Inspection on 11/12/06 for The Crest Residential Home

This inspection was carried out on 11th December 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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.

Other inspections for this house

The Crest Residential Home 17/01/06

The Crest Residential Home 22/06/05

The Crest Residential Home 10/02/05

The Crest Residential Home 14/10/04

The Crest Residential Home 05/02/04

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

CARE HOMES FOR OLDER PEOPLE The Crest Residential Home 32 Rutland Drive Harrogate North Yorkshire HG1 2NS Lead Inspector Anne Prankitt Key Unannounced Inspection 10.45a 11 and 18 December 2006 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 The Crest Residential Home DS0000027960.V324214.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. The Crest Residential Home DS0000027960.V324214.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Crest Residential Home Address 32 Rutland Drive Harrogate North Yorkshire HG1 2NS 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) 01423 563113 01423 505933 www.bupa.co.uk BUPA Care Homes (GL) Ltd *** Post Vacant *** Care Home 31 Category(ies) of Dementia - over 65 years of age (31) registration, with number of places The Crest Residential Home DS0000027960.V324214.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To provide personal care and accommodation to one named service user from the age of 60 years and over (DE), named on application dated 5th October 2006. Date of last inspection Brief Description of the Service: The Crest was previously a home providing nursing care. It was closed for refurbishment, and was reopened in October 2006. It now offers personal care only for a maximum of 31 service users who have dementia. It is situated in a quiet residential area close to Harrogate town centre. The property is a converted Edwardian house with accommodation on two floors that can be accessed by passenger lift. There are three sitting areas and a separate dining area. There are parking facilities at the front of the property, and attractive enclosed gardens to the side and the rear of the building. All of the bedrooms provide single accommodation. Thirteen have en suite facilities. The manager confirmed on 29 November 2006 that the current weekly charges range from £550 - £700. Additional charges are made for hairdressing, chiropody, nail care, magazines and newspapers, and toiletries. Information about the home is available within a brochure provided by BUPA Care Homes. There is a dedicated brochure about the home itself. There is also information on the internet. The Crest Residential Home DS0000027960.V324214.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Before the site visit, the manager sent a completed questionnaire to the Commission. It provided information about the home, including who lived and worked there. The inspector had also kept a record about what had been happening at the home since the last inspection. Surveys were sent to relatives and residents so that their views about the home could be sought. Six hours of planning took place before the visit. The site visit took one inspector approximately ten and a half hours to complete. This included two hours that were spent solely observing the care being given to a small group of service users. Time was also spent talking to staff, other service users and the manager. Some records were looked at, including some care plans, staff records and health and safety records. What the service does well: Because the home has not yet reached full occupancy, staff and residents have had a good opportunity to get to know each other. The manager visits all residents before they are admitted to make sure that the home can meet their needs. The atmosphere is very relaxed, and residents have access to any of the communal areas that they may wish to use. The standard of décor is good, and care has been taken to provide signs and memory aids to help residents find their way about more independently. The home was kept spotlessly clean for residents. Residents look well cared for. Staff speak to them with great respect, and any care is given in private. Residents’ needs are recorded in their care plans, so that staff understand what care is needed and how it is to be provided. Relatives commented: ‘I am very impressed by the quality of care and general surroundings’, ‘(my relative) is well cared for and supported’, ‘Staff are very helpful and look after my relative well’. The meals that residents received looked wholesome, and the dining area is very pleasant. Staff have training so that they can better understand the needs of people with dementia, and how they can best meet them. The Crest Residential Home DS0000027960.V324214.R01.S.doc Version 5.2 Page 6 Staff know that they must pass on any concerns about residents to the manager, who takes such matters seriously. Staff are properly vetted before they provide care. This means that residents are protected from unsuitable workers. The home is kept maintained, so that it remains a safe place to live. The manager is committed to running the home in the best interests of the service users. 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. The summary of this inspection report can be made available in other formats on request. The Crest Residential Home DS0000027960.V324214.R01.S.doc Version 5.2 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 The Crest Residential Home DS0000027960.V324214.