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Inspection on 06/11/06 for The Crescent

Also see our care home review for The Crescent for more information

This inspection was carried out on 6th November 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

A good admissions procedure is in place that ensures that only people whose needs can be met are offered places at the home. Prospective residents and their representatives have the opportunity to visit the home to see if they like it before they move in. Assessments and care plans are of a good standard. They are kept up to date to make sure that staff know how to care for the residents living at the home. A range of community health professionals support the care staff in looking after the residents. There is a good system for medication administration at the home. Staff were observed throughout the inspection to be treating residents with courtesy, and kindness and residents confirm that their privacy and dignity are respected at all times. Residents are free to spend their days doing as they wish and can join in with any activities on offer as they wish. Visitors are always welcome at the home and residents are encouraged to maintain and develop relationships with people in the home and with their families and friends. Meals are varied and a choice is always available. The dining area is both pleasant and comfortable. The complaint and adult protection procedures reassure residents and their representatives that the well-being and comfort of residents is important to the home and that any concerns raised will be properly investigated and resolved. The home and grounds are very well maintained, comfortable and safe for the residents living there and anyone visiting. The home is kept clean and smells pleasant. Sufficient numbers of staff are on duty throughout the day and night to be able to meet the needs of the residents. Staff receive training in aspects of care work and other essential topics e.g. manual handling and first aid. The home is well managed and organised. The care and contentment of residents is clearly at the heart of the way the home is run. Systems are in place and records kept, that demonstrate the homes commitment to keeping residents safe.

What has improved since the last inspection?

After the home has carried out a pre admission assessment of a prospective resident they are now confirming in writing the outcome of that assessment e.g. that they can meet their needs.

What the care home could do better:

It would also be good if more care staff at the home had an NVQ level 2 qualification in care. This would make care staff more knowledgeable about the job they do and potentially improve the quality of care delivered to residents at the home. Whilst only one recommendation has been made as a result of this inspection visit a number of good practice suggestions were discussed. Mrs Graham was agreeable to introducing them all. This is a summary of them. It is suggested that where a discussion takes place with residents and / or their families about changing GPs e.g. to one based nearer to the home, that this be noted in the residents` care records. The home is encouraged to introduce a simple system to make their medication audits easier to carry out e.g. both writing on the packets the date they are brought into use and putting a `carry forward balance` on the MAR sheet. In respect of medication it is also suggested that the home routinely adds a section on medicines to each care plan. This would be an ideal place to record if any resident was self medicating, under what circumstances `when required` medicines are to be given etc. Residents at the home respond well to 1-1 quality time with staff outside of receiving personal or nursing care. To accommodate this Mrs Graham is agreeable to dedicating particular staff hours to do this. The home has an adult protection policy, which should be amended to be in line with the local Dorset guidance based on the Department of Health `No Secrets` and to reflect what the home actually did in practice when the recent allegation was made. The home is advised to obtain a copy of the new Department of Health guidance `Infection control guidance for care homes` June 2006 and up date their own policy appropriately. In addition Mrs Graham agreed to write clear guidelines for staff about how they were to empty and clean commodes and bedpans, empty catheters and dispose of urine, dispose of incontinence products. Once written, she will be bringing this guidance to the attention of staff at the next infection control training events.Rosters could be clearer about what jobs each member of staff is doing especially as some take on different roles on different days. The need to have full employment histories was discussed and Mrs Graham undertook to get more details from prospective staff in future. In respect of recruitment it was also suggested that the home develops a recruitment policy / procedure to underpin their practice and to act as a reminder of all the aspects of recruitment they have to abide by e.g. compliance with the Care Home Regulations, employment law, human rights, preventing illegal working etc. Occasionally the home has to use agency staff. Currently the home is not getting proofs from the agencies they use that all the appropriate employment checks have been carried on the staff that they supply to the home. Mrs Graham undertook to ensure that this was done in future. As well as finding out the views of residents and relatives annually the home should be seeking the views of other stakeholders e.g. visiting health professionals etc. it would be good practice for them then to produce an annual development plan, of which the results of their survey will form part. The inspector alerted Mrs Graham to the recent changes to the Care Home Regulations in respect of `quality of care.` Mrs Graham agreed to build the checking of bed rails into the regular maintenance checks that are already carried out at the home to help keep residents safe. In addition Mrs Graham was asked to check that the use of oxygen is covered in their fire risk assessment. The home also agreed not to decant products e.g. cleaning materials into generic dispensers and to keep any products that might be hazardous to the health of residents safely out of their way.

