Inspection on 17/01/06 for The Crest Residential Home

This inspection was carried out on 17th January 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 11/12/06

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 Crest The Nursing Home 32 Rutland Drive Harrogate North Yorkshire HG1 2NS Lead Inspector Anne Prankitt Unannounced Inspection 17th January 2006 09:30 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 Crest The Nursing Home DS0000027960.V277078.R01.S.doc Version 5.1 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. Crest The Nursing Home DS0000027960.V277078.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Crest The Nursing 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 790925 www.bupa.co.uk BUPA Care Homes (GL) Ltd Mrs Jennifer Jane Firth Care Home 38 Category(ies) of Old age, not falling within any other category registration, with number (38) of places Crest The Nursing Home DS0000027960.V277078.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Age range 60 years upwards Date of last inspection 22nd June 2005 Brief Description of the Service: The Crest is a care home offering nursing care for up to 36 service users. It is situated in a residential area close to Harrogate town centre. The property is a converted Edwardian house with accommodation on two floors. Crest The Nursing Home DS0000027960.V277078.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced, and lasted for approximately six hours. Three hours preparation took place prior to this. The acting manager was available throughout the inspection. She was provided with feedback at the close. During the course of the inspection, some service users, staff and visitor were spoken with. Some care plans were looked at, care practices were observed where applicable, and health and safety records were seen. A tour of the communal areas of the building was made, and a sample of private bedrooms were inspected. What the service does well: What has improved since the last inspection? What they could do better: To provide some extra information in the care plan about social and psychological needs. Crest The Nursing Home DS0000027960.V277078.R01.S.doc Version 5.1 Page 6 To ensure that staff who are given responsibility for the day to day running of the home are given additional training so that they are confident about what needs to be done should they have to deal with an allegation of abuse. To ensure that hot water temperatures are kept at acceptable limits, to ensure that freezer temperatures are recorded, and to implement the plans to provide an assisted shower facility so that residents are afforded extra choice. A letter was left at the home to instruct that some risk assessments needed to be looked at prior to the home being sent a copy of the report. 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. Crest The Nursing Home DS0000027960.V277078.R01.S.doc Version 5.1 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 Crest The Nursing Home DS0000027960.V277078.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 EVIDENCE: Standard 6 is not applicable. The Crest does not provide intermediate care. Crest The Nursing Home DS0000027960.V277078.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 and 8 Access to health care services for service users is enabled by staff, but decisions about the use of equipment which could be seen as restraint should be made within a multi disciplinary framework. EVIDENCE: There was some good information included within the care plans to assist staff in understanding and meeting the needs of service users. There was evidence that input from outside professionals, such as the dietician and tissue viability nurse, is sought where required. Care staff are invited to write within the care plans about the social activities that have taken place. Discussion took place with the acting manager about areas in which the plans could be further improved upon and included: • • The information available where service users have a history of depression and dementia should be expanded upon, so that staff understand how needs can be best met. The information available about the social needs of individual service users could be further explored and improved upon. DS0000027960.V277078.R01.S.doc Version 5.1 Page 10 Crest The Nursing Home • Risk assessments for the safe use of bed rails and overlay mattresses need to match with the company policy for their safe use. The use of wheelchair lap straps, which can be seen as a restraint, should be used only after multi disciplinary consultation. The majority of service users thought that the staff provided good care. One visitor stated that the carer staff were excellent. A service user stated that ‘everyone is caring’, whilst another stated that the ‘staff are nice’. Following discussion with one relative, aspects of the care plan of a service user were discussed, including how areas of need identified within the care plan are addressed in practice. The acting manager agreed to look into this. Crest The Nursing Home DS0000027960.V277078.