CARE HOME ADULTS 18-65
Palmer Crescent (1) Rushmoor Ottershaw Surrey KT16 0HE Lead Inspector
Graham Cheney Announced 21 July 2005 14:30 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. Palmer Crescent (1) H58_s13439_1 Palmer Crescent_v226242_210705_stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Palmer Crescent (1) Address 1 Palmer Crescent, Rushmoor, Ottershaw, Surrey, KT16 0HE 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) 01932 874478 Welmede Housing Association Ltd Ms Christina Liddington CRH Care Home 6 Category(ies) of LD Learning Disability, 6 registration, with number of places Palmer Crescent (1) H58_s13439_1 Palmer Crescent_v226242_210705_stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The age range of the persons to be accomodated will be: 18 - 64 years. Date of last inspection 15 December 2004 Brief Description of the Service: 1 Palmer Crescent, also known as Rushmore, is a detached bungalow providing accommodation for six residents. Building work has been completed in the bungalow to improve the facilities offered, which include additional lounge space and the provision of single bedrooms for all residents. The home is situated in a residential area with similar bungalows 3,5,& 7 also providing residential care. The home provides a good standard of accomodation. Palmer Crescent (1) H58_s13439_1 Palmer Crescent_v226242_210705_stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This visit was the home’s first inspection for the year 2005/2006. This was an announced visit, which meant that staff and residents knew that it was due to happen. The inspection started at 2.00 p.m. and although some were out during the visit, the inspector met and spent some time with most of the residents. This was the first time the inspector had been to Palmer Crescent and the first part of the visit was taken up with an introduction to the residents and a meeting with staff, followed by a tour of the building. The rest of the time was spent looking at records and reports and talking to the manager and staff about how the home was run. Residents and staff made the inspector very welcome and were happy to talk about life at Palmer Crescent. During the course of the inspection one of the parents of a resident visited and spoke with the inspector. Comment cards were sent out to relatives, visiting professionals and care managers details of responses are included in this report. What the service does well:
The relationship between residents and staff was observed to be relaxed and very friendly, creating a warm and homely feel in the home. Residents were encouraged and supported to be as independent as they were able, being encouraged to help or be involved with domestic tasks such as cooking, tidying etc. The home’s staff supported by a ‘floating’ member of staff ensured that a range of activities was undertaken by each of the residents suited to their needs. On the day of the inspection staff took two residents swimming and others were attending day activities. Palmer Crescent (1) H58_s13439_1 Palmer Crescent_v226242_210705_stage 4.doc Version 1.30 Page 6 For one of the residents the activities programme appeared limited consisting each day of going for a walk, out for a drive or remaining in the home playing with balloons and listening to music. The care plan indicated that the resident benefited by having such a regular routine and that change and crowds were particularly problematic. This was confirmed in conversation with the resident’s parent. That said it was noted that the staff continue to try to provide alternative forms of activity and stimulation and work well with the resident, using a process of elimination to understand particular behaviours and meet the individual’s needs. Other residents were able to go into the local community on a regular basis, which included attending day care, leisure activities, shopping and having meals out. The home has its own transport for residents. All of the residents have the opportunity of a holiday, although where they are not able to cope with the change of environment they have days out instead. Care plans were well established and provided a good level of information about the individual their needs and care objectives. Regular diary notes provided evidence that care needs were being met to a high degree. This was commended. Staff stated that Welmede provided a range of training opportunities including NVQ and both on and off site training in fire safety, basic life support and manual handling. The administration and recording of medication was sound although it was recommended that the ordering of a larger medication cabinet should be pursued. Sound procedures were evidence to ensure that residents are appropriately supported with their finances; this included accurate recorded and regular auditing of monies held and spent. What has improved since the last inspection? What they could do better:
The areas where the home could be improved related to the premises.
