Care Home: Crelake House

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What the care home does well People who use the service at Crelake House benefit from a management of the home that aims to raise standards through listening to what people want and through valuing and supporting staff. There are good systems in place to ensure the home is run professionally. There is a good understanding of how to support people to lead fulfilled lives within their capabililties. People are treated with respect and dignity, individuality is understood and supported and the standard of care delivered ensures care and health needs will be met. The home environment is comfortable and homely, well maintained, fresh and light. All comments about the home were positive. They include: "I cannot fault the care I received since I`ve been here" and "They are all wonderful, jolly, cheerful, efficient, welcoming, caring people". What has improved since the last inspection? There were no previous requirements or recommendations for the home to meet. Since the previous inspection there has been a new wing extention to the home and much upgrading which improves the environment for people. What the care home could do better: No requirements were made during this inspection. The correct storage for medicines, known as Controlled Drugs, should be in place at the earliest opportunity and there needs to be a better understanding of the complications of diabetes, reflected in care plans where this applies. The home`s whistle blowing and prevention of abuse policies should include the contact details of the local authority Safeguarding Team. The home should ensure that the kitchen cleaning schedule is closely adhered to so that the standard does not drop. Hand washing facilities must be available where ever staff need to wash their hands so that the risk of cross infection is minimised. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Crelake House 4 Whitchurch Road Tavistock Devon PL19 9BB     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Anita Sutcliffe     Date: 2 5 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Crelake House 4 Whitchurch Road Tavistock Devon PL19 9BB 01822616224 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Crelake Care Ltd care home 27 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is 27. The registered person may provide the following category of service only: Care home providing personal care only- CodePC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category- Code OP Physical disability aged 65 years and over on admission- Code PD(E) Date of last inspection Brief description of the care home Crelake House is registered to provide care and accommodation for up to 27 older people who may also have additional physical difficulties. The home is situated within five minutes walk of the centre of Tavistock; within easy reach of its many and varied facilities. The proprietors live on site in a separate coach house. Care Homes for Older People Page 4 of 27 Over 65 27 27 0 0 Brief description of the care home This is a new ground floor extension and there is level access throughout the whole ground floor of the home. Two pairs of rooms have an interconnecting door (locakable and sound proof) for possible use by established couples. Amongst other bathing facilities, such as rooms with their own shower, there is a new large disabled bathroom (wet floor) with bath, shower and WC. There is a large lounge, conservatory, library and level access to the gardens. The home is staffed 24 hours a day and there are waking staff on duty overnight. In addition to care staff employed there is also a cook, domestic and handyman. Weekly fees at the time of this inspection ranged between 470 pounds and 550 pounds per week. Items that are not included in the fee are: Hairdressing, chiropody, newspapers, and toiletries. Other information is available from the home in their Statement of Purpose and Service Users Guide. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at /www.oft.gov.uk . Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Information about Crelake has been collected by us towards this inspection since the last key inspection January 2007. This key inspection included one unannounced visit to the home, starting at 5:30 a.m. Surveys were sent to people who use the service and staff so they could give their opinion of the service. The information sent to CSCI each year by the care provider gave us some numerical information about the service, such as now many people are resident and how many staff employed. It also describes how they intend to make further improvements to the service. As part of the visit to the home we looked at all communal areas, and several bedrooms. We spoke with several people who use the service, one visiting family and observed staff going about their work. Care Homes for Older People Page 6 of 27 We looked in detail at the care plans, records and daily notes for three people. This is called case tracking. The owner/provider of the home and the manager of day to day care were present for the inspection. People who use the service may be described within this report as residents, clients or service users. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are fully informed and their needs and wishes fully understood before they are admitted to the home. Evidence: We looked at how well the home manages home admissions. The home does not provide Intermediate Care. Nine people told us through survey that they received enough information before moving in, with comments: I knew a lot about this care home due to my previous work and also due to having someone I knew working there, so I had no doubts that Crelake would meet my needs during this period of rehab and They took a great deal of time to show us the facilities and to explain the type of care provided. The manager recorded: Applicants for respite and short stay periods are treated no differently than applicants for long term care and our full pre admission procedure is Care Homes for Older People Page 10 of 27 Evidence: now applied from the enquiry stage. We were told that each potential resident is sent information about the home. We saw that this includes a sample contract; what you get and do not get for your money. People are encouraged to visit, then questions can be answered. We are told that people are also directed to an advocacy service for non bias advice. People are then invited to take some meals at the home or stay for a shorter, respite period to try it. When admitted this is on a months trial period on both sides. We were told that sometimes it is decided the person would not be suitable. One person told us: When it was first suggested to me that I should enter this establishment for rehabilitation I had a lot of foreboding. However, I should not have worried as the level of care and encouragement I received was excellent. We looked at how the last admission to the home was managed. They had their needs assessed by the person managing the care at Crelake. The assessment covered all aspects of the persons needs including interests, hobbies and risks, such as their diet and the likelihood of pressure sores. Although an emergency admission all necessary information was available. Their doctor was involved in decision about their welfare and the home was supporting them to lead the life they