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14 and 15 Service users benefit from a choice of menu. EVIDENCE: Service users can choose to receive visitors in their own rooms, where they may also take their meals should they wish to do so. There are no service users who handle their own affairs, but individual facilities are available should they wish to keep small amounts of money on the premises. The administrator demonstrated how advocacy services had been used in order to act in the financial interests of one service user. There are a choice of two communal lounges where service users may choose to sit. The areas were quiet and relaxed on the day of the inspection. A comment was made that sometimes the noise from the music and television in each of these areas resulted in there being no available quiet area. This was raised with the acting manager, who took on board the comment made, but stated that often the service users control the television and music in each of the rooms concerned. Bedrooms seen contained personal possessions. Service users have a choice of menu. Three meals are served each day. The main meal is served at lunch time. The chef prepares specialist diets, including liquidised meals in separate portions for a number of service users who are unable to manage solid meals. Drinks and snacks are also available, and it was confirmed that night staff have access to food in the kitchen which they can prepare for service users during Crest The Nursing Home DS0000027960.V277078.R01.S.doc Version 5.1 Page 12 the night should this be their wish. Fresh meat and vegetables are available, and the chef prepares home baking. The majority of service users were happy with the food available at the home. Comments included ‘the food is good’, the food is OK’. One minority comment made was that the food was ‘cold and tasteless’. Crest The Nursing Home DS0000027960.V277078.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Staff need additional information about how to report and refer allegations in order that service users are adequately protected from unnecessary risk. EVIDENCE: There has been one complaint made direct to the Commission for Social Care Inspection during the period since the last inspection, which was about smoking arrangements outside the premises for staff. This was referred to the home for attention. The matter was investigated appropriately, the complaint upheld, and appropriate action taken. Two complaints have been made direct to the manager. One was dealt with entirely appropriately, and the matter resolved. The second should have been referred to the local authority for consideration for investigation under the vulnerable adults procedure, and the commission should have been informed about the matter, which was instead dealt with in house. The manager stated that she had been on annual leave at the time that the alleged incident occurred, and that she herself would have referred the allegation to social services. Staff who have responsibilities for the day to day running of the home should be provided with sufficient information so that they are clear about how such matters should be dealt with, to avoid any delay in dealing with these. Crest The Nursing Home DS0000027960.V277078.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 21 The provision of additional assisted bathing facilities would be to the benefit of the service users in the choice that they are afforded. EVIDENCE: There remains a shortfall in the number of assisted baths available for service users. The company is looking at ways in which this shortfall can be addressed in part by the provision of an assisted shower room. It is recommended that these good practice plans are progressed. Crest The Nursing Home DS0000027960.V277078.R01.S.doc Version 5.1 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Staff receive training to help them understand the needs of the service users who they care for. EVIDENCE: There were twenty two service users resident at the home on the day of the inspection. The previously agreed staffing numbers had been decreased by the home to take this into account, but without formal approval having been sought from the commission. There were two trained nurses and three care staff available in the morning, with two trained nurses and two care staff in the afternoon and one trained nurse and two care staff at night. Separate ancillary staff were available in addition to this. The caretaker manager thought that this was sufficient. Service users and staff spoken with agreed with this, although one comment made was that trained nurses were sometimes ‘brusque’. This was discussed anonymously with the manager. On the day of the inspection, staff did not appear unduly rushed. The manager stated that, should the occupancy rise to over twenty five service users, extra staff cover would be considered in order that the needs of service users can be successfully met. The staff recruitment files seen demonstrated that the appropriate documentation is obtained prior to the deployment of staff at the home. It was not clear whether one matter, which was subsequently discussed with the operations manager, had been fully explored at the time of employment. He has provided feedback that the matter was looked into prior to deployment. Crest The Nursing Home DS0000027960.V277078.R01.S.doc Version 5.1 Page 16 Staff undertake a range of training to assist them in the care that they provide. New staff undergo a period of induction training, and a programme of NVQ training is available. In total, seven staff have either completed, or are undertaking, the training programme to NVQ Level 2 in care. In addition, staff undertake training which includes fire safety, health and safety, moving and handling and abuse training. Trained staff have the opportunity to maintain their professional qualification, and attend training such as wound management, continence care and palliative care. The acting manager attempts to cascade relevant training to care staff. Remarks from staff included that they are supported by the home when receiving training. One staff member stated that the acting