Palmer Crescent (1) H58_s13439_1 Palmer Crescent_v226242_210705_stage 4.doc Version 1.30 Page 7 It was a concern that fire doors, in particular the door to the laundry which opened onto the main corridor, were being held open by various means such a box and a pile of books. It was a requirement that the practice of retaining open fire doors must be risk assessed in consultation with the local fire officer. Appropriate retaining devices must be fitted to those doors, which the assessment indicates can safely remain open during the day. Whilst the shower room had been nicely tiled the flooring and grab rails were in a poor condition. It was a requirement that action must be taken to improve or replace the flooring in the shower room and to replace the grab rails. The manager stated that following a recommendation made by the minimal handling advisor, Welmede were looking to replace the bath with an assisted bath, which would reduce the potential risk of injury to residents and staff. It was strongly recommended that this be actioned as a matter of priority given that the service were aware of the potential risks. Direct access from the main lounge to the garden was limited by the potential tripping hazard presented by the frame of the patio door and the depth of the step. Although not designated as a fire door this could provide a direct exit from the home, particularly if a fire started in the kitchen. It was strongly recommended that the use of this door be risk assessed and action taken to minimise the potential tripping hazard. 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. Palmer Crescent (1) H58_s13439_1 Palmer Crescent_v226242_210705_stage 4.doc Version 1.30 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Palmer Crescent (1) H58_s13439_1 Palmer Crescent_v226242_210705_stage 4.doc Version 1.30 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 Sampling of care plans provided evidence that the home has established a sound process of assessing residents’ needs and aspirations these were commended. This should ensure that prospective residents are appropriately assessed and feel assured that the home can meet their needs. EVIDENCE: Although there have not been any recent admissions to the home, care plans sampled demonstrated that appropriate assessments process were in place to ensure that prospective and existing residents are fully assessed. Palmer Crescent (1) H58_s13439_1 Palmer Crescent_v226242_210705_stage 4.doc Version 1.30 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 8, 9 Evidence gathered from this inspection indicated that each of these standards was being met effectively. This gives confidence that each individual’s needs and aspirations were being recognised and met. Care plans were commended for the level of information held. EVIDENCE: The relationship between residents and staff was observed to be relaxed and very friendly, creating a warm and homely feel in the home. Residents were encouraged and supported to be as independent as they were able, being encouraged to help or be involved with domestic tasks such as cooking, tidying etc. Care plans were well established and provided a good level of information about the individual their needs and care objectives. Regular diary notes provided evidence that care needs were being met to a high degree. This was commended. Palmer Crescent (1) H58_s13439_1 Palmer Crescent_v226242_210705_stage 4.doc Version 1.30 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12, 13, 14, 15, 17 Evidence gathered during this inspection confirmed that the home meets each of the assessed standards. This meant that the home was able to demonstrate that residents were encouraged and supported to lead as independent and fulfilling life as they were able. The home’s recognition of individual dietary needs was commended. EVIDENCE: The home’s staff supported by a ‘floating’ member of staff ensured that a range of activities was undertaken by each of the residents suited to their needs. On the day of the inspection staff took two residents swimming and others were attending day activities. Palmer Crescent (1) H58_s13439_1 Palmer Crescent_v226242_210705_stage 4.doc Version 1.30 Page 12 For one of the residents the activities programme appeared limited consisting each day of going for a walk, out for a drive or remaining in the home playing with balloons and listening to music. The care plan indicated that the resident benefited by having such a regular routine and that change and crowds were particularly problematic. This was confirmed in conversation with the resident’s parent. That said it was noted that the staff continue to try to provide alternative forms of activity and stimulation and work well with the resident, using a process of elimination to understand particular behaviours and meet the individual’s needs. Other residents were able to go into the local community on a regular basis, which included attending day care, leisure activities, shopping and having meals out. The home has its own transport for residents. All of the residents have the opportunity of a holiday, although where they are not able to cope with the change of environment they have days out instead. The manager demonstrated that they were very aware of the individual dietary needs of each of the residents and the home was commended on the way they ensured these needs were properly met, for example the home provided five different types of milk. Palmer Crescent (1) H58_s13439_1 Palmer Crescent_v226242_210705_stage 4.doc Version 1.30 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 20 Standard 20 was assessed on this occasion and the practice for administering medication complied with the Royal Pharmaceutical Society’s guidance. On the evidence presented the home was therefore obtaining, storing, administering and recording medication appropriately. EVIDENCE: The administration and recording of medication was sound although it was recommended that the ordering of a larger medication cabinet should be pursued. Palmer Crescent (1) H58_s13439_1 Palmer Crescent_v226242_210705_stage 4.doc Version 1.30 Page 14 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) none assessed. EVIDENCE: Palmer Crescent (1) H58_s13439_1 Palmer Crescent_v226242_210705_stage 4.doc Version 1.30 Page 15 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25, 27, 29 1 Palmer Crescent was a pre-existing, (before 2002) registered care home. Given this the evidence gathered during this inspection confirmed that, with the exception of standards 24 & 27 (please see below), the home meets each of the assessed standards and provides a good level of accommodation appropriate to the needs of the current residents. Fire safety concerns meant that standard 24 was not fully met. The poor condition of the shower room floor and the need for an assisted bath meant that standard 27 was almost met. EVIDENCE: The home has been had major work done recently creating three single rooms to replace shared rooms, two with their own toilet and shower. The manager said that redecoration was ongoing and that the finishing touches such as new lampshades and pictures were in hand. It was a concern that fire doors, in particular the door to the laundry which opened onto the main corridor, were being held open by various means such a box and a pile of books. It was a requirement that the practice of retaining open fire doors must be risk assessed in consultation with the local fire officer.
