Inspection on 05/02/04 for The Crest Residential Home

Care Home For Older PeopleThe Crest Nursing Home32 Rutland Drive Harrogate North Yorkshire HG1 2NSUnannounced Inspection5 th February 2004 Commission for Social Care InspectionLaunched in April 2004, the Commission for Social Care Inspection (CSCI) is the single inspectorate for social care in England. The Commission combines the work formerly done by the Social Services Inspectorate (SSI), the SSI/Audit Commission Joint Review Team and the National Care Standards Commission. The role of CSCI is to: · Promote improvement in social care · Inspect all social care - for adults and children - in the public, private and voluntary sectors · Publish annual reports to Parliament on the performance of social care and on the state of the social care market · Inspect and assess `Value for Money of council social services · Hold performance statistics on social care · Publish the `star ratings for council social services · Register and inspect services against national standards · Host the Childrens Rights Director role.Inspection Methods & FindingsSECTION B of this report summarises key findings and evidence from this inspection. The following 4-point scale is used to indicate the extent to which standards have been met or not met by placing the assessed level alongside the phrase Standard met? The 4-point scale ranges from: 4 - Standard Exceeded (Commendable) 3 - Standard Met (No Shortfalls) 2 - Standard Almost Met (Minor Shortfalls) 1 - Standard Not Met (Major Shortfalls) O or blank in the Standard met? box denotes standard not assessed on this occasion. 9 in the Standard met? box denotes standard not applicable. X is used where a percentage value or numerical value is not applicable. ESTABLISHMENT INFORMATION Name of establishment The Crest Nursing Home Address 32 Rutland Drive, Harrogate, North Yorkshire, HG1 2NS Email Address Name of registered provider(s)/Company (if applicable) BUPA Care Homes Name of registered manager (if applicable) Type of registration Care Home No. of places registered (if applicable) 38 Tel No: 01423 563113 Fax No: 01423 790925Category(ies) of registration, with (number of places) Old age, not falling within any other category (38) Registration number B060000398 Date First registered 30th July 2002 Was the home registered under the Registered Homes Act 1984 Do additional conditions of registration apply ? Date of last inspectionDate of latest registration certificate 1st August 2003 YES NO 7/4/03 If Yes Refer to Part CThe Crest Nursing HomePage 1 Date of Inspection Visit Time of Inspection Visit Name of Inspector Name of Inspector Name of Inspector 1 2 39th February 2004 11:30 am Jan DulieuID Code959618Name of Inspector 4 Name of Lay Assessor (if applicable) Lay assessors are members of the public independent of the NCSC. They accompany inspectors on some inspections and bring a different perspective to the inspection process Name of Specialist (e.g. Interpreter/Signer) (if applicable) Name of Establishment Representative at the time of inspectionThe Crest Nursing HomePage 2 CONTENTSIntroduction to Report and Inspection Inspection Visits Brief Description of the Services Provided Part A: Summary of Inspection Findings Inspection Summary Statutory Requirements/Good Practice Recommendations from last Inspection Conditions of Registration Statutory Requirements/ Good Practice Recommendations from this Inspection Part B: Inspection Findings National Minimum Standards For Older People: Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management & Administration Part C: Part D: Part E: E.1. E.2. E.3. Compliance with additional conditions of registration (if applicable) Lay Assessors Summary (where applicable) Providers Response Providers comments Action Plan Providers AgreementThe Crest Nursing HomePage 3 INTRODUCTION TO REPORT AND INSPECTION Every establishment that falls within the jurisdiction of the National Care Standards Commission (NCSC), is subject to inspection, to establish if the establishment is meeting the National Minimum Standards relevant to that setting and the requirements of the Care Standards Act 2000. This document summarises the inspection findings of the NCSC in respect of The Crest Nursing Home. The inspection findings relate to the National Minimum Standards (NMS) for Care Homes for Older People published by the Secretary of State under the Care Standards Act 2000. The Regulations applicable to the inspected service are secondary legislation, with which a service provider must comply. Service providers are expected to comply fully with the National Minimum Standards. The National Minimum Standards will form the basis for judgements by the NCSC regarding registration, the imposition and variation of registration conditions and any enforcement action. The report follows the format of the NMS and the numbering shown in the report corresponds to that of the standards. The report will show the following: · Inspection methods used · Key findings and evidence · Overall ratings in relation to the standards · Compliance with the Regulations · Required actions on the part of the provider · Recommended good practice · Summary of the findings · Report of the Lay Assessor (where relevant) · Providers response and proposed action plan to address findings This report is a public document. INSPECTION VISITS