CARE HOMES FOR OLDER PEOPLE
The Crescent 27-29 Meyrick Park Crescent Bournemouth Dorset BH3 7AG Lead Inspector
Debra Jones Unannounced 14 April 2005 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 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. The Crescent D55 S20455 THE CRESCENT V220427 140405 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION
Name of service The Crescent Address 27-29 Meyrick Park Crescent Bournemouth Dorset BH3 7AG 01202 553660 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) Rhetor 17 Ltd Care Home with Nursing 40 Category(ies) of OP - Old Age, not falling within any other registration, with number category (40) of places The Crescent D55 S20455 THE CRESCENT V220427 140405 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION
Conditions of registration: 1. No more than 24 service users in need of nursing care may be accommodated. 2. The home may accommodate three service users within the nursing places over 55 years and under 65 years. Date of last inspection 8th November 2004 Brief Description of the Service: The Crescent cares for 40 older people in two converted houses that have been joined together. Up to 24 of the 40 people can have nursing care. The home is situated in a residential area close to Meyrick Park and near the centre of Bournemouth. It overlooks the tree lined Meyrick Park Crescent and is close to the regular bus route into the town. Car parking space are available in the grounds at the front of the home or in the road immediately outside. There is a large attractive patio area with a fishpond and bench situated at the front and a grass area at the side of the home both easily accessible by service users and visitors. The home is on two floors with twenty-three bedrooms on the ground floor and ten on the first floor. 26 of the rooms are single rooms and 7 are doubles. 5 of the single rooms have an en suite toilet. There are five bathroom/ toilets, one bathroom without a toilet, one shower room/ toilet and one toilet. A passenger lift provides easy access to the first floor and there a variety of aids and adaptations around the building to allow residents to move about more independently. The Crescent D55 S20455 THE CRESCENT V220427 140405 Stage 4.doc Version 1.20 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over 5 hours and was one of the two anticipated inspections of the year. Recommendations and requirements made at the last inspection were followed up to see if the home had made any progress towards meeting them. The Inspector looked around some of the building and a number of records were inspected. The Matron, 7 of the thirty- eight (current number) residents, and three visitors were spoken to. What the service does well: What has improved since the last inspection?
Staff files now routinely have proof of identification on them, needed to protect residents from potentially unsuitable people working at the home. The programme of buying beds suitable for people to be nursed in has continued and three more are on order. This is to ensure that staff having to care for people in bed are not putting themselves or the resident at risk of injury. The Crescent D55 S20455 THE CRESCENT V220427 140405 Stage 4.doc Version 1.20 Page 6 The quality assurance system has been expanded to take in the views of people who visit the home such as GPs to get a more rounded picture of what people think of the home and what they do well and might do better. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Crescent D55 S20455 THE CRESCENT V220427 140405 Stage 4.doc Version 1.20 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection The Crescent D55 S20455 THE CRESCENT V220427 140405 Stage 4.doc Version 1.20 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,3,4,5. (6 is not applicable in this home) The home’s Statement of Purpose and Service User Guide provide residents and prospective residents with details of the services the home provides enabling an informed decision about admission to the home. The home has a good admissions procedure. Prospective residents and / or their representatives are welcome to visit the home to decide if the home suits them. The home makes an assessment, based on information collected, that informs their decision to offer a place. This ensures that only service users whose needs can be me by the home are offered places there. The home does not assure prospective residents in writing that their needs can be met. EVIDENCE: A Statement of Purpose and Service User Guide have been developed and distributed. The home gives prospective residents and / or their supporters all the information they need to make the decision to move into the home. One relative said that she was given ‘more than enough’ information.