manager is ‘supportive’ and that she provides them with appropriate supervision. Crest The Nursing Home DS0000027960.V277078.R01.S.doc Version 5.1 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35 and 38 The robust practices which have been adopted at the home to assist in protecting the health and safety of service users need some further improvement in order that any risks can be minimised. EVIDENCE: The day to day running of the home is currently being undertaken by the acting manager. The registered manager is due to return from maternity leave in February 2006. In respect of service users’ finances, the administrator confirmed that she is appointee for two service users, whilst an account has been set up for a third. There are no monies held at the home. These are held in a communal account for service users only, and from which individual statements are received, and interest accrued which is credited to their account. A record is kept of the current state of each account at the home, and of any transactions undertaken on behalf of the service user. Personal allowances are paid into a pooled post office account, of which individual Crest The Nursing Home DS0000027960.V277078.R01.S.doc Version 5.1 Page 18 records are also kept. The administrator can withdraw money at any reasonable time upon the request of the service user concerned in order that they can have access to their monies. Maintenance certificates and details of regular in house checks confirmed that the building is kept maintained, and staff receive training to assist them in safe working practices. There is a maintenance man employed to work at the home. On the day of the inspection, he was available to adjust the temperature to a hot water outlet to an immersion bath which was too hot, and which did not conform with the health and safety guidance provided by the company and posted in the bathroom concerned. Safety systems with regard to the use of bed safety rails with overlay mattresses need to be improved upon in line with the company policy. The distance between the top of the overlay mattress and the top of the bed rail falls short of that being stated as being acceptable. Kitchen records kept include fridge and freezer temperatures, and the service temperature of cooked foods. There is also a cleaning schedule in place. There were no records kept of the temperatures of those freezers kept in the basement. Crest The Nursing Home DS0000027960.V277078.R01.S.doc Version 5.1 Page 19 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 X X 2 X X X X X STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 X X 1 Crest The Nursing Home DS0000027960.V277078.R01.S.doc Version 5.1 Page 20 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 OP18 Regulation 13,37 Requirement Timescale for action 17/01/06 2 OP38 13 3 OP38 13 The responsible person must inform the commission about any future allegations made which involve the vulnerability of service users, and should refer such matters to the local authority for consideration of investigation under the protection of vulnerable adults procedure. Staff who are responsible for the day to day running of the home must be provided with sufficient training in order that they are aware of the correct procedure to follow should an allegation be made. The responsible individual must 25/01/06 look at the discrepancies noted within the bed rails safety checks carried out by the maintenance man, and provide assurance to the Commission for Social Care Inspection that practices at the home pertaining to their use are safe for service users. With regard to the service user 18/01/06 discussed at the time of the inspection: • The risk assessment Version 5.1 Crest The Nursing Home DS0000027960.V277078.R01.S.doc Page 21 pertaining to the use of bed rails must be reviewed to ensure that the systems in place for the service user remain safe. • An assessment of risk must be completed for the service user who is secured in their wheelchair with a lap strap. Hot water temperatures accessible to service users must be maintained close to 43°C. Records must be kept of freezer temperature checks. 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 OP7 Good Practice Recommendations The information available where service users have a history of depression and dementia should be expanded upon, so that staff understand how best needs can be met. The amount of information available about the social needs of individual service users could be further explored and improved upon. Risk assessments for the safe use of bed rails and overlay mattresses needs to match with the company policy for their safe use, and the use of wheelchair lap straps, which can be seen as a restraint, should be used only after multi disciplinary consultation. Staff should ensure that service users are assisted with those areas of need which are highlighted as being required within the care plan. Crest The Nursing Home DS0000027960.V277078.R01.S.doc Version 5.1 Page 22 2 OP14 3 OP21 It is recommended that consultation take place about the entertainment facilities in the communal lounges, so that it can be assured that service users’ choice is afforded with regard to their use. The registered person should implement their plans for the provision of an assisted shower room in order to assist in meeting the shortfall in assisted bathing facilities at the home. Crest The Nursing Home DS0000027960.V277078.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: 0845 015 0120 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. 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