prefer. Family of one person using the service told us: The care which went into settling my mother into the home was incredible. The staff worked so hard to settle her in. Care Homes for Older People Page 11 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be assured that their care and health needs will be well met in the manner of their choice. Evidence: We looked at whether peoples care and health needs were being met. Asked if they receive the care and support they need eight people said always and one said usually. Comments include: I found the level of care and support I received to be of the highest standard and was I feel contributory to my recovery, I cannot fault the care I received since Ive been here and I am very happy with the support Ive received especially when experiencing angina attacks. Staff are described as patient, kind and knowledgeable. We looked in detail at the care planning and care delivery for three people who use the service. Care plans contained some very detailed information, necessary to inform staff what care or support was needed. At the previous inspection we discussed with the deputy manager the need to have a diabetic care plan, for when individuals have Care Homes for Older People Page 12 of 27 Evidence: diabetes, to ensure that their needs are being met in relation to this condition. At this inspection there was such a care plan but it lacked a full understanding of the potential complications associated with the illness. In general we found that risks were fully assessed and steps in place to reduce or remove any risk identified. Staff told us they have all the information they need. People told us:They have taken on board everything I have said about my mothers health, past history and likes and dislikes and I found the staff to be very considerate and discussed fully with me any considered changes they thought may be helpful to my recovery. I also found them receptive to my opinions and always responded by acting on my requests. This indicates that people are fully consulted about the care they wish to receive. Records show that health care professionals are consulted as necessary and their advice is followed. Staff told us the doctor will always be called straight away if necessary. The home monitors any concern, such as diet, swallowing and prevention of pressure sores. People told us that staff treat them with respect and their privacy is upheld. We saw staff knocking and waiting to be invited into peoples rooms. Each person is able to lock their door if they wish for privacy. Staff receive training in the principles of care from when they first start at the home. We had received concerns which included the management of medicines. For this reason we arrived at the home at 5.30 am to see if medicines were already prepared to be given out to people, a practise likely to lead to mistakes. We found that they were not: medicines were securely stored and medicine records were clear and complete. Where a member of staff had not completed records adequately the home had taken disciplinary steps to correct this. One staff organises the handling of medicines. People are able to administer their own if they wish and any risk is assessed and reviewed. Peoples care plans include information on the medicines they take. Staff receive training in the safe handling of medicines. We were unable to substantiate any of the concerns raised which were unknown to the provider. Those known to the provider had been dealt with effectively. There are people at the home who require medicines known as Controlled Drugs. These medicines must have specific storage for additional safety. The home does not have this storage, but it had been ordered and the current arrangements are Care Homes for Older People Page 13 of 27 Evidence: satisfactory for the short term. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are enabled to lead fulfilled lives with choice and individuality upheld. The food provided is tasty, nutritious and enjoyed by most. Evidence: We looked at the daily life and social activities for people at the home. Asked if there are are activities arranged at the home that people can take part in five said always, one said usually and two said sometimes. Comments included: Yes lots. Music and movement, card games, weekly bingo, a coach trip to Plymouth was arranged and the Halloween party and fireworks display were excellent and Singing, parties, church services and outings. One person told us there usually are and two said there sometimes are. We arrived at the home at 5 a.m. Only one person was up and we saw that other people got up over a several hour period. People told us that they only go to bed and get up when they choose. The manager told us: There are no rules, only that one person does not adversely affect another. There is an activities coordinator and a full programme of activities displayed on a Care Homes for Older People Page 15 of 27 Evidence: notice board. Peoples assessment and care plans include information about social needs and we saw good evidence that people are supported to lead individual lives. The home environment provides variety of space, with different lounges and access to the gardens. People have the use of a pay phone in the library available to them. We saw people clearly enjoying an armchair sing along with gentle exercises. Contact with the community is achieved by involvement in local events such as the Whitchurch bell ringers, town band, tea dances, theatre and pantomime. Arrangements are made at the home to support different faith groups as they would wish. Asked whether they like the meals at the home three said always and six said usually. We were told: The food is very good and I was pleasantly surprised at the quality of the food provided which I thought was of a very high standard. Also the fact that you were given choice particularly for tea. People have been asked about their dining experience and changes have been made following this, such as music or not during meals. The dining room was beautifully laid and attractive. Peoples dietary intake is monitored where necessary and we saw that expert advice has been sought where there was concern. Care plans were detailed and staff understood how to keep people safe with the minimum of affect on their preferred lifestyle. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are protected by the homes complaints and safeguarding arrangements. Evidence: We looked at how well people are protected by the complaints and safeguarding arrangements at the home. Asked if they know who to speak to if not happy eight people said always and one said usually. Asked if they know how to make a complaint all said yes. Comments included: I had the procedure outlined to me when I first arrived in a way that was very easy to understand and Yes, my mother would make her comment to any member of staff and would be confident that it would be treated appropriately. The complaints procedure is available to people and also displayed on a prominent notice board. We discussed the good practise of providing it in alternate formats, for example large print for people with reduced eyesight. The policy includes timescales and contact details of the Commission so that people can inform us should they prefer. We have received one complaint about the home. It was not from a person using the service. This was discussed with the provider and manager who were able to provide records and information about how they managed the complaint when initially brought to them. The person had also chosen to contact the Commission. Care Homes for Older People Page 17 of 27 Evidence: Staff are trained in how to safeguarding people from abuse from when they first start at the home. We are told that each staff member has a copy of the whistle blowing policy, which should inform them how they should take concerns to the specialist safeguarding team. However, the contact details for the Safeguarding Team were not included in the policy. Staff we spoke with understood how to protect people from abuse. The person managing the home was a little less sure how to proceed if there was an alert, which might be abuse, but has previously taken steps to protect a person when there were concerns. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home environment meets the needs of the people who live there. Evidence: We looked at how the home environment suited the people using it. July 2007 a new wing was completed with eight new bedrooms and a large lounge and conservatory. All fully complied with expected standards. We are told: We will continue to upgrade the facilities and the decor in the older wing now that the new wing is completed. We found the home to be very domestic/homely and interesting, warm, clean, fresh and in a good state of repair and decor. There is a modern system for calling staff and handrails available to help people move around the building. Staff have a good supply of equipment to provide safe moving of immobile residents and prevent pressure sores. The home has an ongoing maintenance and decoration programme and employs a handyman and a gardener. There are a range of bathing facilities from baths with hoists or walk in showers which cater for the varying needs of people. Each room has a lockable storage space and people can lock their own door if they choose. Care Homes for Older People Page 19 of 27 Evidence: The home complies with the requirements of the local fire service and environmental health department. However, we found that the kitchen was not as clean as it should be and there was no soap or paper towels available in the kitchen or laundry for staff to wash their hands. Staff did confirm that they have protective clothing (gloves and aprons) available for use and staff have received some training in infection control from a professional source. Asked if the home is fresh and clean five people said always with comments: Yes spotless. Most impressive and A NICE home, well decorated and maintained which reflects in the way the staff made sure everything was kept neat and tidy. Three people said it was usually fresh and clean one adding: Sometimes the room is not as clean as it should be. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by a properly recruited and trained staff in sufficient numbers to meet their needs. Evidence: People were very complimentary about the staff with comments including: The staff have all been very kind and helpful and They are all wonderful, jolly, cheerful, efficient, welcoming, caring people. We found that the number of staff employed was sufficient to meet the needs of people at the home. People, asked if staff are available when needed told us they were, adding: My mother has never commented that she has to wait for attention. I have noticed that staff are always busy about their duties while continually interacting with the residents. When communication bells ring they are answered promptly and I am really pleased with the response times. I felt secure as I was never left any length of time unattended. When additional staff are required this is arranged. We looked at the records of the two staff most recently employed at the home and found that all checks, necessary to ensure they are safe to work with vulnerable adults, are completed before they begin unsupervised work. We discussed how people using the service can be involved in staff recruitment; have a say in who will care for them. Although not part of normal practise at the moment they are thinking of ways Care Homes for Older People Page 21 of 27 Evidence: this might be achieved. All staff are encouraged and supported to achieve qualifications in care and some have National Vocational Qualifications (NVQ) to the highest level. People are very satisfied with the level of care they receive and staff told us the standard of training they receive is good, one adding: My induction was very informative and in-depth. Staff training is well planned and monitored and includes all aspects of health and safety plus that relevant to the the needs of older people, such as visual and hearing awareness. The manager also checks staff competence. Records of those seen were moving and handling, first aid and the principles of care. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed in the best interest of people who use the service. Evidence: Tricia Hall has over 20 years experience working with older people and takes lead responsibility for the care of residents as the registered manager. John Waft, the provider, has a background in fire inspection, health and safety and risk assessment. At the time of the inspection a senior care worker was acting as the homes manager, in charge of the full day to day care of people and training and support of staff. People benefit from a very structured staffing, with promotion and recognition of the standard of work achieved. Should staff fail to meet the standards set this is dealt with through supervision of their work or disciplinary procedures. Four staff told us they could not think of any way the home could improve. One person family told us they have great respect for the manager and owner of the home. We confirmed that staff have regular supervision of their work and regular staff Care Homes for Older People Page 23 of 27 Evidence: meetings to discuss the service. People have their opinion of the service surveyed and where improvements have been identified these have been put in place. We were told that staff are being instructed on how regulation governs the care profession and how to achieve higher standards. Each person who uses the service has a lockable space in which they can keep items of importance to them. Some people use it and some choose not to. We are told the home does not keep any money or valuables for people. Most deal with their own finances. We saw no health and safety concerns at the home. We saw several general risk assessments, such as the use of cleaning chemicals, risk of fire and legionella. Staff were very conversant with how to respond should there be a fire alarm and records shoed that equipment is regularly serviced. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 9 18 The correct storage for medicines known as Controlled Drugs should be in place at the earliest opportunity. The homes whistle blowing and prevention of abuse policies should include the contact details of the local authority Safeguarding Team. Hand washing facilities must be available where ever staff need to wash their hands so that the risk of cross infection is minimised. Cleaning routines in the kitchen should always be adhered to so that the standard of cleanliness does not drop. 3 26 4 26 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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