Inspection on 12/06/06 for The Crescent

This inspection was carried out on 12th June 2006.

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 no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Crescent 10/11/05

The Crescent 23/06/05

The Crescent 15/03/05

The Crescent 09/06/04

The Crescent 23/01/04

The Crescent 05/09/03

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Townley Road, 2-3

Chatsworth Care - Tudor Lodge

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

CARE HOME ADULTS 18-65 The Crescent 2 Grayham Crescent New Malden Surrey KT3 5HP Lead Inspector Diane Thackrah Key Unannounced Inspection 12th June 2006 11:00a The Crescent DS0000013412.V298903.R01.S.doc Version 5.2 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.V298903.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 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.V298903.R01.S.doc Version 5.2 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.V298903.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th November 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. A copy of the home’s Service User Guide and Statement of Purpose can be obtained on request from the Registered Provider’s, as can a copy of the most recent Commission for Social Care Inspection, inspection report. Fees for the home at the time of writing range between £450-520. There are no additional charges The Crescent DS0000013412.V298903.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place on 12th June 2006 between 11.00 and 15.00. Care records were examined and a partial tour of the premises took place. There are three service users currently residing in the home. All service users were spoken with. The Registered Manager, her husband and son, and one staff member were also spoken with. What the service does well: What has improved since the last inspection? Four Requirements were set at the last inspection of the home and these have all now been met. Medication Administration Records are now maintained in good order, additionally, staff members have updated their knowledge and skills by attending training in the safe handling of medication. Service user’s personal records have been updated. These now contain information about the service user’s wishes for after death and the staff members are clear about how service user’s wishes will be respected. All staff members have received The Crescent DS0000013412.V298903.R01.S.doc Version 5.2 Page 6 training in the protection of vulnerable adults and staffing files now contain all information required by Regulation. There have been a number of environmental improvements in the home since the last inspection, including a new shower room and conservatory. The Registered Manager and the Deputy Manager have successfully completed training at NVQ Level 4 in Management and one care staff member has successfully completed training at NVQ Level 2 in Care. 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.V298903.R01.S.doc Version 5.2 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.V298903.R01.S.doc Version 5.2 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 2. The Statement of Purpose and Service User Guide provide prospective service users with all information required by Regulation. This enables them to make an informed decision about were to live. There are good arrangements for ensuring that service users have their needs assessed prior to moving into the home. This ensures that staff members are clear about, and able to meet these needs. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: The home has a Service User Guide and Statement of Purpose that provides all required information. Service users and their representatives are provided with this information at the point of moving into the home. A recommendation made at the last inspection has not been addressed and this recommendation is repeated. The Registered Provider should include a review date on the Service User Plan and Service User Guide in order to ensure that service users are made aware of any changes in the service. There have been no new admissions since the last inspection of the home and therefore assessment information was not examined. It has been evidenced at previous inspections of the home that appropriate information about service user’s needs is obtained prior to placement. The Crescent DS0000013412.V298903.R01.S.doc Version 5.2 Page 9 The Crescent DS0000013412.V298903.R01.S.doc Version 5.2 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 the following standard(s): 6, 7 and 9. Service user’s assessed and changing needs and personal goals are reflected in an individual Service User Plan, staff members are therefore clear about how to support service users and meet their needs. Service users receive the assistance they need to enable them to make decisions about their own lives and take risks as part of an independent lifestyle. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: The Registered Manager said that each service user has a written Service User Plan, which has been generated from a Care Management assessment and covers all aspects of personal and social support and health care needs. Service User Plans for two service users were examined. Both contained detailed information about individual needs and how these needs would be met. There was information including how the service user managed to wash and undress, their dietary needs and mobility. Each Service User Plan included information about how staff members should manage challenging behaviour. The Crescent DS0000013412.V298903.R01.S.doc Version 5.2 Page 11 The home’s Registered Manager, the service user’s Care Manager and the service user had signed Service User Plans examined. There were records detailing that Service User Plans had been reviewed recently. All of the service users enjoy independence and are able to make decisions about how they spend their time. One service user left the home independently during this inspection. Another service user said that they enjoyed going out to the local church, and to the shops and that staff members accompanied them. There were records detailing that service users handle their own finances, with some support from the home. One service user is a member of a local advocacy group. Risk assessments were included in Service User Plans, which detailed strategies for managing risks, and there was information about the arrangements for having a key to the home. There are appropriate policies and procedures in place for responding to unexplained absences by service users. The Crescent DS0000013412.V298903.R01.S.doc Version 5.2 Page 12 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, 15, 16 and 17. Service users continue to be 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. Service users receive a healthy diet and enjoy mealtimes, ensuring that their wellbeing is promoted. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: One service user said that they have a part time job that they enjoy and that they attend a local day centre. Another service user said that they enjoyed going out to church, and local restaurants and pubs. Each service user has a daily schedule of activities including domestic tasks such as laundry, shopping and cleaning and leisure activities. One service user spoken with said that they were satisfied with the support that they received to engage in social and leisure activities. Care records for another service user detailed that they were The Crescent DS0000013412.V298903.R01.S.doc Version 5.2 Page 13 able to make decisions about how they spent their day. Bedrooms viewed had music equipment and a television and there is a comfortable lounge for relaxing in. Two service users were spending time chatting in the garden during part of this inspection, they both later went out to a local church. Another service user went out shopping. Service users are supported to go on holiday each year. Service users spoken with said that their friends and family members were welcome in the home. One service user said that some of their friends were coming to the home for a BBQ at the weekend. Of the three service users, two are a married couple. The home is very much as a family home. The Registered Manager’s husband and son were present during part of this inspection and service users were noted to enjoy positive relationships with the family. Daily routines are flexible and service users were observed to enjoy freedom of movement within the home. Service users have keys for the front door and for bedrooms and there are locks on both bathroom doors. The Crescent DS0000013412.V298903.R01.S.doc Version 5.2 Page 14 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, 19, 20 and 21. There are good arrangements for ensuring that service users receive personal and health care support in a way that they prefer, and that promotes their well-being. There have been improvements in the way that medication is handled and, in general, good procedures are followed. However, there remains a need for further improvement to ensure that the wellbeing of service users is fully protected. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: As identified at the last inspection of the home, service users are able to exercise some level of independence in their personal care needs with appropriate support from staff where needed. There is a good culture of semiindependent living, with service users having reasonable control over their lives, with support from staff members where needed. One service user said that there are flexible times for going to bed and getting up. They also said that they were able to choose their own clothes and hairstyle. The Crescent DS0000013412.V298903.R01.S.doc Version 5.2 Page 15 There were records detailing that service users are registered with a local General Practitioner and that there is support for service users to access health care services. One service user’s file examined contained a record of monthly weight monitoring. There was documentation detailing that the health needs of one service user had been reviewed during an annual review arranged by their Care Manager. Medication policies and procedures were examined at the last inspection of the home, and in general, found to be good. However, one Requirement was made regarding the need to ensure that Medication Administration Records be accurately completed at all times. Medication Administration Records for all service users were examined and all were found to be in good order. This Requirement has therefore been met. Medication seen during this inspection was stored securely and safely. Since the last inspection the home Registered Manager has consulted with the service user’s General Practitioner, and produced a ‘Home Remedies’ policy. This is seen as good practice. There were records detailing that there has been training in the safe handling of medication for all who work in the home. One staff member spoken with confirmed this. The Registered Manager generally keeps a record of medication that enters and leaves the home. This record was not up to date at the time of this inspection. A Requirement is made regarding this issue. A Requirement was made at the last inspection of the home regarding the need to consult with service users and/or their relatives about their last wishes and document this in their personal files. Examination of service users’ personal records highlighted that this has now occurred. Service users, their relatives and Care Managers have been involved in this process. The Crescent DS0000013412.V298903.R01.S.doc Version 5.2 Page 16 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): 22 and 23. National Minimum Standard 22 was assessed as being met at the last inspection of the home and as there have been no changes regarding this Standard, it remains that it is considered met. There have been improvements in the arrangements for responding to allegations of abuse, which serve to promote and protect the well being of service users. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: The Registered Manager said that there have been no complaints, or allegations of abuse since the last inspection of the home. The Registered Manager has all relevant policies and procedures for responding to allegations of abuse. Staff files examined contained certificates of attendance at recent protection of vulnerable adults training. One staff member confirmed that they had attended such training and was able to describe good practice for responding to allegations of abuse. A Requirement regarding this issue that was made at the last inspection of the home is now considered met. The Crescent DS0000013412.V298903.R01.S.doc Version 5.2 Page 17 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 and 30. 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. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: There have been a number of environmental improvements since the last inspection of the home. A new shower room has been fitted, there is new flooring throughout much of the home, there have been improvements to the design of the kitchen, and a new conservatory has been built. There is a pleasant communal lounge and a well-kept garden. There are tables and chairs in the garden and two service users ate at these during this inspection. All bedrooms were viewed, these were decorated and furnished to a good standard, were homely and had been personalised to reflect individual tastes and preferences. One service user said that they liked their bedroom and that they had been able to choose the colour that it was painted. Another service The Crescent DS0000013412.V298903.R01.S.doc Version 5.2 Page 18 user confirmed that they were happy with their room. This service user demonstrated that they had a good supply of clean bed linen. The home was clean and hygienic at the time of this inspection. One service user said that they found the home to be clean and tidy and said that they contributed to the cleaning. There are policies and procedures in place for infection control. A certificate was available detailing that the Registered Manager has recently completed training in infection control. There is a small laundry room that is away from the kitchen. The Crescent DS0000013412.V298903.R01.S.doc Version 5.2 Page 19 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): 32, 34, 35 and 36. Staff members have the necessary skills and complete training that allows service users to have their needs met. There have been improvements with the home’s recruitment policies and procedures, which serve to offer more protection to service users. National Minimum Standard 36 was assessed as being met at the last inspection of the home and as there have been no changes regarding this Standard, it remains that it is considered met. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: This is a family run home, were the Registered Manager’s husband and daughter both work. Service users are also familiar with the service user’s son. One staff member, who is not a family member, was working in the home on the day of this inspection. This staff member appeared competent and was able to describe how they provided care in a way that would uphold service user’s dignity and respect their wishes. This staff member also confirmed that they had recently completed NVQ Level 2 in Care training and would be going The Crescent DS0000013412.V298903.R01.S.doc Version 5.2 Page 20 on to study NVQ Level 3 in Care. The Registered Manager said that another staff member is currently undertaking NVQ Level 2 in Care. There is an induction and training programme that is in line with ‘Skills for Care’ specifications. All staff members have an individual training profile and development plan. There were records detailing that there has been ongoing training for all staff members since the last inspection of the home. Records detailed that both the Registered Manager and her husband have recently successfully completed NVQ Level 4 in Management training. A Requirement was made at the last inspection of the home regarding the` need to obtain identification documentation for all staff member. Examination of four staff files identified that this Requirement has now been met. The Registered Manager is aware of the need to obtain this information from any new staff member, prior to them commencing work in the home. All other required information and documentation was available in staff files, including Criminal Records Bureau and Protection of Vulnerable Adults checks. There were records indicating that staff members have continued to receive supervision regularly since the last inspection. The Crescent DS0000013412.V298903.R01.S.doc Version 5.2 Page 21 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): 37, 39 and 42 There is open and transparent management with clear lines of accountability, which is aimed at ensuring the well being of the service users. There are good arrangements for ensuring health and safety and these promote and protect the wellbeing of staff and service users. National Minimum Standard 39 was assessed as being met at the last inspection of the home and as there have been no changes regarding this Standard, it remains that it is considered met. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: The Registered Manager has run this home for over ten years. She previously lived in the home with her family, but moved out when the family required more space. As well as attending a number of training courses, the Registered The Crescent DS0000013412.V298903.R01.S.doc Version 5.2 Page 22 Manager has recently achieved NVQ Level 4 Management, as has her husband. The Registered Manager’s husband is the home’s Deputy Manager, and is a registered nurse in fulltime employment at a local hospital. Service users were noted to enjoy relaxed and positive relationships with the Registered, and Deputy Managers during this inspection. At the last inspection of the home it was noted that good systems were in place for monitoring the quality of the service, based on the views of those who use the service. There continues to be good systems for monitoring the quality of the service. Records available detailed that safety checks have occurred on the home’s emergency lighting and fire detection systems. The Registered Manager said that fire drills have occurred regularly. There were up to date Landlord’s gas safety, and electrical installation certificates. There were records detailing that all portable appliances in the home have been safety checked and that there have been legionella checks. Suitable insurance is in place. Records also indicate that there are good systems in place for ensuring that all staff members are trained in safe working practices including food hygiene, first aid and infection control. The Crescent DS0000013412.V298903.R01.S.doc Version 5.2 Page 23 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 Standard No Score 1 3 2 X 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 3 3 X 3 X X 3 X The Crescent DS0000013412.V298903.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP20 Regulation 13(2) Requirement The Registered Provider must ensure that there is an up to date record that details all medication leaving, and entering the home. Timescale for action 01/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations The Registered Provider should ensure that a review date is included on the Statement of Purpose and the Service Users Guide. 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