilities. Home crest is registered to provide care for up to 34 people Dementia over the age of 65 and may accommodate younger adults between the age of 60 and 65 from time to time. All communal facilities are on the ground floor and a lift serves all storeys. Homecrest is an accredited holder of the British standards Institute ISO 9001and is also accredited for the ‘Investors in people’ award. Fees at Homecrest are within the range £300 to £399 per week. Homecrest Residential Home DS0000033293.V331097.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit took place on 12th February and lasted for a total of 4 hours. During the visit time was spent examining records, policies and procedures and a tour of the home was undertaken. Members of staff were observed to be going about their work in a cheerful manner and clearly had good relationships with the residents. All residents appeared to be well cared for and were interacting with staff and fellow residents. Homecrest has a homely ambience and relaxed atmosphere. 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. Homecrest Residential Home DS0000033293.V331097.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 Homecrest Residential Home DS0000033293.V331097.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): 3,4,6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents or their representatives can be sure that their needs will be fully assessed but cannot be confident that their needs can be fully met. EVIDENCE: Residents are only admitted to Homecrest following a detailed pre-admission assessment. The pre-admission assessment includes information in relation to mental health and behavioural patterns. All pre-admission assessments are carried out by the homes acting manager or deputy and include direct input from the prospective residents family or representative and other health care professionals involved. The dependency of residents at Homecrest has increased particularly in terms of residents’ predictability due to either worsening dementia or concurrent medical conditions and the home must ensure that current and changing needs can be met in full. Homecrest Residential Home DS0000033293.V331097.R01.S.doc Version 5.2 Page 8 The home is fully equipped with appropriate aids such as handrails and assisted bathrooms. A well-motivated and stable workforce provides care and a training programme has been commenced which is ongoing. At the time of this visit 77 of care staff had completed training in dementia and 51 had completed training in non-violent intervention. The home is reminded that training in these important skills should be extended to non-care staff. Homecrest does not provide intermediate care Homecrest Residential Home DS0000033293.V331097.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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a comprehensive planning process in place but an improvement in consistency is required to fully support residents. Medication management needs improvement to meet good practice guidelines. EVIDENCE: A selection of care files and related documentation was examined during this visit. Care plans included biographical, physical and mental health details and risk assessments. Risk assessments for pressure sores e.g. Waterlow score, Nutrition, falls risk, mobility and handling were in place and up to date for most residents. Care plans detailed specific interventions for mental health as well as physical problems and also detailed behavioural triggers and specific interventions. One file examined showed an admission date in early December 2006 but the care file contained no manual handling, mobility, continence or Waterlow risk assessments. A nutritional risk assessment was present but not completed and there was no record of residents weight in the file. The promotion of Homecrest Residential Home DS0000033293.V331097.R01.S.doc Version 5.2 Page 10 independence invariably involves an element of risk, which is managed via the completion of relevant risk assessments. Where risk assessments were present and reviewed, examination showed that the assessments were not always accurate or dated and any reviews did not always reflect changes, which were evidenced in other parts of the care file. A second file showed a complete absence of care plans for a resident admitted in early January. The lack of required care plans fails to demonstrate that the interventions to meet assessed needs have been put in place. The risk of required care not being given due to lack of appropriate care plans is not acceptable. Care plans were reviewed on a regular basis and demonstrated that changing needs were reported. However the care plans are not always updated to reflect the changes detailed in the reviews. It is essential that care plans are up to date and show the current care needs and associated interventions. A separate record within the care plan recorded all visits by health care professionals and records were seen detailing visits by GPs, district nurses, continence specialists etc. Medication management has improved since the previous visit. There are no residents self-medicating at Homecrest. The MAR sheets were examined and all were completed with no signature gaps. Residents drugs returned to pharmacy are recorded, a date and signature from the pharmacy representative being obtained when returned. It is strongly recommended that guidelines for medications prescribed on a ‘as and when required’ basis are put in place to assist administration of such items. It is further recommended that the temperature of the clinic room be monitored to ensure that the temperature does not rise above 250C, the maximum recommended for safe storage. There were no controlled drugs in use at the time of this visit but the home must obtain an appropriate register for the recording of such items in the future. Staff members were observed interacting with residents and always spoke courteously, addressing residents respectfully at all times and delivering care with dignity. Shared rooms are provided with screens to allow personal care to be given in a discrete and sensitive way. Homecrest Residential Home DS0000033293.V331097.