Inspections are undertaken in line with the agreed regulatory framework with additional visits as required. This is in accordance with the provisions of the Care Standards Act 2000. The report is based on the findings of the specified inspection dates.The Crest Nursing HomePage 4 BRIEF DESCRIPTION OF THE SERVICES PROVIDED. The Crest is owned by BUPA. The Home has 38 places for older people requiring physical nursing care. The property is a period house with a modern garden wing extension and is situated in The Duchy residential area of Harrogate.The Crest Nursing HomePage 5 PART A SUMMARY OF INSPECTION FINDINGSINSPECTORS SUMMARY (This is an overview of the inspectors findings, which includes good practice, quality issues, areas to be addressed or developed and any other concerns.) The inspection of the home was unannounced. Service users looked well cared for and the staff on duty are knowledgeable about their care. Some service users were in the main lounge but a considerable number of service users in the home are nursed in bed due to their physical dependency. A number of the National Minimum Standards have not yet been reached. A number of these have been identified at previous inspections and have not been addressed. The most serious concerns are the staffing levels especially in the afternoon and evening, combined with the large number of physically dependent service users who require the assistance of two staff to deliver personal care. This results in delays in service users receiving care, in some instances especially in the late afternoon. This is combined with a lack of adjustable beds for service users nursed in bed. Service users have a number of group activities but service users who spend a lot of time in their room and would benefit from individual activities. The home is clean and welcoming but the corridors are cluttered with equipment especially on the ground floor. One service user had a hoist stored inappropriately in their room. Choice of Home (Standards 1-6) 0 of these 2 standards assessed are met. The terms and conditions for service users must be amended to include details of the room they are to occupy. Health and Personal Care (Standards 7-11) 1of these 2 standards assessed are met. The service users plans of care included a range of assessment documents to meet the service users needs and they are well maintained and up to date. There is evidence of reviews of care taking place. Daily Life and Social Activities (Standards 12-15) 1of these 2 standards assessed are met. The home does offer choices of meals and times to get up. Daily activities for service users must be introduced especially for service users nursed in their room.The Crest Nursing HomePage 6 Complaints and Protection (Standards 16-18) 1 of these 2 standards assessed are met. The BUPA policies and procedures for the protection of vulnerable adults and the whistle blowing policy must include details of how and when to contact the National Care Standards Commission. Environment (Standards 19-26) 1of these 2 standards assessed are met. The environment of the home is clean and pleasant but there is insufficient storage for essential equipment. In some areas of the home this presents a health and safety hazard. There are insufficient assisted bathrooms for service users to meet the standard required. Staffing (Standards 27-30) 2 of these 6 standards assessed are met. The current occupancy of the home is 29 service users. The staffing levels must reflect the requirements of the previous regulatory authority, commensurate with the occupancy levels and with particular attention given to the dependency levels of service users. The number of staff in the afternoon and evening requires assessment by the Registered Person. There is no activities coordinator at the time of the inspection. Management and Administration (Standards 31-38) 2 of these 5 standards assessed are met. The home has a newly appointed manager who is addressing many of the issues raised. The Registered Person must provide sufficient resources to meet the shortfalls in standards.The Crest Nursing HomePage 7 Requirements from last Inspection visit fully actioned? If No please list belowNOSTATUTORY REQUIREMENTS Identified below are areas not addressed from the last inspection report which indicate a noncompliance with the Care Standards Act 2000 and accompanying Regulations. No. Regulation Standard Required actions Timescale for action 1 12 OP10 The Registered Person must ensure that the call bell response times are audited at the time of Regulation 26 visits to ensure that service users receive care within a reasonable time period. The Registered Person must address the serious shortfall in the provision of adjustable beds provided for service users who require them. The Registered Person must address the inadequate number of staff on duty on the 2pm-8pm shifts to meet the assessed needs of service users. The Registered Person must ensure that a system of appraisal and supervision is fully implemented in the home commensurate with the standard of a minimum of six times per year. The Registered Person must address the shortfall of two assisted bathrooms to meet the standard. The Registered Person must address the lack of identified storage space for hoists and wheel chairs, which currently present a hazard when stored in the corridors and service