CARE HOME ADULTS 18-65
The Crescent 2 Grayham Crescent New Malden Surrey KT3 5HP Lead Inspector
Mohammad Peerbux Unannounced Inspection 10th November 2005 9:30 The Crescent DS0000013412.V263764.R01.S.doc Version 5.0 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 The Crescent DS0000013412.V263764.R01.S.doc Version 5.0 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 Adults 18-65. 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. The Crescent DS0000013412.V263764.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service The Crescent Address 2 Grayham Crescent New Malden Surrey KT3 5HP 020 8287 2490 020 8287 2490 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) Mrs Maya Patten Mrs Maya Patten Care Home 4 Category(ies) of Learning disability (0), Mental disorder, registration, with number excluding learning disability or dementia (0) of places The Crescent DS0000013412.V263764.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 23rd June 2005 Brief Description of the Service: The Crescent is a privately owned care home situated in a quiet residential area of New Malden. The Home is registered with the Commission For Social Care Inspection, for the provision of care to four younger adults with a learning disability or mental health issue. Despite its tranquil setting, the home is a short walk away from New Malden town centre, which offers a range of shops, pubs, restaurants and transport facilities. The Home offers two bedrooms on the ground floor and two further bedrooms for service users on the first floor. Both ground and first floors offer toilet and bathroom facilities. The lounge and kitchen both afford access to the rear garden. This area is mostly laid to lawn, although it also provides a pleasant seating area and additional storage space in the shed. The Crescent DS0000013412.V263764.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the home’s second inspection for the year 2005/06. It was an unannounced inspection and took place over two hours. Some times were spent looking at the policies and procedures, talking to the manager and to all three service users. A tour of the building was also carried out. Requirements and recommendations from the previous inspection were also discussed with the manager. Overall the home continues to provide a good standard of care. They are all thanked for their time and assistance. What the service does well: What has improved since the last inspection?
The Statement of Purpose has been reviewed and a copy of the latest inspection report is included in the Service User’s Guide. All policies and procedures pertinent to the home are now signed and dated. The medication policy has been amended to include how receipt of medications will be recorded. There is a detailed record of money entering service users’ accounts, and money being transferred for safekeeping and distribution. A running is also in evidence. One of the rooms downstairs has been redecorated with the involvement of the service user is choosing the colour. The Crescent DS0000013412.V263764.R01.S.doc Version 5.0 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. The Crescent DS0000013412.V263764.R01.S.doc Version 5.0 Page 7 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 Outcomes Statutory Requirements Identified During the Inspection The Crescent DS0000013412.V263764.R01.S.doc Version 5.0 Page 8 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 the following standard(s): 1 and 3 The Statement of Purpose, and Service User’s Guide provide prospective service users with details of the services the home offers. This enables them to make an informed decision about admission to the home. The home is able to demonstrate that service users needs are being properly assessed, and that the range of needs presented is being appropriately met. EVIDENCE: It was previously required that the registered person must ensure that all information are included in Statement of Purpose as per schedule1 of the Care Standard Act 2000 . This has been met and the Statement of Purpose has been reviewed since the last inspection. The Service User’s Guide now also includes a copy of the latest inspection report in line with requirement made at the last inspection. However both documents still have to include a review date on them. This was a previous recommendation and therefore would be repeated. It was clear from care plans sampled at random that service user’s needs are being met. Records revealed that service users are in regular contact with other health and social care professionals who regularly visit the home to check that assessed needs are being met. The home has a staff team who offer a range of personal and individual care support to help maximise the independence, wellbeing and welfare of service users. The Crescent DS0000013412.V263764.R01.S.doc Version 5.0 Page 9 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 the following standard(s): 6 and 8 Service user’s care plans are comprehensive and include detailed information about their needs and personal goals. This will help staff know the service users’ needs and how to meet them. Choice and decision making for service users is promoted to a high standard enabling their involvement and opportunities to contribute to the operation of the home. EVIDENCE: All three service users have an individual plan of care in place and were found to address