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6. Quality in this outcome area is good. Prospective service users are assessed before they are admitted, to make sure that the home will be able to meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All fourteen service users have been admitted to the home within the last eight weeks. The manager collects detailed information about service users before they are admitted so that they can be sure that the home will be able to meet their needs. Following admission, the manager completes a short term care plan. This gives staff good information that they can refer to about care until the care plans and risk assessments are completed. One service user said ‘I don’t want to leave. I like it here’. The home does not provide intermediate care. The Crest Residential Home DS0000027960.V324214.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. Whilst their medication could be better managed, service users can be assured that they will be well cared for by staff who understand their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff have undertaken training in how to write care plans. This is reflected in the good quality information seen about service users’ needs. Care plans are drawn up initially from the assessment carried out before the service user is admitted. Those seen were well developed, especially considering the short amount of time that service users have lived at the home. They looked at holistic needs, and risks to individual service users were identified. A key worker system has been introduced so that staff are allocated to a small number of service users. This will help to make the care more individualised. The Crest Residential Home DS0000027960.V324214.R01.S.doc Version 5.2 Page 10 The manager agreed to ask the district nurse to review one service user whose risk assessments suggested that they may need extra input about their nutritional needs and pressure area care. They also agreed to ask the General Practitioner to review a service user who was sometimes unsettled, and who does not like to take their medication, to see if there was anything further that could be done to improve their wellbeing. This was requested on day one of the site visit, but had not been followed through properly by staff, and there had been no record made of the discussion that took place with the GP. During the inspection, a period of two hours was spent in one of the communal areas of the home, observing the daily life of service users. Staff were found to be very patient and respectful, and service users were treated as individuals. Staff interactions with service users were good, and service users responded well to this. Service users were supported in choosing what they wanted to do, and where they wanted to sit. Service users were individually dressed and looked well cared for. Staff treated them with respect. Personal care was given in private. One service user had been provided with a key to their bedroom. Staff explained that, because of the position of the room, other service users sometimes confused the room for the toilet. Providing them with a key helps to protect their privacy. Staff said that they enjoy caring for the service users. Comments from relatives included ‘I am very impressed by the quality of care and general surroundings’, ‘(my relative) is well cared for and supported’, ‘Staff are very helpful and look after my relative well’. Staff said that there has been one concern raised with the manager since the home reopened. It related to the care of one service user. The manager said that staff were consulted about how the care given needed to be changed for the benefit of the service user. They said that the outcome was to the satisfaction of the person who raised their concern. Staff who are responsible for medication have had training. The medication is provided in blister packs, so that the risk from error is minimised. There were some gaps seen in the recording of the medication that had been given. The senior carer spoken with was already aware of the matter. She had spoken to the staff member concerned, so that she could confirm that the medication had been given. The home keeps one controlled medication, which was locked away safely. A record of the medication was kept in the controlled drugs register. The last bottle of medication received into the building had not been signed in. Also, the amount that was left exceeded the amount that there should have been. It was agreed that the cause of this discrepancy must be investigated and resolved. The Crest Residential Home DS0000027960.V324214.R01.S.doc Version 5.2 Page 11 It was also advised that: • • The manager must carry out a regular audit of the medication. The blister packs be renewed each month, even where there are a number of tablets remaining that the service user has refused. This will make auditing of the system easier. Where service users are able to tell staff when they need their ‘when required’ (prn) medication, this should be recorded in the care plan. The medication records should then be signed when the medication is actually administered. Where the service user is not able to decide, and staff are making a decision on their behalf about whether or not they need their medication, then the home should record on each occasion why the medication has, or has not, been administered. • The Crest Residential Home DS0000027960.V324214.