users rooms. Immediately216OP241st Dec.2003318OP27Immediately418OP361st July 2003523OP211st Dec 2003 1st July 2003623OP38Action is being taken by the National Care Standards Commission to ensure compliance in regard to the above requirements. RECOMMENDATIONS Identified below are recommendations from the last inspection that have not been implemented The Crest Nursing Home Page 8 No.Refer to Standard OP22Good Practice Recommendations1The Registered Person should obtain an assessment of the premises by an occupational therapist.CONDITIONS OF REGISTRATION THAT APPLY (OTHER THAN NUMBERS AND CATEGORY OF SERVICE USERS).Met (Yes / No)The Crest Nursing HomePage 9 STATUTORY REQUIREMENTS IDENTIFIED DURING THE INSPECTION Action Plan: The Registered Person is requested to provide the Commission with an Action Plan, which indicates how requirements and recommendations are to be addressed with the time scale within which such actions will be taken. This action plan will be made available on request to the Area Office.STATUTORY REQUIREMENTS Identified below are areas addressed in the main body of the report, which indicate noncompliance with the Care Standards Act 2000, and accompanying Regulations 2001 and the National Minimum Standards. The Registered Provider(s) is/are required to comply within the given time scales. No. Regulation Standard * Requirement Timescale for action 1 5 OP1 The Registered Person must ensure that the statements of terms and conditions for service users contains details of the room to be occupied. The Registered Person must ensure that the policies for the protection of adults and the whistle blowing procedure include details of how to contact the National Care Standards Commission. The Registered Person must provide activities for service users. In particular those service users who are nursed in their room. The Registered Person must meet the minimum staffing requirements of the previous regulatory authority. The Registered Person must ensure that fire doors are not prevented from being used by furniture and equipment. 1st April 2004212OP181st March 2004316OP121st April 2004 Immediately and to be maintained thereafter. Immediately and to be maintained thereafter.418OP27523OP19RECOMMENDATIONS Identified below are areas addressed in the main body of the report, which relate to National Minimum Standards and are seen as good practice issues which should be considered for implementation by the registered Provider(s) The Crest Nursing Home Page 10 No.Refer to Standard * OP37Good Practice Recommendations1The Manager of the home must ensure that service users and their next of kin are fully involved in the review of their plan of care.* Note: You may refer to the relevant standard in the remainder of the report by omitting the 2-letter prefix e.g. OP10 refers to Standard 10.The Crest Nursing HomePage 11 PART BINSPECTION METHODS & FINDINGSThe following inspection methods have been used in the production of this report Direct Observation Indirect Observation Sampling · Pre-inspection Questionnaire · Records · Care Plans / Care Pathways · Meals · Activities · Other (Specify) `Tracking care and support Group discussion with service users Individual discussion with service users Group discussion with staff Individual discussion with staff Discussion with management Service user survey Relatives/significant others survey/feedback Visiting Professionals survey / feedback Tour of Premises Formal Interviews Document reading Additional Inspection Information: Number of Service Users spoken to at time of inspection Number of Relatives/significant others the inspectors had contact with Number of letters received in respect of the service CRB check for the Responsible Individual seen CRB check for the Manager seen Certificate of registration was displayed at the time of the inspection Certificate of registration accurately reflected the situation in the service at the time of inspection Total number of care staff employed (excluding managers) Total number of staff with nursing qualifications employed Date of Inspection Time of Inspection Duration Of Inspection (hrs) YES YES NA YES YES YES NO NO YES YES YES NO YES NO NA NA NA YES NO YES 9 2 0 NO NO YES YES X X 5/02/04 11.30 2.5The Crest Nursing HomePage 12 The following pages summarise the key findings and evidence from this inspection, together with the NCSC assessment of the extent to which the National Minimum Standards for Care homes for older persons have been met. The following scale is used to indicate the extent to which standards have been met or not met by placing the assessed level alongside the phrase Standard met? The scale ranges from: 4 - Standard Exceeded 3 - Standard Met 2 - Standard Almost Met 1 - Standard Not Met (Commendable) (No shortfalls) (Minor shortfalls) (Major shortfalls)0 or blank in the Standard met? box denotes standard not assessed on this occasion. 