social, emotional and health care issues. Individual preferences were also recorded, as was involvement from other health professionals. The home reviews the care plan of the service users on a monthly basis. There are service users meetings that take place monthly. At these meetings service users have the opportunity to discuss what is happening in the home or raise any matters. All three service users are involved in the household chores, as they are able. The Crescent DS0000013412.V263764.R01.S.doc Version 5.0 Page 10 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 the following standard(s): 12,13 and 14 Service users are encouraged to explore opportunities to enhance their quality of life as well as maintain and participate with friends and the local community, with the aim of maximum integration. EVIDENCE: One service user has a part-time job and uses public transport to travel to and from work. She also attends a centre once a week where she learns IT skills. The other two service users enjoy listening/ singing to old records. One of whom goes out regularly to music shops in search of old 78 records. The home has a gramophone, which allows such records to be played. The service user obviously gets a lot of pleasure from this and spoke positively and enthusiastically about his collection of records. The Crescent DS0000013412.V263764.R01.S.doc Version 5.0 Page 11 The evidence examined plus discussions held with service users and staff, indicated each service users is supported to access a range of community events. Some are designed specifically for people with learning disability; others are generic and open to all members of the local communities. The service users are clearly all able to express their social / leisure needs and interests. Staff support service users in pursuing these activities if and when necessary / requested. Service users take part in a range of local leisure activities. The Crescent DS0000013412.V263764.R01.S.doc Version 5.0 Page 12 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 the following standard(s): 18,20 and 21 Overall the arrangements for health care needs of the service users is good and they receive personal support in the way they prefer. The systems for administration of medications are poor and potentially place service users at risk. EVIDENCE: The findings indicated that service users are able to exercise some level of independence in their personal care needs with appropriate support from staff where needed. The overall impression gained from observing how service users live at the home, indicated a good culture of semi-independent living, with most users have reasonable control over their lives and support from staff where needed. The home has a policy on the administration of medication. Medications are stored in a locked cupboard. It was previously required that the medication policy must be amended to include how receipt of medications will be recorded. This is now in place. The medication administration records were audited and it was noted that one medication which was not being administered but was being signed for. The manager must ensure that medication administration records are accurately completed at all times.
The Crescent DS0000013412.V263764.R01.S.doc Version 5.0 Page 13 The home does have any records of the service user’s last wishes. The manager must consult the service users and/or their relatives about their last wishes and this needs to be documented in their personal files. The Crescent DS0000013412.V263764.R01.S.doc Version 5.0 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 the following standard(s): 23 Service users are protected from abuse and are living in a safe environment as the home has appropriate adult protection policies and procedures in place. EVIDENCE: The home has a detailed adult protection procedure and an appropriate whistle blowing procedure. However the registered person must make suitable arrangements by training staff to prevent service user’s being harmed or suffering abuse or being placed at risk of harm and/or abuse. There have not been any adult protection concerns raised since the last inspection. In respect of service users money, it was previously required that the Registered Person must ensure that there is a detailed record of money entering service users accounts, and being transferred for safekeeping and distribution. There were evidence of records now being kept accordingly. The Crescent DS0000013412.V263764.R01.S.doc Version 5.0 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 the following standard(s): 24,26,27,28 and 29 The overall impression when visiting this home is that it is homely, comfortable clean and hygienic and the staff successfully promote a family-like environment which contributes to the service users’ health and emotional wellbeing. EVIDENCE: The home appears to suit its purpose well. The two service users on the ground floor are a married couple and have indicated that the availability of toilet and bathroom facilities on this floor preserves an element of privacy that they value highly. The home has a further two bedrooms on the first floor, one of which is currently vacant. Communal spaces are comfortably furnished and domestic in character. The room on the ground floor has been redecorated in line with a requirement made at the last inspection. However with regards to the broken bath panel in the ground floor bathroom, the manager stated that the whole bathroom would be replaced in February next year. The lounge has recently been extended and there is plan to put up a conservatory. The inspection findings indicated the home provides adequate living and bedroom spaces for each service user. All bedrooms were checked. They were