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. Service users can be assured that staff will take an interest in their social needs, and will welcome their visitors into the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There has been an activities person employed to work at the home between 11am – 3pm Monday to Friday. They are new in post, so their programme of activities is very flexible while they get to know service users. They carry out both group and one to one activities. Daily events include creative art, gentle exercise, music and board games. Nail care and aromatherapy is also available. There have been festive events organised, including a carol service. The activities organiser keeps a record of the activities that have taken place for each service user. The records discuss the emotional needs of service users, and reflect on how they have enjoyed the activity. The Crest Residential Home DS0000027960.V324214.R01.S.doc Version 5.2 Page 13 The activities organiser has just finished training in dementia awareness. They hope to use their knowledge so that they can provide more meaningful activities for service users. Once established in their post, they intend to develop links for service users with the local community. They are currently arranging for a pastor to visit. This will help to meet service users’ spiritual needs. Service users can walk around the communal areas as they wish. They are not made to feel that they must sit down. Staff spoke to service users in a most dignified way, and considered service users’ choices. Service users are able to bring in their own belongings if they wish, and their bedrooms are personalised. There is a choice of menu at each mealtime, and there is also a ‘night bite menu’, which is advertised in the main reception area and which is available from 6.30pm to 6.30am. Fresh home baking is provided. Care staff ask what service users would prefer from the menu. The dining room was beautifully set out. Each table was provided with napkins and table decorations. There were views over the garden and decking. Service users appeared to be enjoying their meal. They were given help sensitively where needed. The cook explained that, whilst there is a food warmer available, they like to serve food fresh onto service users’ plates. The cook explained that the staff give them sufficient information so that they know who needs a special diet, and whether there are any particular likes and dislikes. Fresh meat, vegetables and fruit are delivered regularly. Care staff prepare the teatime meal. They are provided with protective aprons whilst they are working in the kitchen. The Crest Residential Home DS0000027960.V324214.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. Service users are protected by staff that will report any concerns and complaints which will be dealt with, but which must be recorded. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure is posted in a public area of the home. It is clear, and it gives details about how to contact the Commission for Social Care Inspection. There has been one concern raised with the home. The manager said that this was dealt with informally at the request of the person who raised the concern. Whilst the manager said that the matter was taken seriously, and that the referrer was satisfied with the outcome for the service user, the matter should have been recorded within the complaints register. There was one complaint made to the Commission for Social Care Inspection prior to the home closure. This related to care staff that worked in the kitchen. It alleged that they were not taking adequate hygiene precautions. The matter was investigated by the home, with a satisfactory response received. The home has received three commendations since reopening. Whilst BUPA Healthcare have a regular training programme in place for Abuse Awareness, this has not yet been rolled out to all staff in the home. The manager explained that this would be provided soon. Staff spoken with knew The Crest Residential Home DS0000027960.V324214.R01.S.doc Version 5.2 Page 15 that they must report any concerns or allegations of abuse to the manager. Senior staff were clear that, in the absence of the manager, it would be their duty to report to the acting manager. The manager was clear about the role of the local authority in leading any investigation. All care staff knew that they must not keep secrets where they suspect abuse has taken place. There have been no allegations made. The Crest Residential Home DS0000027960.V324214.R01.S.doc Version 5.2 Page 16 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 and 26. Quality in this outcome area is good. Service users live in a clean, homely environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home now provides care for service users who need personal care, and who have dementia. The environment has been tastefully converted and decorated. All areas of the home were clean and tidy and a credit to the cleaning staff. There were no malodours. The grounds have been enclosed, so that service users are safe from the risk of traffic. This means that they will be able to enjoy the garden facilities in the warmer weather. The Crest Residential Home DS0000027960.V324214.R01.S.doc Version 5.2 Page 17 To assist service users, their doors are clearly marked with their name, and outside their room is a ‘memory box’, which contains a picture belonging to them. This helps to promote independence, by assisting service users to identify their room easily. Rooms have been provided with lockable facilities, so that service users may keep things that are of value to them safe. There are clear signs to identify toilets, which include Braille text, which will assist service users who have poor sight. There are three communal sitting areas that are all situated on the ground floor. One is