9 in the Standard met? box denotes standard not applicable. X is used where a percentage value or numerical value is not applicable.The Crest Nursing HomePage 13 Choice of HomeThe intended outcomes for the following set of standards are: · · · · · · 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.Standard 1 (1.1 ­ 1.3) The registered person produces and makes available to service users an up to date statement of purpose setting out the aims, objectives, philosophy of care, services and facilities and terms and conditions of the home; and provides a service users guide to the home for current and prospective residents. The statement of purpose clearly sets out the physical environmental standards met by a home in relation to standards 20.1, 20.4, 21.3, 21.4, 22.2, 22.5, 23.3 and 23.10: a summary of this information appears in the homes service users guide Range of fees charged Any charges for extras If yes, please state what the extras are: Key findings/Evidence From (£) 400 YES HAIRDRESSING,CHIROPODY 3 Standard met? To (£) 600A statement of purpose has been produced by BUPA, which has been personalised with relevant information about the home.Standard 2 (2.1 ­ 2.2) Each service user is provided with a statement of terms and conditions at the point of moving into the home (or contract if purchasing their care privately). 1 Key findings/Evidence Standard met? Each service user receives a statement of terms and conditions on admission to the home however this does not currently identify the room to be occupied. This must be addressed. Please see requirements not met from this inspection.No.1The Crest Nursing HomePage 14 Standard 3 (3.1 ­ 3.5) New service users are admitted only on the basis of a full assessment undertaken by people trained to do so, and to which the prospective service user, his/her representatives (if any) and relevant professionals have been party. 0 Key findings/Evidence Standard met? This standard has not been assessed on this occasion.Standard 4 (4.1 - 4.4) The registered person is able to demonstrate the homes capacity to meet the assessed needs (including specialist needs) of individuals admitted to the home. 0 Key findings/Evidence Standard met? This standard has not been assessed on this occasion.Standard 5 (5.1 ­ 5.3) The registered person ensures that prospective service users are invited to visit the home and to move in on a trial basis, before they and / or their representatives make a decision to stay; unplanned admissions are avoided where possible. 0 Key findings/Evidence Standard met? This standard has not been assessed on this occasion.Standard 6 (6.1 - 6.5) Where service users are admitted only for intermediate care, dedicated accommodation is provided together with specialised facilities, equipment and staff to deliver short-term intensive rehabilitation and enable service users to return home. 9 Key findings/Evidence Standard met? The home does not provide intermediate care.The Crest Nursing HomePage 15 Health and Personal CareThe intended outcomes for the following set of standards are: · · · · · The service users health, personal and social care needs are set out in an individual plan of care. Service users make decisions about their lives with assistance as needed. Service users, where appropriate, are responsible for their own medication, and are protected by the homes 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.Standard 7 (7.1 ­ 7.6) A service user plan of care generated from a comprehensive assessment (see Standard 3) is drawn up with each service user and provides the basis for the care to be delivered. 3 Key findings/Evidence Standard met? The service user plans of care examined included a range of assessment documentation. The plans of care are detailed and up to date.Standard 8 (8.1 ­ 8.13) The registered person promotes and maintains service users health and ensures access to health care services to meet assessed needs. Number of incidents where service users have been taken to Accident and Emergency during last 12 months Number of service users with pressure sores at time of inspection (from information taken from care notes) Key findings/Evidence This standard has not been assessed on this occasion.X 1 0Standard met?The Crest Nursing HomePage 16 Standard 9 (9.1 ­ 9.11) The registered person ensures that there is a policy and staff adhere to the procedures for the receipt, recording, storage, handling administration and disposal of medicines, and service users are able to take responsibility for their own medication if they wish, within a risk management framework. 3 Key findings/Evidence Standard Met? The medication records checked are up to date and efficiently run. The storage of medication is appropriate and well maintained.Standard 10 (10.1 ­ 10.7) The arrangements for health and personal care ensure that service users privacy and dignity are respected at all times, and with particular regard to: personal care giving, including nursing, bathing, washing, using the toilet or commode, consultation with and examination by health and social care professionals, consultation with legal and financial advisors, maintaining social contacts with relatives and friends, entering bedrooms, toilets and bathrooms, and following death. 1 Key findings/Evidence Standard met? Service users privacy and dignity is maintained within the constraints of the home, however in the afternoon and evening the staffing levels, combined with the level of dependency of the service users means that service users can wait an unacceptable length of time to have their call bell answered. (Please see Standard 27) This compromises their safety and dignity. This finding has not been adequately addressed from the previous inspection. Please see previous requirements not met from previous inspections. No.1Standard 11 (11.1 ­ 11.12). Care and comfort are given to service users who are dying, their death is handled with dignity and propriety, and their spiritual needs, rites and functions observed. 