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): 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. As far as possible residents have choice and flexibility in how they spend their day in the home, and pursue leisure activities according to their choice and preferences thereby allowing independence and individuality for each resident. Meals at Homecrest are good, offering choice and variety whilst catering for residents dietary needs or cultural preferences EVIDENCE: Daily routines are as far as possible arranged to meet individual preferences. The home’s activities co-ordinator has not as yet attended an appropriate course and is currently making efforts to source an appropriate course. A range of activities on both a group and one to one basis using a resource pack from Age Concern are provided. Each resident has their own individual activities programme and care staff are encouraged to participate in all aspects. It is strongly recommended that participation in activities be recorded in the care files. This would help to develop a profile of likes and dislikes of individual residents. There is an accepted need for ongoing development of social and recreational activities based upon individual life experiences and Homecrest Residential Home DS0000033293.V331097.R01.S.doc Version 5.2 Page 12 capabilities particularly for those residents who have limited communication or sensory impairment. All religious denominations are served by a catholic service being held in the home every Friday and there are regular interdenominational services. Outside entertainers visit the home regularly. Family members and friends and other visitors are welcomed at the home at any time and visitors were seen in the home from early morning and throughout the day. A varied and healthy diet is provided with residents special dietary needs or cultural preferences being catered for. Homecrest Residential Home DS0000033293.V331097.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): 16,18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are policies and procedures in place for the management of complaints and protection from abuse and residents may be confident that their complaints will be taken seriously. EVIDENCE: The CSCI has received no complaints since the last visit and there is no record of any complaints made directly to the home. The acting manager documents details of all complaints or concerns received together with details of any investigation and actions taken. Policies and procedures to be implemented in the event of abuse being suspected are held within the home and the acting manager is responsible for ensuring compliance. Staff members have received training in the recognition of abuse, its various forms and the procedures to follow if abuse is seen or suspected. A training programme is in place and 85 of staff members have now been trained in this area to date. The home has a whistle blowing policy and all staff members are made aware of their responsibility to ensure the protection of service users. Homecrest Residential Home DS0000033293.V331097.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): 19,26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The standard of environment at Homecrest is improving and ongoing investment will promote a safe and comfortable place to live for the residents. EVIDENCE: Ramps and handrails facilitate access to both the homes front entrance and the rear garden. Rooms are spacious and airy and decorated to a good standard. A tour of the home showed that: Lounge 1 carpet requires deep cleaning Lounge 2 has a lot of items being stored that present a risk to residents Vanity units in 5 rooms were in poor condition and need replacement Rooms 19 and 20 have been redecorated but need new floor coverings New flooring required in toilet 1 – outstanding requirement from last 2 visits New flooring and refurbishment required in bathroom 5– outstanding requirement from last 2 visits New flooring required in bathroom 4 Homecrest Residential Home DS0000033293.V331097.R01.S.doc Version 5.2 Page 15 New flooring has been laid in dining room On the day of inspection the home was clean, pleasant and hygienic. Homecrest Residential Home DS0000033293.V331097.