used as a quiet room. Service users also choose to sit in the reception area. There is a separate dining area. There are two assisted bathrooms, and a large communal shower room. The senior carer said that this was very popular with service users, but some have their own en suite shower facilities. The maintenance man checks the hot water temperatures on a regular basis. Staff also check and record that the temperature of the bath or shower is safe before it is used by the service user. Information collected as part of the application to change the purpose of the home confirmed that the water has been chlorinated. This reduces the risk to service users from Legionella. The laundry facilities are provided on the first floor of the building. There is a bolted gate between the laundry room and the area which can be accessed by service users, so that they cannot access the equipment stored within. As an extra precaution, the manager has had a lock fitted to the laundry door. Facilities include two washing machines with a sluice facility. Staff are provided with protective clothing, and safety information about the chemicals that they handle, so that they know what to do in the case of spillages. Soiled and infected linen is delivered in special bags, so that staff know to take extra care when handling the contents. There is a sluice disinfector, and a macerator, which is used for the disposal of soiled, disposable items, such as bed pans. This reduces the risk of infection. The Crest Residential Home DS0000027960.V324214.R01.S.doc Version 5.2 Page 18 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 and 30. Quality in this outcome area is good. Service users are cared for by staff who are properly vetted, and who are subject to a training programme, to make sure that they are fit to provide care safely and sensitively. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff thought that, generally, they were supplied in sufficient numbers to meet the needs of service users. At the time of the first site visit, there were either two or three staff available each afternoon. One of these prepares the evening meal. During the afternoon, there was a period of time when there were no staff available in the communal areas. Based on this observation, and due to the increasing occupancy at the home, the responsible individual has agreed that three staff will now always be provided every afternoon and evening. This is good practice, and will ensure that service users can be observed. Staff are provided with the name of an on call senior staff member who is available to give them guidance at any time. It is the intention that staffing will be increased further as the occupancy demands. The manager has not yet compiled training files or a plan, so it was difficult to see what training staff had undertaken. The manager understands that these The Crest Residential Home DS0000027960.V324214.R01.S.doc Version 5.2 Page 19 records needs to be completed, so that any gaps in training can be quickly identified. Although the staff records are in the early stages of development, staff spoken with explained the wide range of training that they receive. They thought that gaps in statutory training were currently being addressed. They receive additional training including palliative care, care planning and dementia awareness. All new staff receive health and safety training. The manager is a specialist trainer in challenging behaviour and intends to train staff in this area of care. There is a rolling programme in place for care staff to train towards NVQ Level 2 and above in care. The two staff recruitment files seen confirmed that staff are properly vetted before they are allowed to provide care to service users. There were no new starters on duty, so their induction files, which they keep with them, could not be seen. However, the manager had a blank pack, which, upon completion, will provide a thorough and detailed induction. The Crest Residential Home DS0000027960.V324214.R01.S.doc Version 5.2 Page 20 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 and 38. Quality in this outcome area is good. The home is run by an enthusiastic manager who is supported by the organisation to run the home in the best interests of service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a new manager in post who is applying to become registered with the Commission for Social Care Inspection. She already holds the Registered Managers Award, and has completed a degree in social care. She has prior experience of managing a care home. The manager said that she is well supported by BUPA Care Homes. She receives regular training in order to update her skills. The Crest Residential Home DS0000027960.V324214.R01.S.doc Version 5.2 Page 21 Staff said that she provides them with good support. Comments from them included: ‘She is good to work for’. ‘(The manager) is nice’. ‘She’s good’. Staff are aware that it is her intention to introduce regular supervision in the near future. She is currently looking at the training needs of the staff group, and organising training where shortfalls are identified. She arranges staff meetings to improve communication. She has already highlighted one issue about communication and record keeping which will be looked at as part of the individual supervision process. BUPA Care Homes has a Quality Assurance programme, which will be implemented now that the home has reopened. It involves seeking the views of service users and relatives. The manager has already introduced a system for auditing the care plans. An audit of the kitchen service is also