The Crescent D55 S20455 THE CRESCENT V220427 140405 Stage 4.doc Version 1.20 Page 9 Residents talked of how they or their relatives / friends came to visit the home before they moved there and of how impressed they were with the home and the matron/ staff they met. Paperwork seen shows that the home gets all the information needed to decide if they can care for a prospective resident. The home does not confirm this in writing. The Crescent D55 S20455 THE CRESCENT V220427 140405 Stage 4.doc Version 1.20 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,10 There is a consistent and clear care planning system in place to make sure that staff have the information they need to meet residents needs. The health needs of residents are also well met with evidence of good support from community professionals – such as GPS, Opticians and Dentists. Residents confirmed that they felt they were treated with respect and their right to privacy upheld. EVIDENCE: Residents talked about the specific help that the staff gave them and this was reflected in their care plans. One newer resident talked about how she had been involved in developing her care plan. Residents talked of how kind and gentle staff were, how they were sensitive to privacy and dignity issues and of how they really listened to them and responded to any requests they made. Residents said they felt that the staff knew what they were supposed to do and did it well, always knocking on the door and waiting for an answer before coming into their rooms. The Crescent D55 S20455 THE CRESCENT V220427 140405 Stage 4.doc Version 1.20 Page 11 Residents said they had access to GPs, opticians and dentists and daily notes showed the involvement of community professionals in the care of the residents. The Crescent D55 S20455 THE CRESCENT V220427 140405 Stage 4.doc Version 1.20 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13,14 and 15 Residents lives are enriched by the social opportunities afforded by their visitors and are encouraged to exercise choice and control over their lives by staff at the home. The meals in this home are good offering both choice and variety and in catering for special dietary needs. EVIDENCE: A number of visitors were at the home and spoke of how welcome they were made to feel and how the service provided was flexible to respond to the changing routines of residents and more spontaneous activities such as trips out. All visitors spoken to visited the home very regularly – some daily. They were very pleased with the way they were treated and in the way the home accommodated their needs when visiting. The visitors book further confirmed the number of visitors to the home. Residents said that they were able to do what they wanted when they wanted such as getting up and going to bed, and felt able to ask for things outside of the norm e.g. whatever they fancied to eat, and that the home respected how they wanted to do things and how they wanted things done for them. People spoke very highly of the quality of the food, ingredients and of the skills of the chef. One resident talked of her very special diet for a health complaint and of how the chef never got it wrong for her. The meal being prepared on
The Crescent D55 S20455 THE CRESCENT V220427 140405 Stage 4.doc Version 1.20 Page 13 the day of inspection was a homemade toad in the hole with vegetables followed by bread and butter pudding. Those not wanting this meal had been made agreed alternatives. The Crescent D55 S20455 THE CRESCENT V220427 140405 Stage 4.doc Version 1.20 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 The home has a satisfactory complaints system and evidence showed that complaints are handled objectively and concerns raised are taken seriously. EVIDENCE: The home has a complaints procedure and keeps a record of any complaints made, the investigation of the complaint and the outcome to the complainant. The Commission for Social Care Inspection had recently received a complaint that they had asked the home to investigate. The complaint was in relation to a death at the home and the involvement of the GP. The complaint was not upheld and the Commission was happy with the way that the home had conducted their investigation and in the time it took them to do this and to feed back to the complainant. Residents spoken to said that they could not think of anything to complain about and that they would talk to the matron or staff about any worries that they had. The Crescent D55 S20455 THE CRESCENT V220427 140405 Stage 4.doc Version 1.20 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,23,24 and 26 Ongoing investment in the upkeep of the home maintains the comfortable and safe environment for the residents living there and anyone visiting. Bedrooms are well decorated, well furnished and personalised to suit the residents. Adequate facilities are available to meet the number and needs of the current residents. The home is kept clean and smells pleasant thereby making daily life for residents more pleasurable. EVIDENCE: The home is well maintained both inside and out. A new shed is being built and the older one will be removed. No major works have been carried out at the home since the last inspection and none are planned. The home was clean and smelt pleasant throughout. Residents’ bedrooms were well furnished and they are able to bring in personal possessions as they wish. Not all those receiving nursing care have adjustable beds. Some rooms have en suite facilities. There are a number of communal bathrooms and toilets, with appropriate aids and adaptations, available in the home for the number of residents living there.
