CARE HOME ADULTS 18-65
The Crescent Care Home 7 South Crescent Headland Hartlepool TS24 0QG Lead Inspector
John Trainor Unannounced Inspection 16th November 2006 12:00 The Crescent Care Home DS0000021731.V319970.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Crescent Care Home DS0000021731.V319970.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Crescent Care Home DS0000021731.V319970.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service The Crescent Care Home Address 7 South Crescent Headland Hartlepool TS24 0QG 01429 861350 P/F Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Theresa Evans Mrs Claire Morgans Mrs Theresa Evans Mrs Claire Morgans Care Home 9 Category(ies) of Learning disability (9) registration, with number of places The Crescent Care Home DS0000021731.V319970.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home may provide residential care to one named individual with learning disabilities aged over 65 years until such a time as this care is no longer needed. 22nd November 2005 Date of last inspection Brief Description of the Service: The Crescent Care Home is a nine bedded home for adults with learning disabilities and is jointly managed by Mrs Theresa Evans and Mrs Claire Morgans. It is located in a substantial old terraced house on the sea front at Hartlepool Headland, overlooking the town walls and pier and is indistinguishable from any other house. This is a heritage and preservation area with much character, but with modern amenities close by. The views from The Crescent, across the harbour and Tees Bay to the Cleveland Hills are exceptional. The Crescent is not a purpose built care home. Its facilities are located on 3 levels and some residents are accommodated in double bedrooms. The Crescent is careful to ensure that the premises are suitable for potential residents and that residents are happy with their living arrangements. Support is provided to the people who live there in such a way as to involve them as much as possible in their own care. A full meals service is provided and relatives and visitors are welcome at the home at any reasonable time. Service users take part in various activities during the day. Generally, The Crescent operates with 1 member of staff per shift, with double cover provided around shift change times, for parts of the weekend and for particular activities. The Crescent does use volunteers occasionally and has a network of dedicated informal supporters. Fees for the service were £467 at the time of inspection. The Crescent Care Home DS0000021731.V319970.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was conducted with information being provided to the Commission for Social Care Inspection by the providers prior to a site visit which was unannounced. The site visit took place over nine hours spread over two days. During this time records were inspected including health and safety records and care plans. People resident, staff and management were spoken to about their experience of the home as well as other professionals and relatives. The way staff deliver care in the home was observed. What the service does well: What has improved since the last inspection? What they could do better:
Two rooms had suffered some water damage from a leak. The problem had been put right but they were waiting for it to dry out thoroughly and so these rooms needed some redecoration. Contracts for service users needed to be revised in order to make the fees clear including who is responsible for paying them. The service users guide needed some revision to make it explicit that compromise was necessary in communal living and lack of waking night staff did impact on times people could come and go without special arrangement.
The Crescent Care Home DS0000021731.V319970.R01.S.doc Version 5.2 Page 6 The fire risk assessment needed revision in consultation with the fire officer to ensure all risks were well managed. Care plans would benefit from improvement to task specific detail so the plans tell staff the story about how people like to be cared for with their personal and health care needs. The frequency of formal supervision for staff needed to be increased to 6 times per year to ensure good quality of care was maintained. Quality in the home was measured though this information was not compiled into a report and made available to people on an annual basis. The home needed to do this. 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. The Crescent Care Home DS0000021731.V319970.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Crescent Care Home DS0000021731.V319970.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4 and 5. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. People had enough information to make an informed choice about moving into the home knowing that the home would meet their needs before making a decision to move in. EVIDENCE: All files inspected had assessments to ensure peoples needs could be planned for and met. People had contracts outlining terms and conditions of residence though these needed minor revision to detail fees and who was responsible for paying them. Relatives and service users said they had enough information before a decision was made to move in and made several visits to the home to help decide. People had a statement of purpose and service user guide describing the service in the home. This needed a minor revision to make it explicit that compromises were necessary in communal living with regard to times people could come and go in order to protect the rights of all people in the service. The Crescent Care Home DS0000021731.V319970.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. People had their health and social care needs met in a planned way based on risk management principles and with regard to choice and preference. EVIDENCE: All files inspected had care plans based on assessment of need though improvement of task specific detail to plans to tell the story of how people like their care to be delivered would be of benefit to service users and staff. Care files included risk assessment and risk management plans. Residents were consulted and able to make choices. They and their relatives fed back that they were happy with the service. Files showed evidence of input from both primary and secondary health care professionals to look after peoples health and social care.