The Crescent DS0000013412.V263764.R01.S.doc Version 5.0 Page 16 decorated to a good standard. The rooms contained a variety of personal furniture and fittings that reflected the individual’s personality. The home has sufficient communal space that is both freely accessible to service users and is pleasantly decorated and furnished. There is ample space for all the homes service users to sit together in and receive visitors in private. The home provides service users with adequate toilet and bathroom facilities, which meet their assessed needs and offer sufficient personal privacy. The service users are all mobile and do not require any adaptations to the home at present. The Crescent DS0000013412.V263764.R01.S.doc Version 5.0 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34 and 36 One concern was identified in regard to recruitment checks not being completed satisfactorily, which impinge on the safety and protection of service users being ensured. Care staff are receiving supervision on a regular basis, which contributes to the standards of care being provided to service users. EVIDENCE: It was previously required that the Registered Person must ensure that all records required in Schedule 2 are available on all staff working in the home. As part of the inspection process staff files were sampled and it was noted that none of the staff had any form of identification on file. This requirement still has to be achieved therefore will be repeated. The manager advised that all the homes care staff receive at least six supervisions a year covering good care practices and career development. It was recommended that the manager keep a yearly record of staff supervision signed by both the supervisor and supervisee for easy monitoring. This is now in place. The Crescent DS0000013412.V263764.R01.S.doc Version 5.0 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39,41 and 43 Generally the health, safety and welfare of the service users and staff were being promoted and protected. The home has an excellent quality monitoring system. This ensures the home is run in a way that is in the best interests of the service users. EVIDENCE: It was previously required that the Registered Person must ensure that the quality assurance system in place takes into account the views of stakeholders such as relatives, GPs and other involved professionals. Feedback is now actively sought from all professionals as well as from service users and their relatives. The home has a range of policies and procedures that are required by legislation. All policies and procedures are now signed and dated to ensure that staff are reading the most up-to-date document - and are also using the one specifically sanctioned by the proprietors. This was a requirement from the last inspection.
The Crescent DS0000013412.V263764.R01.S.doc Version 5.0 Page 19 The home ensures so far as is reasonably practicable the health, safety and welfare of service users and staff. All COSHH materials were stored appropriately on the day of inspection. No business and financial plan was available at the time of inspection. However this was forwarded to the Commission following the inspection. The Registered Provider has produced an excellent business plan, which clearly demonstrated that the home was financially viable for its stated purpose. The Crescent DS0000013412.V263764.R01.S.doc Version 5.0 Page 20 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 3 X 3 X X Standard No 22 23 Score X 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 X 3 X X Standard No 24 25 26 27 28 29 30
STAFFING Score 3 X 3 3 3 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X X X 2 X 3 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
The Crescent Score 3 X 2 2 Standard No 37 38 39 40 41 42 43 Score X X 3 X 3 X 3 DS0000013412.V263764.R01.S.doc Version 5.0 Page 21 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA20 Regulation 13(2) Requirement The manager must ensure that medication administration records are accurately completed at all times. Timescale for action 10/11/05 2. YA21 12(3) The manager must consult the 31/01/06 service users and/or their relatives about their last wishes and this needs to be documented in their personal files. The registered person must make suitable arrangements by training staff to prevent service user’s being harmed or suffering abuse or being placed at risk of harm and/or abuse. The Registered Person must ensure that all records required in Schedule 2 are available on all staff working in the home. (Previous timescale 31/08/05 not met) 31/01/06 3. YA23 13(6) 4. YA34 19 & Sche 2. 31/12/05 The Crescent DS0000013412.V263764.R01.S.doc Version 5.0 Page 22 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 YA1 Good Practice Recommendations It is recommended that a review date is included on the Statement of Purpose and the Service Users Guide. The Crescent DS0000013412.V263764.R01.S.doc Version 5.0 Page 23 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
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