The Crescent D55 S20455 THE CRESCENT V220427 140405 Stage 4.doc Version 1.20 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29 and 30 Sufficient staff are employed and deployed to ensure that the needs of residents can be met. Limited progress has been made in the standard of vetting and recruitment with appropriate checks not being carried out and potentially leaving residents at risk from unsuitable staff working at the home. Staff are well trained and able to do their jobs resulting in residents being well cared for. EVIDENCE: Staff rosters demonstrate that the home is continuing to meet the staffing notice of the last registration authority. Staff were described by residents as ‘polite, cheerful, kind’ and one resident said ‘they put themselves out to help you’. Staff files are kept for staff and much of the information required in law was on file. Not all staff files showed that CRBs or POVA 1st checks had been applied for. Two written references were not on all files. The home employs a number of foreign workers. It was clear from the files that the home was gathering the right sort of information about people’s rights to work in the country and any restrictions on that work. The home was advised to get hold of a recent publication issued by the Home Office to inform
The Crescent D55 S20455 THE CRESCENT V220427 140405 Stage 4.doc Version 1.20 Page 17 them of the documents they need to see and copy. A system was not in place to trigger staff being asked for updated visas when theirs ran out. Records are kept of the training that staff undertake. This showed that staff have access to a range of training opportunities and are interested in taking them up. The Crescent D55 S20455 THE CRESCENT V220427 140405 Stage 4.doc Version 1.20 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,36,37 and 38 The matron leads her staff by example to ensure that residents receive a consistently high quality of care. Residents are consulted about the way that the home is run and the home takes on board any suggestions that will improve the way the home is run. Staff are not formally supervised as often as they should be potentially affecting the running of the home and care of the residents. Records do not demonstrate that residents would be safe in the event of a fire breaking out. EVIDENCE: The home is run and managed by Helen Graham who is an experienced nurse and manager. Residents spoke highly of Ms Graham and her hands on approach to her job and the positive impact that they felt this had on the standard of care that the staff provided. The Crescent D55 S20455 THE CRESCENT V220427 140405 Stage 4.doc Version 1.20 Page 19 The home has recently carried out their annual quality assurance survey and had expanded it to include residents, their friends and relatives, and other people involved with the home. The results of the survey had been analysed, circulated to interested parties and acted upon where needed and good ideas put into practice. Staff are supervised on a daily basis but the formal supervisions are not yet at the desired regularity, with some staff not having had a formal supervision since autumn 2004. Fire records were in place and internal checks being carried out at satisfactory intervals. Residents confirmed that they heard the testing of the fire bells. An external company carries out quarterly checks and although there was evidence of these visits no certificates had been issued to the home. Fire training records for staff did not show that all staff, both day and night, had had fire training at the required intervals. Accident records were well completed and analysed with plans put in place where appropriate to minimise the risk of further accidents happening. Records are kept of the tests of the temperature of the hot water in basins. The Crescent D55 S20455 THE CRESCENT V220427 140405 Stage 4.doc Version 1.20 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 3
COMPLAINTS AND PROTECTION 3 3 3 x 3 2 x 3 STAFFING Standard No Score 27 3 28 x 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 3 3 3 x x 2 2 2 The Crescent D55 S20455 THE CRESCENT V220427 140405 Stage 4.doc Version 1.20 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 3 Regulation 14 Requirement The matron must confirm in writing to the service user that having regard to th assessment the care home is suitable for the purposes for meeting the service users needs in respect of his health and welfare. Adjustable beds should be provided for all residents needing nursing care. (previous timescale of 31.12.04 not met). Full Criminal Records Bureau disclosures or Pova Ist checks must be received by the home prior to any member of staff starting work there. Two written references must also be obtained. (previous timescale of 31.8.03, 30.6.04,30.9.04 and 28.2.05 not met.) All staff must receive regular fire training at the appropriate intervals. Timescale for action 1.9.05 2. 24 16 1.9.05 3. 29 19 31.5.05 4. 38 23 31.5.05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. The Crescent D55 S20455 THE CRESCENT V220427 140405 Stage 4.doc Version 1.20 Page 22 No. 1. 2. 3. Refer to Standard 29 36 38 Good Practice Recommendations It is recommended that a system be put in place to trigger the home to ask staff for proof of visa extensions. It is recommended that staff have formal supervision sessions 6 times a year. It is recommended that the home gets their external fire equipment maintenance contractor to issue them with quarterly certificates as evidence that the checks have been carried out and appropriate work resulting from these checks completed. The Crescent D55 S20455 THE CRESCENT V220427 140405 Stage 4.doc Version 1.20 Page 23 Commission for Social Care Inspection Unit 4, New Fields Business Park Stinsford Road Poole, Dorset BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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