CARE HOMES FOR OLDER PEOPLE Crescent (The) 27-29 Meyrick Park Crescent Bournemouth Dorset BH3 7AG Lead Inspector Debra Jones Unannounced Inspection 6th & 8th November 2006 12:30 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.V319016.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 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.V319016.R01.S.doc Version 5.2 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.V319016.R01.S.doc Version 5.2 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. 3rd October 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. The current weekly charges for this home range between £431 and £635. Crescent (The) DS0000020455.V319016.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place on 6th and 8th November 2006 and was the anticipated key inspection of the year. During the inspection records were looked at and the inspector walked around some of the building. The inspector also chatted with residents in one of the lounges and in bedrooms. The 1 requirement made at the last inspection was followed up and had been addressed. At the time of the visit there were 37 people living in the home. Twenty-three people were receiving nursing care and the other fourteen residential care. Mrs Graham (registered owner and manager) and her staff helped the inspector in her work. Prior to the inspection the Commission asked the home to send out a number of comment cards to get people’s views of the home. Forty- six comment cards were returned. Fourteen were from residents, 18 were from relatives/ friends, 6 were from health and social care professionals, 2 were from care managers and 6 were from GP surgeries. Comment cards returned were generally positive about the staff and service provided at the Crescent and the majority said that they were satisfied with the overall care provided there. ‘This really is a first class home’. (a resident) ‘I am very happy, staff are very friendly and helpful’. (another resident) ‘I am very happy with the care I receive’. (another resident) ‘I am very happy here, satisfied with everything that the home has done’. (another resident) ‘If they want me out of the home they will have to drag me out by my hair!’ (another resident) ‘People have done their best for me’. (another resident) ‘My mother’s health has improved at the Crescent for which I am grateful’. (a relative) ‘Always find staff friendly – cheerful and very caring towards their residents. A thoroughly recommended nursing home’. (another relative) ‘I think this is a very friendly home and very helpful to the patients’. (another relative) ‘I find the staff mostly helpful and courteous’. (another relative) ‘My children and I are very happy with the care my wife receives and with the general atmosphere of the Crescent nursing home’. (another relative) Crescent (The) DS0000020455.V319016.R01.S.doc Version 5.2 Page 6 ‘A very good home. Friendly, caring and considerate at all times’. (another resident) ‘A well run nursing home – matron (Helen) professional, approachable and has empathy for client group – home appears to have low staff turnover’. (a care manager) ‘Very pleasant and attentive staff’ (a GP) What the service does well: A good admissions procedure is in place that ensures that only people whose needs can be met are offered places at the home. Prospective residents and their representatives have the opportunity to visit the home to see if they like it before they move in. Assessments and care plans are of a good standard. They are kept up to date to make sure that staff know how to care for the residents living at the home. A range of community health professionals support the care staff in looking after the residents. There is a good system for medication administration at the home. Staff were observed throughout the inspection to be treating residents with courtesy, and kindness and residents confirm that their privacy and dignity are respected at all times. Residents are free to spend their days doing as they wish and can join in with any activities on offer as they wish. Visitors are always welcome at the home and residents are encouraged to maintain and develop relationships with people in the home and with their families and friends. Meals are varied and a choice is always available. The dining area is both pleasant and comfortable. The complaint and adult protection procedures reassure residents and their representatives that the well-being and comfort of residents is important to the home and that any concerns raised will be properly investigated and resolved. The home and grounds are very well maintained, comfortable and safe for the residents living there and anyone visiting. The home is kept clean and smells pleasant. Sufficient numbers of staff are on duty throughout the day and night to be able to meet the needs of the residents. Staff receive training in aspects of care work and other essential topics e.g. manual handling and first aid. The home is well managed and organised. The care and contentment of residents is clearly at the heart of the way the home is run. Systems are in place and records kept, that demonstrate the homes commitment to keeping residents safe. Crescent (The) DS0000020455.V319016.