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): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff members are recruited via robust policies and procedures, but do not appear to be deployed in sufficient numbers and skill mix. EVIDENCE: Homecrest has a staff complement that is an appropriate skill mix and number to meet the needs of residents within the registered category. At the time of this visit there had been 14 accidents in the first 11 days of February and 16 accidents requiring further assessment at hospital since 1st November 2006.The number of accidents at the home supports the view that current staffing levels are not sufficient to provide the appropriate level of supervision for the current dependency level. The gradual and inevitable deterioration of some residents leads to higher levels of dependency. Such changes in dependency may be addressed by requesting reassessment of needs by social services but where this is not the case the home is reminded that staffing levels must be kept under review and adjusted accordingly to meet increased needs. The home currently has 61 of staff members qualified to NVQ standard and two members of staff are currently studying for NVQ level 3. The home follows a robust recruitment procedure for all staff. Prospective staff is required to complete an application form prior to interview. Two references Homecrest Residential Home DS0000033293.V331097.R01.S.doc Version 5.2 Page 17 are taken together with Pova First clearance and enhanced Criminal Record Bureau checks being obtained. Staff files examined held all the required documentation. Training records examined show that mandatory training is not yet up to date with only 50 of staff having up to date manual handling training but all staff have completed fire safety training. All members of kitchen staff have valid food hygiene certificates but only one carer has received this training. All members of staff that handle food should receive this training. Only two members of staff have valid first aid qualifications. The home is reminded that there is an expectation that a qualified first aider will be on duty at the home at all times including the night time periods. There has been no training in understanding and practice of measures to prevent spread of infection and communicable diseases. There has been some training in dementia care and non-violent intervention with 47 of staff having completed training and assurances were given that this training is ongoing. Protection of the vulnerable adult training is addressed in an earlier section of this report. Homecrest Residential Home DS0000033293.V331097.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): 31,33,35,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The acting manager is well supported by senior management EVIDENCE: A new manager has been appointed following the resignation of the previous manager. The acting manager was previously the deputy manager and has a good knowledge of the home. She is qualified to NVQ level 3 and commenced working towards the level 4 qualification and registered managers award. It is a requirement that an application for registration with the CSCI be made. Homecrest was awarded ‘Investor in People’ status in March 2004 and is also accredited by the British Standards Institute (BSI) and holds ISO 9001 certification. The BSI conducts six monthly quality assurance inspections. Homecrest Residential Home DS0000033293.V331097.R01.S.doc Version 5.2 Page 19 Residents or their representatives are consulted about the service offered on a yearly basis by way of a questionnaire, which is distributed and processed by the providers’ head office every December. Staff meetings are held on a regular basis. Homecrest Residential Home DS0000033293.V331097.R01.S.doc Version 5.2 Page 20 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 3 2 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 Standard No Score 16 3 17 x 18 3 2 x x x x x x 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x 3 x X 3 Homecrest Residential Home DS0000033293.V331097.R01.S.doc Version 5.2 Page 21 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 OP7 Regulation 15 Requirement Timescale for action 31/03/07 2 OP9 13(2) 3 OP27 18(1)(a) 4 OP30 18(1)(c)(i ) The registered person must produce a care plan for each service user that must be completed in a timely manner and kept relevant and updated on a regular basis to ensure that staff have the information required to provide appropriate care The registered person must 31/03/07 ensure that an appropriate register for the recording of controlled drugs is provided The registered person shall, 31/03/07 having regard to the size of the care home, the statement of purpose and the number and needs of the service users (a) ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. The registered person shall, 30/04/07 having regard to the size of the care home, the statement of purpose and the number and DS0000033293.V331097.R01.S.doc Version 5.2 Homecrest Residential Home Page 22 5 OP31 6 OP38 7 OP38 needs of the service users (c)(i) ensure that the persons employed by the registered person to work at the care home receive training appropriate to the work they are to perform. (Previous timescales of 30/11/06 partially met) 9(2)(b)(1) The registered person must 31/03/07 ensure an application for registration of the acting manager with the CSCI is submitted 13(4)(c) The registered person shall 30/04/07 ensure that unnecessary risks to the health or safety of service users are identified and so far as possible eliminated and shall make suitable arrangements for the training of staff in first aid (Previous timescale of 30/10/06 not met) 13(3) The registered person shall make 30/04/07 suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home (refer specifically to training in infection control. (Previous timescale of 30/12/06 not met) 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 Homecrest Residential Home DS0000033293.V331097.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS 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 Homecrest Residential Home DS0000033293.V331097.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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