The Crescent Care Home DS0000021731.V319970.R01.S.doc Version 5.2 Page 10 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. People lead a lifestyle which met their individual expectation and choice though some compromise was necessary due to a communal living environment. EVIDENCE: The home was run like a group home with a family atmosphere and efforts were clearly made to maximise people’s potential. Care plans included individual activities and preferences and were updated as needs changed. There were regular group meetings and people were encouraged to be involved in decisions. The Crescent Care Home DS0000021731.V319970.R01.S.doc Version 5.2 Page 11 People went to day centres, participated in supported employment went out with family and friends and had active social lives. People had televisions in their rooms and could spend time there should they wish. There was a communal lounge with television and equipment for watching films. Those people who shared rooms had a clear choice to share documented in their care files. People reported the food was good. Diet was varied and balanced, staff were aware of individual likes and dislikes. The Crescent Care Home DS0000021731.V319970.R01.S.doc Version 5.2 Page 12 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People had their health and personal care needs met in a planned way with regard to the dignity and privacy of the individual. EVIDENCE: People said their personal and health care needs were met with regard for their dignity and privacy. Staff were observed to prompt and offer assistance sensitively and in private, “ I’ll come to your room and help you with that.” Double rooms did not have screens however and only had one sink to share between the two occupants though service users had signed to acknowledge a choice to share. People and their relatives were happy with the care. There was evidence in care files of input from practice nurses, G.P., and secondary health professionals and social care staff.
The Crescent Care Home DS0000021731.V319970.R01.S.doc Version 5.2 Page 13 Medication was stored in a locked cupboard in the kitchen and there was a separate fridge should any medication need to be stored. There were no controlled drugs in use in the building but should, they be needed they would be stored separately in a locked cabinet in the locked office. Staff had received safe handling of medication training. Medication Administration Record Sheets were signed and an accurate record of administration. Drugs were recorded into and out of the building and returns were sent to the pharmacy. The Crescent Care Home DS0000021731.V319970.R01.S.doc Version 5.2 Page 14 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Procedures were in place to respond to complaints and protect people from the potential of abuse EVIDENCE: The home had a complaints procedure and relatives and service users said they knew who to complain to if they needed to. The home had policies and procedures to protect people from abuse. Staff had received training in this area and the home had a copy of the multi agency strategy outlining action to be taken in case of abuse. The Crescent Care Home DS0000021731.V319970.R01.S.doc Version 5.2 Page 15 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People lived in a clean and homely environment. EVIDENCE: Hall carpet now laid as had been required at a previous inspection. The environment was clean and tidy and decorated well. One room had some water damage due to a leak which also caused a damp patch to the ceiling of the room below. The leak had been fixed and they were awaiting the plaster to dry out thoroughly to redecorate. People’s rooms were personalised according to their taste. The Crescent Care Home DS0000021731.V319970.R01.S.doc Version 5.2 Page 16 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff were deployed in sufficient number and with sufficient skill to meet the needs of the people resident. EVIDENCE: Staff reported they felt able to manage with one on per shift as much of the care was prompting rather than delivery of personal care. Service users and relatives thought there were enough staff. The home also makes use of volunteers for social support and driving etc. The home managed to deliver good outcomes on current staffing. Staff received training to enable them to deliver good care to people in a safe way. The Crescent Care Home DS0000021731.V319970.R01.S.doc Version 5.2 Page 17 Staff were not receiving formal supervision six times per year as they should be in line with National Minimum Standards, though the staff did comment that the managers were available on a daily basis for guidance and support and they felt supported in their role. The Crescent Care Home DS0000021731.V319970.R01.S.doc Version 5.2 Page 18 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was well managed in the interests of service users. EVIDENCE: The manager had achieved the NVQ 4 in care management since the last inspection and was experienced in the management of the home. Health and safety tests were carried out and gas and electrical installations were safe. Service user monies were held and managed safely. The Crescent Care Home DS0000021731.V319970.R01.S.doc Version 5.2 Page 19 Quality audit questionnaires were completed with the people resident to get their views on the home. Residents meetings were held regularly to enable people to feedback on quality issues. The home did not compile their findings on quality audit into an annual report which they should do to make available for service users and other stakeholders. The Crescent Care Home DS0000021731.V319970.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 2 3 3 X 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 X 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 3 x 3 X 2 X X 3 X The Crescent Care Home DS0000021731.V319970.R01.S.doc Version 5.2 Page 21 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 The Crescent Care Home DS0000021731.V319970.R01.S.doc Version 5.2 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA1 Good Practice Recommendations The service user guide should be revised to make clear and explicit the compromise necessary around times for coming in at night when living in a communal environment. Restrictions on people should be agreed within a risk management framework and recorded. Contracts/statements of terms and conditions should clearly state fees and who has responsibility for paying them. Care plans would benefit from task specific detail to tell the story in a clear way how people would like their health, social and personal care needs to be delivered. Screens should be available in double rooms to allow for the delivery of personal care needs with regard for the privacy of the individual. Staff should be supervised 6 times per year in line with the National Minimum Standards. It is recommended that a formal system of quality assurance be implemented to measure the home meets its stated aims and this information is shared on an annual basis with residents, the Commission for Social Care Inspection and other stakeholders. The fire risk assessment should be updated with guidance from the fire safety officer. 2. 3. 4. 5. 6. YA5 YA6 YA18 YA36 YA39 7. YA42 The Crescent Care Home DS0000021731.V319970.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Darlington Area Office No. 1 Hopetown Studios Brinkburn Road Darlington DL3 6DS 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
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