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: It would also be good if more care staff at the home had an NVQ level 2 qualification in care. This would make care staff more knowledgeable about the job they do and potentially improve the quality of care delivered to residents at the home. Whilst only one recommendation has been made as a result of this inspection visit a number of good practice suggestions were discussed. Mrs Graham was agreeable to introducing them all. This is a summary of them. It is suggested that where a discussion takes place with residents and / or their families about changing GPs e.g. to one based nearer to the home, that this be noted in the residents’ care records. The home is encouraged to introduce a simple system to make their medication audits easier to carry out e.g. both writing on the packets the date they are brought into use and putting a ‘carry forward balance’ on the MAR sheet. In respect of medication it is also suggested that the home routinely adds a section on medicines to each care plan. This would be an ideal place to record if any resident was self medicating, under what circumstances ‘when required’ medicines are to be given etc. Residents at the home respond well to 1-1 quality time with staff outside of receiving personal or nursing care. To accommodate this Mrs Graham is agreeable to dedicating particular staff hours to do this. The home has an adult protection policy, which should be amended to be in line with the local Dorset guidance based on the Department of Health ‘No Secrets’ and to reflect what the home actually did in practice when the recent allegation was made. The home is advised to obtain a copy of the new Department of Health guidance ‘Infection control guidance for care homes’ June 2006 and up date their own policy appropriately. In addition Mrs Graham agreed to write clear guidelines for staff about how they were to empty and clean commodes and bedpans, empty catheters and dispose of urine, dispose of incontinence products. Once written, she will be bringing this guidance to the attention of staff at the next infection control training events. Crescent (The) DS0000020455.V319016.R01.S.doc Version 5.2 Page 8 Rosters could be clearer about what jobs each member of staff is doing especially as some take on different roles on different days. The need to have full employment histories was discussed and Mrs Graham undertook to get more details from prospective staff in future. In respect of recruitment it was also suggested that the home develops a recruitment policy / procedure to underpin their practice and to act as a reminder of all the aspects of recruitment they have to abide by e.g. compliance with the Care Home Regulations, employment law, human rights, preventing illegal working etc. Occasionally the home has to use agency staff. Currently the home is not getting proofs from the agencies they use that all the appropriate employment checks have been carried on the staff that they supply to the home. Mrs Graham undertook to ensure that this was done in future. As well as finding out the views of residents and relatives annually the home should be seeking the views of other stakeholders e.g. visiting health professionals etc. it would be good practice for them then to produce an annual development plan, of which the results of their survey will form part. The inspector alerted Mrs Graham to the recent changes to the Care Home Regulations in respect of ‘quality of care.’ Mrs Graham agreed to build the checking of bed rails into the regular maintenance checks that are already carried out at the home to help keep residents safe. In addition Mrs Graham was asked to check that the use of oxygen is covered in their fire risk assessment. The home also agreed not to decant products e.g. cleaning materials into generic dispensers and to keep any products that might be hazardous to the health of residents safely out of their way. 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 summary of this inspection report can be made available in other formats on request. Crescent (The) DS0000020455.V319016.R01.S.doc Version 5.2 Page 9 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.V319016.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3. 6 is not applicable to this home. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 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 process ensures that only service users whose needs can be met by the home are offered places there. EVIDENCE: The owner / manager carries out all pre admission assessments. Copies of these assessments are kept on residents’ files along with letters from the home confirming that their needs can be met. The inspector met with a resident who had moved to the home quite recently. He was being visited by one of his family. They talked to the inspector of how Crescent (The) DS0000020455.V319016.R01.S.doc Version 5.2 Page 11 another family member had known of the home and had visited on the residents’ behalf before he moved there. The resident was pleased that since living at the home he had moved, to what he considered, a more suitable room. When new residents move to the home a member of staff is allocated to spend time with them for the first few hours to help them settle in. Twelve of the 14 residents who returned comment cards said that had been issued with a contract. One could not remember. Nine said that they had enough information before they moved in to the home so they could decide if it was the right place for them. Three said that they didn’t with one of these saying ‘my son chose the home on my behalf’. Another said ‘I can’t remember I’ve been here for years!’ The inspector alerted Mrs Graham to the recent change to the care home regulations in respect of contracts for people receiving nursing care. Crescent (The) DS0000020455.V319016.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a clear, consistent care planning system in place, which provides staff with the information they need to meet the needs of residents. The health needs of residents are well met with evidence of good support from a range of community health professionals. The medication at this home is well managed promoting the good health and well being of residents. Residents are treated with respect and their privacy and dignity are promoted at all times. EVIDENCE: Files sampled contained thorough care plans, which were clearly laid out and specified the needs of the residents. These are developed in the first week that the resident moves into the home. Crescent (The) DS0000020455.V319016.R01.S.doc Version 5.2 Page 13 Care plans cover the same general areas for all residents but are tailored to the individual e.g. where there are specific conditions these are covered. Care plans are backed up by a variety of assessments. Each file contains a range of risk assessments as well as a manual handling assessment. Daily notes demonstrate how the care plans are delivered. Care plans and assessments are reviewed every month. A new resident talked of how the staff at the home had got to know about him and his needs and of how they were working together to get him back on his feet. Another talked of how well he got on with the staff ‘I love the joking, love the people, they are all great’. When asked ‘do you get the care and support you need?’ Eight of the 14 residents who returned comment cards prior to the visit replied ‘always’, with the other 6 saying ‘usually’. One commented ‘I get excellent care at all times’. When asked ‘do the staff listen and act on what you say’. All 14 residents said ‘yes’. One relative spoken to at the visit said ‘they look after mum so well. I am so pleased. The care is second to none’ She went on to praise the home for encouraging her mother to leave her room and socialise with other residents and be in the company of others. Fifteen of the 18 relatives/friends who responded by comment card said that they were informed of important matters in respect of their relatives, 3 said they were not and one did not answer. Thirteen said that where it was appropriate they were consulted about their care, with two saying they were not. Care managers who returned comment cards said that there were plans for the people that they placed at the home and this was being followed and reviewed within the home. One care manager commented ‘Overall high levels of care maintained and good support given to service users and their families. Records keeping could be more robust. Matron always very helpful and has excellent insight into the needs of residents’. Care records also showed the interventions of community professionals. Senior staff at the home said that the home was very well supported by local GP surgeries. As well as GP’s residents have access to community services such as nurses, chiropodists, dentists and opticians. Where residents are in need of aids to help them around the home, or in and out of bed, residents have been assessed and aids made available to them e.g. hoists, pressure cushions, bath seats, wheel chairs, slide sheets, zimmer frames etc. Crescent (The) DS0000020455.V319016.R01.S.doc Version 5.2 Page 14 When residents move to the home it is discussed with them if there is a need for them to change their GP. The need to do this might arise if they have moved from another area. It is suggested that where this need is identified and agreed with either the resident or their family that this be noted in the care records. All fourteen residents who returned comment cards said that they ‘always’ received the medical support they needed. The 6 GP surgeries and the health professionals that returned comment cards to the Commission said that the home communicated clearly and worked in partnership with them. They also said that the home took appropriate decisions when they could no longer manage the care needs of residents. GP’s, health professionals and care managers all said that staff demonstrated a clear understanding of the care needs of residents. Medication at the Crescent is only administered by the trained members of staff and a sheet with their signatures is kept at the front of the file as per good practice. Medication administration records (MARs) sampled were up to date and properly completed. Any allergies known are clearly recorded, and where there are none known this is noted. The quantities of medicines coming to the home were signed as received on the MARs. Where staff had made handwritten