0 Key findings/Evidence Standard met? This standard has not been assessed on this occasion.The Crest Nursing HomePage 17 Daily Life and Social ActivitiesThe intended outcomes for the following set of standards are: · · · · 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.Standard 12 (12.1 ­ 12.4) The routines of daily living and activities made available are flexible and varied to suit service users expectations, preferences and capacities. 1 Key findings/Evidence Standard met? Service users have choices in the times they get up and can choose where they take their meals. On the day of inspection a number of service users mentioned that they had few activities to occupy them although there are a variety of group entertainments arranged for service users. The service users nursed in bed do not have access to any individual activities or entertainments. This is not acceptable and must be addressed by the Registered Person. Please see requirements not met from this inspection. No.3Standard 13 (13.1 ­ 13.6) Service users are able to have visitors at any reasonable time and links with the local community are developed and/or maintained in accordance with service users preferences 0 Key findings/Evidence Standard met? This standard has not been assessed on this occasion.Standard 14 (14.1 ­ 14.5) The registered person conducts the home so as to maximise service users capacity to exercise personal autonomy and choice. 0 Key findings/Evidence Standard met? This standard has not been assessed on this occasion.The Crest Nursing HomePage 18 Standard 15 (15.1 ­ 15.9) The registered person ensures that service users receive a varied, appealing, wholesome and nutritious diet which is suited to individual, assessed and recorded requirements and that meals are taken in a congenial setting and at flexible times. 3 Key findings/Evidence Standard met? The provision of meals has significantly improved since the last inspection. All meals are now prepared on site and alterations to the kitchen and the staffing provision have also improved. An environmental health inspection took place on the day of inspection that identified the necessity of ensuring hazard analysis procedures are introduced and that all foodstuffs must be covered. This is being addressed by the chef. Service users said that the lunchtime meal was enjoyable.The Crest Nursing HomePage 19 Complaints and ProtectionThe intended outcomes for the following set of standards are: · · · 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.Standard 16 (16.1 ­ 16.4) The registered person ensures that there is a simple clear and accessible complaints procedure which includes the stages and time-scales for the process and that complaints are dealt with promptly and effectively. No. of complaints made to the home during last 12 months No. of these complaints fully substantiated No. of these complaints partly substantiated No. of these complaints not substantiated No. of these complaints not yet resolved No. of complaints sent direct to NCSC Percentage of complaints responded to within 28 days Key findings/Evidence 0 0 0 0 0 0 0 3Standard met?The complaints procedure meets the standard required. The new manager has dealt with some significant issues regarding service users, which have been handled professionally and appropriately.Standard 17 (17.1 ­ 17.3) Service users have their legal rights protected, are enabled to exercise their legal rights directly and participate in the civic process if they wish. 0 Key findings/Evidence Standard met? This standard has not been assessed on this occasion.The Crest Nursing HomePage 20 Standard 18 (18.1 ­ 18.6) The registered person ensures that service users are safeguarded from physical, financial, or material, psychological or sexual abuse, neglect, discriminatory abuse or self harm, inhuman or degrading treatment through deliberate intent, negligence or ignorance, in accordance with written policies. The home has an Adult Protection procedure (including Whistle Blowing) which complies with the Public Disclosure Act 1998 and the Department of Health Guidance No Secrets No. of staff referred for inclusion on POVA lists Key findings/Evidence Standard met? YES 0 1BUPA as a company have policies in place to safeguard service users including a whistle blowing policy. The policies available in this home do not include details of how to contact the National Care Standards Commission (NCSC) both when an alleged incident occurs or how to report an incident directly to the NCSC. Staff on duty knew where to find the policies, but they are not sufficiently aware of the content. They would benefit from specific training in this issue. Please see requirements not met at this inspection. No.2The Crest Nursing HomePage 21 EnvironmentThe intended outcomes for the following set of standards are: · · · · · · · · 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.Standard 19 (19.1 ­ 19.6) The location and layout of the home is suitable for its stated purpose; it is accessible, safe and well maintained; meets service users individual and collective needs in a comfortable and homely way and has been designed with reference to relevant guidance. 