This inspection was carried out on 22nd June 2005.
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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.
CARE HOMES FOR OLDER PEOPLE
The Crest Nursing Home 32 Rutland Drive Harrogate North Yorkshire HG1 2NS Lead Inspector
Jan Dulieu Unannounced 22 June 2005 09:30 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 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 Nursing Home J53_J04_S27960_The Crest Nursing Home_V232466_220605_stage4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service The Crest Nursing Home Address 32 Rutland Drive Harrogate North Yorkshire HG1 2NS 01423 563113 01423 790925 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) BUPA Caare Homes Limited Mrs Jennifer Jane Firth Care Home 38 Category(ies) of Old age, not falling within any other category registration, with number (38) of places The Crest Nursing Home J53_J04_S27960_The Crest Nursing Home_V232466_220605_stage4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 17/2/05 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. The Crest Nursing Home J53_J04_S27960_The Crest Nursing Home_V232466_220605_stage4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection of the home was unannounced. The registered manager, Mrs Jennifer Firth was available for the inspection, which took place over two and a half hours. A tour of the home was conducted and a number of service users and relatives gave their views about the home and the care received. Service user plans of care were inspected also. What the service does well: What has improved since the last inspection?
A sensory garden has been created at the rear of the property, which has improved the outside facilities for service users. The home now has an activities coordinator who has a caring and sensitive approach. Service users are benefiting from a regular programme of activities and one to one visits. The high standards of care and communication between the registered manager and staff have ensured consistency in the delivery of nursing care. A health and safety audit conducted by the company together with a continued focus on internal auditing of the quality of care and training has raised the standards of care in this home. All staff have received training in abuse awareness.
The Crest Nursing Home J53_J04_S27960_The Crest Nursing Home_V232466_220605_stage4.doc Version 1.30 Page 6 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 Crest Nursing Home J53_J04_S27960_The Crest Nursing Home_V232466_220605_stage4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection The Crest Nursing Home J53_J04_S27960_The Crest Nursing Home_V232466_220605_stage4.doc Version 1.30 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 standard(s) 1 and 3 Service users and their relatives are given sufficient information about the home to make an informed choice. EVIDENCE: Both service users and relatives said that the registered manager and staff are professional, friendly and welcoming. One relative had been particularly reassured and impressed by the open and welcoming approach, which had been confirmed in the care, their relative received after their admission to the home. The care plans examined indicate that a full assessment of needs is conducted and implemented following this process. The Crest Nursing Home J53_J04_S27960_The Crest Nursing Home_V232466_220605_stage4.doc Version 1.30 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 standard(s) 7,8,9 and10 Service users health care needs are met. EVIDENCE: Service users plans of care contain a full range of assessment documentation which forms the basis for the individual plan of care. The plans of care address service users nursing care needs and it was evident that they are reviewed regularly. Most importantly the registered manager audits the plans of care to support staff in meeting service users care needs. Medication records are well kept overall with the exception that the trained nurses must liaise with the service users GP if changes to service users prescription is required. The medication records are well kept but the identifying photograph for service users have been inserted loosely in front of their record and it is difficult to be certain that they are attached to any particular sheet. This should be improved. The Crest Nursing Home J53_J04_S27960_The Crest Nursing Home_V232466_220605_stage4.doc Version 1.30 Page 10 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 standard(s) 12, 13 Service users have access to group and individual activities. EVIDENCE: An activities coordinator has improved the range and quality of activities for service users. Outings are planned on a weekly basis and group games such as dominoes and cards are played. Most importantly the activities coordinator visits service users in their room on the days she is on duty. Relatives are made to feel welcome and the administrator of the home who works from the reception area is able to facilitate this process which is helpful to service users and relatives. A garden party to celebrate the creation of the sensory garden was planned later in the week of the inspection and staff were working hard to ensure this was a success. The Crest Nursing Home J53_J04_S27960_The Crest Nursing Home_V232466_220605_stage4.doc Version 1.30 Page 11 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 standard(s) 16 and 18 Service users can be confident that their concerns or complaints would be listened to. Service users are protected by staff who have all received training in abuse awareness. EVIDENCE: The home has not received any recent complaints and this is possibly due to the managers open approach, which ensures concerns are addressed at an early stage. The home does have a robust complaint policy and procedure. All staff have undergone abuse awareness training and staff spoken to on the day of inspection demonstrated their understanding of how service users should be protected. The Crest Nursing Home J53_J04_S27960_The Crest Nursing Home_V232466_220605_stage4.doc Version 1.30 Page 12 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 standard(s) 19,20,21,23,24 and26 Service users live in a clean and well maintained environment. EVIDENCE: The Crest is a converted period house and this does present some challenges for the management of the home in meeting all the National Minimum Standards. The home does not have sufficient assisted bathrooms if it was fully occupied or the option of an assisted shower. There are plans to address the shortfall but they have not been implemented. Storage space is at a premium and this means that equipment required for the day-to-day care of service users is more visible than it should be. However the management of the home are unable to address this further due to the limitations in the layout of the home. The home is well maintained and clean. Service users have individually decorated rooms and can bring personal furniture and possessions if they choose to do so.
The Crest Nursing Home J53_J04_S27960_The Crest Nursing Home_V232466_220605_stage4.doc Version 1.30 Page 13 Service users have access to adjustable beds and pressure relieving mattresses as required. The Crest Nursing Home J53_J04_S27960_The Crest Nursing Home_V232466_220605_stage4.doc Version 1.30 Page 14 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 Staffing levels meet service users nursing care needs. EVIDENCE: The occupancy of the home is currently twenty three service users. The staffing levels have been inspected taking into account these numbers. The home has sufficient staff to meet service users needs and these staff have access to NVQ training. There are two trained nurses on duty during the day supported by five care staff in the morning and four in the evening. One trained nurse and two care staff are on duty at night. All staff have received moving and handling training, fire awareness and health and safety training. The Crest Nursing Home J53_J04_S27960_The Crest Nursing Home_V232466_220605_stage4.doc Version 1.30 Page 15 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33 and 36 Service users benefit from living in a well run home with an open management style. EVIDENCE: The registered manager has an open approach to the management of the home and both service users, relatives and staff find her approachable. Mrs Firth has ensured that the welfare of service users is at the forefront of care by holding meetings and consulting with service users and staff. Staff receive regular supervision. In recent months increased internal audit has improved all aspects of record keeping especially service user plans of care. During the current registered managers planned absence an experienced nurse who has worked at the home for a number of years will deputise for her with the support of the operations manager and the general manager of Southlands a short distance away.
The Crest Nursing Home J53_J04_S27960_The Crest Nursing Home_V232466_220605_stage4.doc Version 1.30 Page 16 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 x
COMPLAINTS AND PROTECTION 3 3 1 x 3 3 x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 3 x x 1 x x The Crest Nursing Home J53_J04_S27960_The Crest Nursing Home_V232466_220605_stage4.doc Version 1.30 Page 17 yes Are there any outstanding requirements from the last inspection? 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 23 Regulation 21 Requirement The Registered Person must address the shortfall of two assisted bathrooms to meet the standard. This requirement has not been met from previous inspections. Timescale for action 1/12/03 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 9 Good Practice Recommendations The registered manager should ensure that the trained nurses liaise with service users GP if their medication requirements change. Also the photographs should be attached to a front sheet together with the record of service users date of birth and details of any allergies. 2. 3. The Crest Nursing Home J53_J04_S27960_The Crest Nursing Home_V232466_220605_stage4.doc Version 1.30 Page 18 Commission for Social Care Inspection 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
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