changes to the MARs the home were aware that they needed to get another member of staff to countersign these entries. This had not been done on the new sheets in use and was to be addressed. Most medicines at the home are delivered in monitored dosage packs and so it is easy to match medicines taken with the records and to know how much should be on the premises. Some medicines are in ordinary packets; some of these are prescribed to be taken ‘when required’. For these medicines it was not immediately clear how many tablets should be in the home. Introducing a simple system to make this audit possible was discussed e.g. both writing on the packets the date they are brought into use and putting a ‘carry forward balance’ on the MAR sheet. Medication was tidily stored in appropriate places e.g. medication cupboards, trolleys and in the fridge. The temperature of the fridge is appropriately monitored to ensure that the medicines in it are stored at the right temperature. The home has a contract with a waste disposal company to deal with medicines that are not used at the home. Proper records are kept of the medicines that are sent for disposal. It is suggested that the home routinely adds a section on medication to each care plan. This would be an ideal place to record if any resident was self medicating, under what circumstances ‘when required’ medicines are to be given etc. The GPs and health professionals who returned comment cards said that in their opinion medication was appropriately managed in the home. Crescent (The) DS0000020455.V319016.R01.S.doc Version 5.2 Page 15 Residents confirmed that they felt treated with respect and that their privacy was respected. All those who returned comment cards to the Commission confirmed that they were able to see residents in private when they visited. ‘The need has never arisen but I am sure they would arrange it’. (a relative) Crescent (The) DS0000020455.V319016.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ lives are enriched by the choices they are able to exercise in their daily lives, the social opportunities afforded by their visitors and the activities and entertainment available in the home. The meals in this home are very good offering both choice and variety and are served where it suits the resident. A pleasant dining area is available. EVIDENCE: When residents move to the home they are asked about their previous occupations and interests. This helps encourage conversation between residents and staff and enables staff to get to know the residents better. Some activities take place at the home. An entertainer visits monthly. There is a monthly communion service. A hairdresser visits twice a week. Whilst opportunities are available to join in with the organised activities at the home comments from residents showed that they do not feel obliged do so. Crescent (The) DS0000020455.V319016.R01.S.doc Version 5.2 Page 17 Photographs of a trip to a local garden centre over the summer where residents enjoyed a cream tea were on display in the hallway. A trip to the pantomime after Christmas is planned. Of the 14 residents who returned comment cards 6 said that it was ‘always’ the case that there are activities arranged by the home that they can take part in; 2 said that this was true ‘usually’ and 1 said ‘sometimes’. Three said that they were never able to take part in activities ‘because of the state of my health I am happy doing what I want’. ‘I have my own activities in my room to do’. ‘I am bedridden otherwise I would take part in the activities put on’. Two did not give an answer but commented ‘I need a new bum so I can go to the activities. Please supply!’ ‘I am not well so I can’t take part. I rarely leave my room due to my lack of mobility’. Recently Mrs Graham has increased staffing at the home by one member of care in the afternoons with a view to staff being able to spend more quality time with residents. This was discussed at the visit and Mrs Graham was agreeable to dedicating particular staff hours to this e.g. rostering members of staff to do this. Residents talked of their families and how often they visited. They said that their visitors were welcome to come at any time. One relative talked of how he and his family were regular visitors and always felt welcome. All but one of the relatives/ friends who returned comment cards to the Commission all said that they felt welcome in the home at any time. The visitors’ book confirmed the number and range of visitors to the home. Residents spoken to talked of the choices they were able to make in their lives, within the limitations of a group environment. They talked of how they chose where they spent their days, what they did, what possessions they had around them, who they saw and what they ate. One resident who spends all her days in her room talked of how pleased she had been in being involved in the redecoration of her room, of how she had chosen the curtain colour, the wallpaper, lampshade and bed cover. At the visit all residents spoken to spoke highly of the food ‘the food is lovely’. ‘Excellent!’ Residents are offered meal choices the day before but can change their mind on the day. If they go out, or have appointments at meal times a meal can be saved for them. The meal on the first day of inspection was minty lamb casserole or fried plaice. This was served with peas, cauliflower and boiled potatoes. Dessert was a choice of home made jam tart and custard or ice cream. Supper was to be home made fish pie or sandwiches. For dessert there was to be jelly and cream, ice cream, yoghurts and / or fresh fruit. Food is also Crescent (The) DS0000020455.V319016.R01.S.doc Version 5.2 Page 18 available later in the evening for anyone who wants it and those with diabetes are automatically given evening snacks. The chef confirmed that there is always food available. All residents have hot milky drinks and biscuits before bed. Appropriate food records are kept of what residents have eaten. Residents either have their meals in their rooms or in the dining areas / lounges. Residents on the day of the visit praised the food at the home. One resident with a special diet said of the chef ‘she never lets me down. I really appreciate it, she is very good I cannot fault her’. Fourteen comment cards were received by the Commission from residents. Ten of the 14 said that they ‘always’ liked the meals at the home, 3 said that they liked them ‘usually’ and one ‘sometimes’. One person commented ‘I am only here for the food!’ Crescent (The) DS0000020455.V319016.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A system is in place to deal with complaints that are made by residents and their representatives. The home’s adult protection policy, pre employment checks and ongoing staff training demonstrate the homes commitment to understanding abuse and of protecting residents. EVIDENCE: The Crescent has a formal complaints procedure in place. One complaint had been received by the home in the last 12 months. This had been looked into by both the home and the local Social Services department on behalf of the complainant. It had not been substantiated. Some concerns had been received by the Commission. These were taken up during the course of the inspection. The home has a complaints policy / procedure that is included in the information given to residents and a copy is on display in the entrance hall. Residents spoken to said that they were confident that if they had any concerns they would raise them with the manager or staff and that they would be listened to. ‘If anything wrong I just call for matron, it is quickly remedied’. ‘I have no problems, everything’s fine’. Crescent (The) DS0000020455.V319016.R01.S.doc Version 5.2 Page 20 The comment cards sent to residents asked the question ‘Do you know who to speak to when you are not happy?’ Fourteen residents sent back cards. Eleven answered ‘always’ to this question, 1 ‘usually,’ and 1 ‘sometimes’. The person who did not answer said: ‘I have never had a problem, never been unhappy, however I would speak to matron if had a complaint’. In respect of knowing how to make a complaint thirteen said yes ‘always’, and one said ‘sometimes’. Ten of the 18 relatives / friends who returned comment cards said that they were aware of the complaints procedure. Seven said they were not, one did not answer. One person said ‘have never needed it, would speak to the nurse in charge, if necessary, the owner’. Fifteen people said they had not had to make a complaint, 1 said they had and one did not answer. One health and social care professional said ‘I found the crescent to be a very good home and I have found good professional working with the staff. Any issues that have arisen have always been addressed quickly. Any complaints have always been found to be groundless’. Following allegations earlier in the year the home were involved in an adult protection investigation. Allegations were not substantiated. The home worked closely with the appropriate agencies to establish what happened. A care manager commented on how they had had ‘recent involvement following protection of vulnerable adult alert. The home were proactive in being open in response to the concerns raised’. The home has an adult protection policy, which needs to be amended to be in line with the local Dorset guidance based on the Department of Health ‘No Secrets’ and to reflect what the home actually did in practice when the recent allegation was made. There was evidence to show that staff are trained in adult protection. As part of the recruitment procedure new staff are checked against the protection of vulnerable adults list, held by the Department of Health. Crescent (The) DS0000020455.V319016.