1 Key findings/Evidence Standard met? The home is a converted house and is generally suitable for its purpose although there is an area of the home, which can only be accessed by a small flight of stairs with the assistance of a stair master lift. There are service users in this area of the home who cannot easily access a bathroom, if they chose to have a bath. The use of these rooms should be reviewed if there is any change in occupancy. On the day of inspection one service users room was wedged open with an armchair despite the door having an opener that would keep it open appropriately. The nurse in charge did not take any remedial action. This would present a hazard in the event of a fire. This practice must cease. Please see requirements not met at this inspection.No.5Standard 20. (20.1 ­ 20.7) In all newly built homes and first time registrations the home provides sitting, recreational and dining space (referred to collectively as communal space) apart from service users private accommodation and excluding corridors and entrance hall amounting to at least 4.1 sq. metres for each service user. 0 Key findings/Evidence Standard met? This standard has not been assessed on this occasion.The Crest Nursing HomePage 22 Standard 21 (21.1 ­ 21.8) Toilet, washing and bathing facilities are provided to meet the needs of service users. 1 Key findings/Evidence Standard met? There are insufficient assisted bathrooms in this home to meet the standard. There are a number of en-suite baths but service users are unable to use the bath due both to the absence of appropriate hoisting equipment and space for staff to assist service users in the en-suites. These bathrooms cannot be used to meet the standard of one assisted bath/shower to be available for service users. Please see requirements not met from previous inspections.No.5Standard 22 (22.1 ­ 22.8) The registered person demonstrates that an assessment of the premises and facilities has been made by suitably qualified persons including a qualified occupational therapist, with specialist knowledge of the client groups catered for and provides evidence that the recommended disability equipment has been secured or provided and environmental adaptations made to meet the needs of service users. 2 Key findings/Evidence Standard met? The home has not been assessed by an Occupational Therapist. Residents have equipment to assist their mobility where required. Please see recommendations not met from previous inspections.No.1The Crest Nursing HomePage 23 Standard 23 (23.1 ­ 23.11) The home provides accommodation for each service user which meets minimum space as prescribed Total number of single bedrooms with at least 10 sq.m usable space or additional compensatory space Pre-existing homes only (1 April 2003) - single bedrooms below 10 sq.m usable space or additional compensatory space Total number of wheelchair users accommodated for in rooms at least 12sq.m Total number of wheelchair users accommodated for in rooms at less than 12sq.m Total number of shared rooms at least 16 sq.m Total number shared rooms less than 16 sq.m Percentage of places within single rooms: 100 80 - 99 Less than 80 Total number of single bedrooms Total number of single rooms with en suite Total number of double rooms Total number of double rooms with en suite YES NO NO 32 11 0 3 3 32 00 0 0 0Key findings/Evidence Standard met? All the rooms are singly occupied and meet the standard required.The Crest Nursing HomePage 24 Standard 24 (24.1 ­ 24.8) The home provides private accommodation for each service user, which is furnished and equipped to assure comfort and privacy and meets the assessed needs of the service user. 1 Key findings/Evidence Standard met? The accommodation provided for each service user is comfortable, but there are insufficient adjustable beds provided in the home for service users nursed in bed. It is evident that there are a number of service users who require a bed that can be adjusted, both for their comfort and to ensure that staff can deliver personal care safely and appropriately, for example when assisting service users to receive food and drinks. This requirement has been identified at previous inspections and has not been addressed. Please see requirements not met from previous inspections.No.2Standard 25 (25.1 ­ 25 8) The heating, lighting, water supply and ventilation of service users accommodation meet the relevant environmental health and safety requirements and the needs of individual service users. 3 Key findings/Evidence Standard met? The water temperatures in the hand basins and bathrooms meets the standard required. The previous requirement regarding this issue has been met. There are comprehensive records maintained demonstrating that this standard is being met on an ongoing basis.Standard 26 (26.1 ­ 26.9) The premises are kept clean, hygienic and free from offensive odours throughout and systems are in place to control the spread of infection in accordance with relevant legislation and published professional guidance. 