Palmer Crescent (1) H58_s13439_1 Palmer Crescent_v226242_210705_stage 4.doc Version 1.30 Page 16 Appropriate retaining devices must be fitted to those doors, which the assessment indicates can safely remain open during the day. Whilst the shower room had been nicely tiled the flooring and grab rails were in a poor condition. It was a requirement that action must be taken to improve or replace the flooring in the shower room and to replace the grab rails. The manager stated that following a recommendation made by the minimal handling advisor, Welmede were looking to replace the bath with an assisted bath, which would reduce the potential risk of injury to residents and staff. It was strongly recommended that this be actioned as a matter of priority given that the service were aware of the potential risks. Direct access from the main lounge to the garden was limited by the potential tripping hazard presented by the frame of the patio door and the depth of the step. Although not designated as a fire door this could provide a direct exit from the home, particularly if a fire started in the kitchen. It was strongly recommended that the use of this door be risk assessed and action taken to minimise the potential tripping hazard. Palmer Crescent (1) H58_s13439_1 Palmer Crescent_v226242_210705_stage 4.doc Version 1.30 Page 17 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 35 Evidence gathered during this inspection confirmed that the home meets each of the assessed standards. Staff appeared to be enthusiastic and committed to supporting residents, with training and development given a high priority. EVIDENCE: Staff stated that Welmede provided a range of training opportunities including NVQ and both on and off site training in fire safety, basic life support and manual handling. The relationship between residents and staff was observed to be relaxed and very friendly, creating a warm and homely feel in the home. Residents were supported to be as independent as they were able, being encouraged to help or be involved with domestic tasks such as cooking, tidying etc. Palmer Crescent (1) H58_s13439_1 Palmer Crescent_v226242_210705_stage 4.doc Version 1.30 Page 18 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38, 41, 42, 43 Evidence gathered during this inspection confirmed that, the home meets each of the assessed standards and was seen to be well run with sound and accountable management support. The manager and staff’s commitment to the continual development of the service was commended. EVIDENCE: Sound procedures were evidence to ensure that residents are appropriately supported with their finances; this included accurate recorded and regular auditing of monies held and spent. Overall evidence gathered during the inspection indicated that the manager and staff continue to strive to improve the quality of service provided. Palmer Crescent (1) H58_s13439_1 Palmer Crescent_v226242_210705_stage 4.doc Version 1.30 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x x Standard No 22 23
ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 4 3 3 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 3 x 2 x 3 x Standard No 11 12 13 14 15 16 17 x 3 3 x 3 3 4 Standard No 31 32 33 34 35 36 Score x x 3 x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Palmer Crescent (1) Score x x 3 x Standard No 37 38 39 40 41 42 43 Score 3 3 x x 3 3 x H58_s13439_1 Palmer Crescent_v226242_210705_stage 4.doc Version 1.30 Page 20 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 YA24 Regulation 23(4) Requirement It was a requirement that the practice of retaining open fire doors must be risk assessed in consultation with the local fire officer. Appropriate retaining devices must be fitted to those doors, which the assessment indicates can safely remain open during the day. It was a requirement that action must be taken to improve or replace the flooring in the shower room and to replace the grab rails. Timescale for action 27/08/05 2. YA27 23(2)(b) 27/08/05 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 YA20 YA27 Good Practice Recommendations it was recommended that the ordering of a larger medication cabinet should be pursued. The manager stated that following a recommendation made by the minimal handling advisor, Welmede were looking to replace the bath with an assisted bath, which would reduce the potential risk of injury to residents and staff. It was strongly recommended that this be actioned
H58_s13439_1 Palmer Crescent_v226242_210705_stage 4.doc Version 1.30 Page 21 Palmer Crescent (1) 3. YA24 as a matter of priority given that the service were aware of the potential risks. Direct access from the main lounge to the garden was limited by the potential tripping hazard presented by the frame of the patio door and the depth of the step. Although not designated as a fire door this could provide a direct exit from the home, particularly if a fire started in the kitchen. It was strongly recommended that the use of this door be risk assessed and action taken to minimise the potential tripping hazard. Palmer Crescent (1) H58_s13439_1 Palmer Crescent_v226242_210705_stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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