CARE HOMES FOR OLDER PEOPLE
Crescent (The) 27-29 Meyrick Park Crescent Bournemouth Dorset BH3 7AG Lead Inspector
Debra Jones Unannounced Inspection 3rd October 2005 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Crescent (The) DS0000020455.V255932.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 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. Crescent (The) DS0000020455.V255932.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Crescent (The) Address 27-29 Meyrick Park Crescent Bournemouth Dorset BH3 7AG 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) 01202 553660 Rhetor 17 Limited Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Crescent (The) DS0000020455.V255932.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. No more than 24 service users in need of nursing care may be accommodated. The home may accommodate three service users within the nursing places over 55 years and under 65 years. 14th April 2005 Date of last inspection 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 spaces 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 are a variety of aids and adaptations around the building to allow residents to move about more independently. Crescent (The) DS0000020455.V255932.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over 2 hours and was the second of the two anticipated inspections this year. The core standards that had not been inspected at the last inspection were looked at and the four requirements and three recommendations 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 at some records. The Owner / Manager – Helen Graham - assisted the Inspector. A number of the residents were spoken to during the tour of the premises about their experience of life at the home. Prior to the inspection the Commission sent out comment cards, asking people to tell them about the home. 10 were returned. 1 was from a care manager, one from a health social care professional, 6 were from residents at the home and 2 were from General Practitioners. All gave positive responses. One GP commented ‘senior nursing staff are always available, polite and informed of patients problems.’ What the service does well:
The Crescent provides a very homely atmosphere in which residents are well cared for. Medication is well managed and residents can have confidence that staff look after their medicines well and administer them properly. Stimulating social activities are available at the home, which residents can join in with as they wish. Residents say they are happy living there. Residents are protected from abuse through staff having an understanding of adult protection issues and access to clear policies and procedures. The home acts appropriately in not being involved in handling the money or finances of residents. (The Commission is aware of the one exception to this and her finances are considered to be handled properly with records kept.) The home is well on their way to achieving the Department of Health target of having 50 of care staff having National Vocational Qualification level 2 in care, or equivalent. Crescent (The) DS0000020455.V255932.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Crescent (The) DS0000020455.V255932.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Crescent (The) DS0000020455.V255932.R01.S.doc Version 5.0 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 the following standard(s): 3. Standards 1 and 5 were met at the last inspection. 6 does not apply. The home does not currently assure prospective residents in writing that their needs can be met. EVIDENCE: At the last inspection paperwork was seen that showed that the home gets all the information they need to decide if they can care for prospective residents. The home was not confirming this in writing and a requirement was made that this be done. At this inspection the draft letter to confirm that the home can meet needs was discussed and agreed and the home will be sending or handing this letter out as appropriate following assessments of prospective residents in future. Crescent (The) DS0000020455.V255932.R01.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9. Standards 7, 8 and 10 were met at the last inspection. The medication at this home is well managed promoting the good health and well being of residents. EVIDENCE: A robust system for the ordering, administering, recording and disposal of medication is in place at the home. Medication at The Crescent is only administered by the qualified staff who are confident in carrying out this task. Medication records sampled were up to date and properly completed. Where it is recommended that 2 staff sign to confirm balances of certain medicines this was seen to be happening. Medicines and dressings were tidily stored in appropriate places e.g. medication cupboards, trolleys and in the fridge. The maximum and minimum temperature of the fridge used to store medication is correctly monitored. A new system for the disposal of medicines that have not been used is in place. Disposal is now through a licensed waste disposal company and records are kept of the medicines handed over for disposal. Controlled drugs are being
Crescent (The) DS0000020455.V255932.R01.S.doc Version 5.0 Page 10 appropriately de-natured in the home before being handed to the waste disposal company. The medication policy has been updated in respect of the changes to the disposal of medicines. No residents are looking after their own medication. Crescent (The) DS0000020455.V255932.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12. Standards 13, 14 and 15 were met at the last inspection. Stimulating social activities are available in the home and residents are able to make choices as to whether they take part in them or spend their days in pursuit of individual interests. EVIDENCE: Regular activities take place in the home. Entertainers come to the home twice a month and the home organises outings. Later this week a trip to a local garden centre is planned, one resident said how much she was looking forward to it. Communion is held once a month in the home. Over the summer there was a barbeque in the garden for residents and their families and friends. On a less formal basis residents enjoy the time that staff spend with them, chatting and generally passing the time of day. Some residents get on well with each other and enjoy meals together, visit each other’s rooms and sit in the outside areas when the weather is good. Residents are able to keep in contact with families and friends by post and by phone. Some are able to go out unaided or with friends and families on trips. Residents have radios and Televisions as they wish. One resident spoken with enjoyed listening to her music tapes.