0 Key findings/Evidence Standard met? This standard has not been assessed on this occasion.The Crest Nursing HomePage 25 StaffingThe intended outcomes for the following set of standards are: · · · · 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 homes recruitment policy and practices. Staff are trained and competent to do their jobs.Standard 27 (27.1 ­ 27.7) Staffing numbers and skill mix of qualified/unqualified staff are appropriate to the assessed need of the service users, the size, the layout and purpose of the home, at all times. Number of staff /hours in respect of service user needs based on guidance recommended by Department of Health. Personal Nursing Care No. service users High No. staff hours X X X needs allocated No. service users Medium needs No. service users Low needs No. of staff hours required No. of full time equivalent first level registered nurses No. of care staff No. of ancillary staff Key findings/Evidence X X 672 No. staff hours allocated No. staff hours allocated No. of staff hours provided X X 294 X X 2526 7 X Standard met? 1The Crest Nursing HomePage 26 The National Care Standards Commission has been advised that the above-recommended staffing guidance should only be applied to new registrations. For those care homes registered prior to 1st April 2002 there is a policy of no regression, therefore staffing levels must at least meet the minimum requirement of the previous regulatory authority. The staffing levels set by the previous regulatory authority in 1996 detail that for 38 service users there must be 305 hours of trained nurse on duty and 520 care staff hours over one week. The current occupancy level of 29 service users would necessitate a minimum of 249 trained staff and 423 untrained staff being available. These figures exclude a member of staff designated to provide activities and a percentage of hours to provide the manager of the home with supernumerary hours. From the duty rota available at the time of inspection there is a shortfall in the hours of care delivered to service users. Currently there is no member of staff designated to provide activities for service users. The Registered Person must address the staffing levels so that the previous regulatory authority requirements are met. Please see requirements not met from previous inspections No.3 and identified at this inspection.No.5Standard 28 (28.1 ­ 28.3) A minimum ratio of 50 trained members of care staff (NVQ Level 2 or equivalent) is achieved by 2005, excluding the registered manager and/or care manager, and in care homes providing nursing, excluding those members of care staff who are registered nurses. No. care staff (excluding registered nurses) with NVQ level 2 or equivalent of care staff with NVQ level 2 Key findings/Evidence This standard has not been assessed on this occasion. X X Standard met? 0The Crest Nursing HomePage 27 Standard 29 (29.1 ­ 29.6) The registered person operates a thorough recruitment procedure based on equal opportunities and ensuring the protection of service users. 0 Key findings/Evidence Standard met? This standard has not been assessed on this occasion.Standard 30 (30.1 ­ 30.4) The registered person ensures that there is a staff training and development programme, which meets the National Training Organisation (NTO) workforce training targets and ensures staff fulfil the aims of the home and meet the changing needs of service users. 0 Key findings/Evidence Standard met? This standard has not been assessed on this occasion.The Crest Nursing HomePage 28 Management and AdministrationThe intended outcomes for the following set of standards are: · · · · · · · · 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 homes record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected.Standard 31 (31.1 ­ 31.8) The registered manager is qualified, competent and experienced to run the home and meet its stated purpose, aims and objectives. 3 Key findings/Evidence Standard met? The home has a new manager who is addressing the shortfalls in standards in the home. Ms Gilham is an experienced nurse and manager. The process for completing the National Care Standards Commission Registration procedure is being completed at the time of the inspection.Standard 32 (32.1 ­ 32.7) The registered manager ensures that the management approach of the home creates an open, positive and inclusive atmosphere. 0 Key findings/Evidence Standard met? This standard has not been assessed on this occasion.The Crest Nursing HomePage 29 Standard 33 (33.1 ­ 33.10) Effective quality assurance and quality monitoring systems, based on seeking the views of service users are in place to measure success in meeting the aims, objectives and the statement of purpose of the home. 2 Key findings/Evidence Standard met? The home has not completed any recent quality assurance based on seeking service user views. This should be addressed. Please see recommendations identified at this inspection.No.1Standard 34 (34.1 ­ 34.5) Suitable accounting and financial procedures are adopted to demonstrate current financial viability and to ensure that there is effective and efficient management of the business. 3 Key findings/Evidence Standard met? The home is owned by BUPA and there are no current concerns expressed by the Registered Person in Regulation 26 visits to the home that would suggest the home is not financially viable.Standard 35 (35.1 ­ 35.6) The registered manager ensures that service users control their own money except where they state that they do not wish to or they lack capacity and that safeguards are in place to protect the interests of the service user. Number of service users subject to Power of Attorney processes Number of service users subject to Enduring Power of Attorney processes Number of service users subject to Guardianship Orders Key findings/Evidence This standard was not assessed on this occasion. Standard met? 0 X X XThe Crest Nursing HomePage 30 Standard 36 (36.1 ­ 36.5) The registered person ensures that the employment policies and procedures adopted by the home and its induction, training and supervision arrangements are put into practice. 