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of the environment is good providing residents with an attractive, comfortable and homely place to live. Bedrooms are decorated, furnished and personalised to suit the residents. Adequate facilities are available to meet the number and needs of the people living there. The home is kept clean and smells fresh thereby making daily life for all in the home more pleasurable. EVIDENCE: The home has a warm and homely atmosphere. It is well decorated throughout. Lounges and dining areas are comfortably furnished. Crescent (The) DS0000020455.V319016.R01.S.doc Version 5.2 Page 22 There have been no changes to the premises since the last inspection. Ongoing maintenance keeps the home up to it’s good standard, currently there are plans to re-point the brickwork and re-lay the patio. There are a number of communal bathing areas in the home. Some rooms have en suite facilities. Aids and adaptations are available throughout the home e.g. grab rails, raised toilet seats and some residents with particular needs have their own personal equipment to assist with their independence. Adjustable beds are in place for those who need them. Residents are able to personalise their rooms with furniture and general belongings as they wish and in agreement with the home. The upper level of the home is accessible by lift. There are emergency alarm bells throughout the home. The home is registered as having 7 bedrooms large enough to share which can be used at any time. The home was clean and there were no unpleasant odours. The laundry was clean and tidy. It is equipped with suitable washing machines. All laundry is done at the home. Residents said they were happy with the cleaning and laundry services at the home. All of the 14 residents that returned comment cards said that the home is ‘always’ fresh and clean. The home is advised to obtain a copy of the new Department of Health guidance ‘Infection control guidance for care homes’ June 2006 and up date their policy appropriately. In addition Mrs Graham agreed to write clear guidelines for staff about how they were to empty and clean commodes and bedpans, empty catheters and dispose of urine, dispose of incontinence products. Once written she will be bringing theme to the attention of staff at the next infection control training events (the first scheduled to be the week after the visit.) Crescent (The) DS0000020455.V319016.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Sufficient, well-trained nursing and care staff are employed and deployed to ensure that the needs of residents can be met. Recruitment procedures are in place to protect residents from the risk of unsuitable staff working at the home. The home does not meet the recommended standard for at least 50 of care staff to hold a National Vocational Qualification in care at level 2. EVIDENCE: Duty rosters are kept that showing who is on duty and when. Rosters could be clearer about what jobs each member of staff is doing especially as some take on different roles on different days. On the first day of the inspection visit 2 nurses were on duty in the morning (8am – 2pm) along with 5 care assistants. In the afternoon (2pm – 8pm) there was one nurse on duty with 6 care assistants. At night there was to be one nurse and 3 care assistants. Care staff are supported by cooks, kitchen assistants, laundry staff and cleaners. Care staff carry out some laundry duties. Crescent (The) DS0000020455.V319016.R01.S.doc Version 5.2 Page 24 Residents were asked are the staff available when you need them? Eight residents who responded said ‘always’ with 6 saying this was the case ‘usually.’ One commented ‘there is sometimes a lack of staff at changeover’. Thirteen of the 18 relatives / friends who returned comment cards to the Commission said that in their opinion there were always sufficient numbers of staff on duty, three thought there were not. The GP’s, health care professionals and care managers all said that there was always a senior member of staff for them to confer with when they needed to. Seven of the twenty one members of care staff at the Crescent have achieved a National Vocational Qualification at level 2 in care. (The target set by the Department of Health is for 50 of care staff to have this qualification.) Nine have nursing qualifications from other countries. Some staff are studying for NVQ level 3 and 2 others are studying for nursing qualifications. One member of staff is taking a lecturers course and takes the lead in a number of in house training courses e.g. control of infection, abuse awareness, dementia. A system is in place to monitor ongoing staff training and to identify when refreshers are needed. All staff have training every year in manual handling, infection control and emergency aid. Recent training has included wound care and dementia, and training in diabetes is planned. Records are kept of staff induction. The home is set to begin using the newly developed (October 2006) staff induction / foundation programme by Skills for Care (the industry standard) with any new staff employed at the home. Two staff files of newly employed care staff were sampled to see how the home manages recruitment. Prospective staff complete application forms, are interviewed and if successful, when they start working, they are issued with a contract. All information that should be on file was. Pre employment checks had been carried out including checking the Protection of Vulnerable Adults list (held by the Department of Health). There was evidence that all qualified staff are registered with the National Midwifery Council. The need to have full employment histories was discussed and Mrs Graham undertook to get more details from prospective staff in future. It is suggested that the home develops a recruitment policy / procedure to underpin their practice and to act as a reminder of all the aspects of recruitment they have to abide by e.g. compliance with the Care Home Regulations, employment law, equal opportunities, preventing illegal working etc. Crescent (The) DS0000020455.V319016.R01.S.doc Version 5.2 Page 25 Occasionally the home has to use agency staff. Currently the home is not getting proofs from the agencies they use that all the appropriate employment checks have been carried on the staff that they supply to the home. Mrs Graham undertook to ensure that this was done in future. Crescent (The) DS0000020455.V319016.