Crescent (The) DS0000020455.V255932.R01.S.doc Version 5.0 Page 12 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 the following standard(s): 18. Standard 16 was met at the last inspection. The home’s adult protection policy demonstrates the homes commitment to understanding abuse and of protecting residents. EVIDENCE: The home has a comprehensive Adult Protection procedure, including whistle blowing. No adult protection issues have been raised with the home, nor any staff be referred to the Protection of Vulnerable Adults list held by the Department of Health. Crescent (The) DS0000020455.V255932.R01.S.doc Version 5.0 Page 13 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 the following standard(s): 24. Standards 19,20,21,25 and 26 were met at the last inspection. Residents enjoy personalised, comfortable and safe bedrooms. EVIDENCE: Residents’ rooms are appropriately furnished and carpeted. Screens are in place in the double rooms. Since the last inspection more adjustable beds have been purchased. There are now 24 beds in the home, this number being equivalent to the number of nursing places that the home is registered for. Crescent (The) DS0000020455.V255932.R01.S.doc Version 5.0 Page 14 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28 and 29. Standards 27 and 30 were met at the last inspection. A significant proportion of staff have qualifications in nursing and care enabling them to do their jobs well and resulting in residents being well cared for. Significant progress has been made in the standard of vetting and recruitment with appropriate checks now being carried out protecting residents from potentially unsuitable staff working at the home. EVIDENCE: The home continues to promote the study of National Vocational Qualifications (NVQs) for care staff. Currently out of the 25 care staff employed at the home 7 members of staff have achieved NVQ level 2 in care and 3 more are studying for this award. In addition the home employs 6 members of staff who are nurse qualified in their country of origin. Staff files are kept for all staff. Files were sampled for the two newest recruits. All the information required in law was on file including Criminal Record Bureau disclosures and / Protection of Vulnerable Adult list checks. The home employs a number of foreign workers. It was clear at the last inspection from the files that the home is gathering the right sort of information about people’s rights to work in the country and any restrictions on that work. Since that time the home has introduced a simple but effective system to trigger requests to staff for updated visas when theirs run out.
Crescent (The) DS0000020455.V255932.R01.S.doc Version 5.0 Page 15 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35, 36 and 38. Standards 31,32,33 and 37 were met at the last inspection. Residents are assured that their financial interests are safeguarded by practices at the home. Residents will benefit from having a well-supervised staff group. Records now demonstrate that residents would be safe as safe as they could be in the event of a fire breaking out. EVIDENCE: The home does not handle any money belonging to residents with one exception– this is a long-standing and acceptable arrangement, and appropriate records are kept. Staff continue to be supervised on a daily basis. In addition a formal supervision system is now in place and it is anticipated that supervisions will
Crescent (The) DS0000020455.V255932.R01.S.doc Version 5.0 Page 16 take place at the desired regularity. To enable this to happen an extra member of care staff is on duty each afternoon (2pm-8pm) Monday to Friday. Fire records were in place and internal checks being carried out at satisfactory intervals. At the last inspection residents confirmed that they heard the testing of the fire bells. An external company carries out quarterly checks and they are now issuing certificates to the home to show that these checks have been carried out and that any faults identified as part of the checks have been rectified. Fire training records for staff were significantly improved showing that staff, both day and night, are having fire training at the required intervals. Crescent (The) DS0000020455.V255932.R01.S.doc Version 5.0 Page 17 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 x 8 x 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 3 x x x x x 3 x x STAFFING Standard No Score 27 x 28 3 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x x x x 3 x 3 Crescent (The) DS0000020455.V255932.R01.S.doc Version 5.0 Page 18 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14 Requirement The matron must confirm in writing to the service user that having regard to the assessment the care home is suitable for the purposes for meeting the service users needs in respect of his health and welfare. Timescale for action 01/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Crescent (The) DS0000020455.V255932.R01.S.doc Version 5.0 Page 19 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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