1 Key findings/Evidence Standard met? BUPA have introduced an induction-training programme. One record was examined and a new care assistant had commenced with this programme. Supervision of staff has commenced but further work in implementing this process is required o meet the standard. Please see requirements not met and identified at previous inspections.No.4 Standard 37 (37.1 ­ 37.3) Records required by regulation for the protection of service users and for the effective and efficient running of the business are maintained, up to date and accurate. 2 Key findings/Evidence Standard met? Records are stored appropriately in the home. It must be demonstrated that service users and their next of kin are involved in maintaining their records to meet the standard required. Please see recommendations identified at this inspection.No.1Standard 38 (38.1 ­ 38.9) The registered manager ensures so far as is reasonably practicable, the health, safety and welfare of service users and staff. 1 Key findings/Evidence Standard met? There has been an improvement in identifying storage for the meal trolleys in newly built cupboards. The home overall is cluttered with wheelchairs, hoists, linen skips and cleaning trolleys. The Registered Person must ensure that staff do not obstruct access to fire exits at any time with equipment, or use service users rooms to store equipment.. The Registered Person must address the provision of storage overall and staff must store equipment appropriately when not in use. Please see requirements identified and not met from previous inspections. No.6The Crest Nursing HomePage 31 PART C(where applicable)COMPLIANCE WITH CONDITIONSCondition CommentsComplianceCondition CommentsComplianceCondition CommentsComplianceCondition CommentsComplianceLead Inspector Second Inspector Locality Manager DateJan DulieuSignature Signature SignatureThe Crest Nursing HomePage 32 PART D(where applicable) Not applicableLAY ASSESSORS SUMMARYLay Assessor Date Public reportsSignatureIt should be noted that all NCSC inspection reports are public documents.The Crest Nursing HomePage 33 PART EE.1PROVIDERS RESPONSE TO IDENTIFIED STATUTORY REQUIREMENTSRegistered Persons comments/confirmation relating to the content and accuracy of the report for the above inspection.We would welcome comments on the content of this report relating to the Inspection conducted on 5 February 2004 and any factual inaccuracies: Please limit your comments to one side of A4 if possibleThe Crest Nursing HomePage 34 Action taken by the NCSC in response to provider comments: Amendments to the report were necessary YESComments were received from the provider Provider comments/factual amendments were incorporated into the final inspection report Provider comments are available on file at the Area Office but have not been incorporated into the final inspection report. The inspector believes the report to be factually accurateYESYESYESNote: In instances where there is a major difference of view between the Inspector and the Registered Provider both views will be made available on request to the Area Office. You will also note that the Commission has identified in the inspection report good practice recommendations and it would be useful to have some indication as to whether you intend to take any action to progress these. Status of the Providers Action Plan at time of publication of the final inspection report: Action plan was requiredAction plan was received at the point of publicationAction plan covers all the statutory requirements in a timely fashion Action plan did not cover all the statutory requirements and required further discussion Provider has declined to provide an action planOther: enter details here The Crest Nursing HomePage 35 E.3PROVIDERS AGREEMENT Registered Persons statement of agreement/comments: Please complete the relevant section that applies.E.3.1 I of confirm that the contents of this report are a fair and accurate representation of the facts relating to the inspection conducted on the above date(s) and that I agree with the requirements made and will seek to comply with these. Print Name Signature Designation Date Or E.3.2 I of am unable to confirm that the contents of this report are a fair and accurate representation of the facts relating to the inspection conducted on the above date(s) for the following reasons:Print Name Signature Designation Date Note: In instance where there is a profound difference of view between the Inspector and the Registered Provider both views will be reported. Please attach any extra pages, as applicable.The Crest Nursing HomePage 36 The Crest Nursing Home / 5 th February 2004Commission for Social Care Inspection 33 Greycoat Street London SW1P 2QF Telephone: 020 7979 2000 Fax: 020 7979 2111 National Enquiry Line: 0845 015 0120 www.csci.org.ukS0000027960.V133865.R02© This report may only be used in its entirety. 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