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 7 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well organised and the daily management and running of the home centres round the care and contentment of residents. Good management practice, systems in place, and records kept, confirm the health and safety of all in the home. EVIDENCE: Helen Graham is the owner / manager of the Crescent. She has a nursing background and remains ‘live’ on the National Midwifery Council register. Mrs Graham also has the foundation degree in care management. Crescent (The) DS0000020455.V319016.R01.S.doc Version 5.2 Page 27 Members of staff said that the Crescent was a good place to work and that they had what they needed to do their jobs well. The home sent out and made available comment cards for the Commission as requested prior to this inspection. Those that came back were generally very positive about home. Residents and relatives were last asked for their views on the home by the home in 2005 by questionnaire. A report based on the analysis of the results of the survey was compiled and a copy is available in the entrance hall. The home are due to carry out their 2006 in the next few weeks. As well as finding out the views of residents and relatives the home should be seeking the views of other stakeholders e.g. visiting health professionals etc. it would be good practice for them then to produce an annual development plan, of which the results of their survey will form part. The inspector alerted Mrs Graham to the recent changes to the Care Home Regulations in respect of ‘quality of care’. The home holds some small amounts of money belonging to residents. This is kept safely locked away and appropriate records are kept of expenditure and balances. All records kept in the home were made available to the inspector as requested and are appropriately stored. Records required by regulation in respect of each resident are being kept. The registration certificate was clearly displayed as was the home’s insurance certificate. Prior to the inspection the home submitted a ‘pre inspection questionnaire’ to the Commission. This showed that the home was up to date with their maintenance and fire safety equipment checks ensuring safety in the home. Internal checks of fire safety equipment are being carried out and records demonstrated these were being done regularly weekly and monthly as appropriate. Records also show that staff have regular fire training and fire drills are carried out. Dorset Fire and Rescue last visited the home in December 2005 at which time the existing fire precautions were being satisfactorily maintained. They are due to visit again in December 2007. The home has completed a fire risk assessment that was last reviewed in September 2006. The home is asked to check that the use of oxygen is covered in this assessment. Accident records were looked at. Records are well completed in that they are clear about how staff writing up accident reports knew about accidents e.g. if they came across someone who had fallen or if a resident told them of the accident. Mrs Graham carries out an accident analysis every 3 months. Based Crescent (The) DS0000020455.V319016.R01.S.doc Version 5.2 Page 28 on these measures are then put in place to minimise the risk of future accidents e.g. putting ‘bumpers’ over bed rails, encouraging another to wear her hip protectors. The inspector gave Mrs Graham a copy of a Medicines and Healthcare products Regulatory Agency (MHRA) notice about the use of bed rails. Mrs Graham agreed to build the checking of bed rails into the regular maintenance checks that are already carried out at the home to help keep residents safe. When the inspector was walking round the home a cleaning product was found in a communal bathroom that had been decanted into a container that had the product name written on it, this meant that important information about the product was not with the product. Not decanting products for safety reasons was discussed and the flash was immediately put somewhere safely out of reach residents. Crescent (The) DS0000020455.V319016.R01.S.doc Version 5.2 Page 29 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 3 3 Crescent (The) DS0000020455.V319016.R01.S.doc Version 5.2 Page 30 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. Standard Regulation Requirement Timescale for action 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 OP28 Good Practice Recommendations 50 of care staff should have a qualification at NVQ level 2 or equivalent. Crescent (The) DS0000020455.V319016.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 Crescent (The) DS0000020455.V319016.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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