carried out, and the maintenance man carries out a number of in house checks of equipment at the home. It is important that the manager implements an audit of the medication systems as soon as possible. (Please refer to outcome group ‘Health and Personal Care’) The manager stated that the home does not handle any monies for service users. Food in the kitchen was labelled and appropriately stored. The cook does not have a kitchen assistant at present, so they are responsible for the cleaning tasks as well as the recording of these, and of temperature checks of food and storage temperatures. There were some gaps in the recording of the serving temperature of hot food. The cook explained that although the temperatures are always checked, they sometimes forget to record because they are so busy. The kitchen surfaces, which were quite cluttered, would benefit from being tidied. This will help the cook to make sure that all areas are kept easy to clean. All staff spoken with confirmed that they had received fire safety training, although the records seen did not confirm this. The training was not necessarily provided at The Crest, but at another BUPA home which staff were allocated to whilst The Crest was undergoing refurbishment. However, there have been some minor changes to the building. Whilst the records identified that all new staff have received fire induction training, the manager was advised to make sure that all staff who previously worked at The Crest, and have now returned, are also provided with a tour of the fire safety facilities at the home, so that they can be assured that they know where any changes to the fire equipment and exits have been made. The health and safety records were looked at as part of the recent application to vary the registration for the home. They were found to be in order. The weekly fire checks were looked at as part of this key inspection. The records evidenced that they systems are checked on a weekly basis. The Crest Residential Home DS0000027960.V324214.R01.S.doc Version 5.2 Page 22 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 2 9 1 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 2 4 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X N/A X X 2 The Crest Residential Home DS0000027960.V324214.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP8 Regulation 12,13 Requirement Appropriate advice must be sought in order to review the needs of the service user whose risk assessments suggested that they may need extra input about their nutritional needs and pressure area care. A request must be made to the General Practitioner to review the service user identified at the site visit, who was sometimes unsettled, and who does not like to take their medication, to see if there was anything further that could be done to improve their wellbeing. 2 OP9 13 A record must always be made of controlled medication received into the building. The reason why there is a discrepancy between the amount of controlled medication remaining, and the amount that is recorded, must be investigated. The registered person must make sure that the medication system is audited on a regular basis, to make sure that: The Crest Residential Home DS0000027960.V324214.R01.S.doc Version 5.2 Page 24 Timescale for action 31/12/06 31/12/06 • • • • medication records are kept up to date errors in the recording of controlled medication are investigated and rectified without delay blister packs are replaced each month service users who refuse their medication on a regular basis are quickly identified, and have the opportunity to be referred to the General Practitioner for advice. 3 OP16 22 A record must be kept of all 31/01/07 complaints/concerns made to the home, the action taken by staff in dealing with the complaint, and also the outcome. As part of her plan of development for the home, the manager must give priority to the completion of the staffing matrix to ensure that any staff that need an update in statutory fire, moving and handling, infection control, food hygiene and first aid training can be easily identified, and the training provided. The kitchen must be kept free from clutter so that it can be easily cleaned. Records of hot food serving temperatures must be kept up to date. 31/01/07 4 OP30 18 5 OP38 13 18/12/06 The Crest Residential Home DS0000027960.V324214.R01.S.doc Version 5.2 Page 25 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 OP9 Good Practice Recommendations Where service users are able to tell staff when they need their ‘when required’ (prn) medication, this should be recorded in the care plan. The medication records should then be signed when the medication is actually administered. Where the service user is not able to decide, and staff are making a decision on their behalf about whether or not they need their medication, then the home should record on each occasion why the medication has, or has not, been administered. 2 OP18 All staff should be provided with training in abuse awareness linked with the local authority guidance as soon as is practicable. All staff who have previously worked at The Crest, and who have now returned, should be provided with an update about the fire procedure at the home, pending the next formal training session. 3 OP38 The Crest Residential Home DS0000027960.V324214.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ 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 The Crest Residential Home DS0000027960.V324214.R01.S.doc Version 5.2 Page 27 - 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. 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