Care Home: Crescent The (1)

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What the care home does well We spoke to two people about what it is like to live at the home. They both said they are happy and can make decisions about what they do. One person said they decide when to go to bed and `just have to ask for things` and the staff help. Another person said they have `meetings` and talk about what they want to do. People receive good quality care that is delivered by a competent and caring staff team. Staff have very good knowledge about the people who live at the home. They talked about people`s specialist needs, likes, dislikes and daily routines, and what they told us matched what was recorded in people`s care records. One staff member said, "People are involved with everything in the home, including how the home is run, choosing shopping, menus, outings etc. They have a very full life with good activities." Another staff said, "We are very person centred and have lots of little meetings with people to check what they want." Relatives told us they are very happy with the service. When asked what the home does well, one person said, "It is a very well cared for house. My relative is very happy there, and it has good food." Another person said, "Looks after the people staying there very well indeed." And another person said, "A very happy home." People`s health and personal care needs are well met. We received very positive feedback from three healthcare professionals. They all said the care service always seeks advice and acts on it to meet people`s social and healthcare needs, and the care service always respects people`s privacy and dignity. One professional said, "This service continues to provide outstanding care for residents. Care is efficient and competent but also compassionate." Another professional said, "They treat their clients with the utmost respect and can always answer questions on their clients behalf if needed. To me the service seems excellent." And another professional said, "They work in collaboration with other agencies and with a person centred approach. They show respect for the clients." Care records have excellent information about people`s needs and aims, and have points of action that help the person achieve their aims. They are very detailed and are reviewed regularly to make sure the information is correct. The home is very well managed which has resulted in people receiving very good care that meets their needs. What has improved since the last inspection? At the last inspection we did not make any requirements and recommendations. We said the manager and staff are always looking at ways to make things better for the people who live there. At this inspection we found that they continue looking at how they can improve the service. What the care home could do better: Better arrangements could be put in place to ensure that all prescribed medication is administered correctly as directed by the prescriber`s instructions. This will help to make sure that people`s health and wellbeing is improved and maintained.Any incidents of threatening or challenging behaviour that affect other people who live at the home could be managed through safeguarding procedures. This will make sure people who live at the home are safeguarded and are getting the right support. The Care Quality Commission (CQC) could be notified of more significant events that affect the health and welfare of people who live at the home. This will make sure the regulatory authority receives appropriate information and can monitor the service. Daily records contain some very good information about what people who live at the home have been doing but sometimes not enough information is recorded. Daily records could contain more information to show that people`s care needs are being met. Use of the home`s vehicle could be more carefully monitored. This will make sure people who pay for the vehicle are getting fair access and value for money. The area manager visits the home very regularly and is good at monitoring the service but people who live and work at the home have not seen the visit reports. A copy of each report could be sent to the home. This will help make sure the quality of the home is properly monitored. Key inspection report Care homes for adults (18-65 years) Name: Address: Crescent The (1) 1 The Crescent Green Hammerton Nr York North Yorkshire YO26 8BW     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Carol Haj-Najafi     Date: 0 5 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Adults (18-65 years) Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Crescent The (1) 1 The Crescent Green Hammerton Nr York North Yorkshire YO26 8BW 01423331440 F/P01423331440 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.st-annes.org.uk St Anne`s Community Services care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Registered for 5 service users with learning disabilities, who may also have physical disabilities. Date of last inspection Brief description of the care home 1 The Crescent is a care home registered by St Annes Community Services to provide personal care and accommodation for up to five adults with learning disabilities who may be aged over 65 years old and some of who may have a physical disability. The home is a detached two-storey property converted from two former semi-detached houses and is located in the village of Green Hammerton, which is accessible from the A59. The home is close to a range of community amenities and facilities including a church, a pub, a social club and a post office/shop. Each of the five bedrooms is for single accommodation, none of which has en-suite facilities. They are all situated on the first floor and the home has a passenger lift. There are well-maintained garden areas to the front and the rear of the home and there is level/ramped access to the home. Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 5 5 Brief description of the care home Current information about services provided at 1 The Crescent in the form of a statement of purpose, service user guide and the most recent inspection report published by the Commission are available by contacting the home. Information provided by the registered manager on 4th November 2009 indicated that the current weekly fee for the home ranges from £340.47 to £862.53. Additional costs include toiletries, hairdressing and a contribution to the funding of transport. Care Homes for Adults (18-65 years) Page 5 of 31 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: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The Care Quality Commission (CQC) inspects care homes to make sure they are operating for the benefit and well being of the people who use their service. More information about the inspection process can be found on our website www.cqc.org.uk We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations- but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. The last key inspection was carried out in November 2006. Before this visit we reviewed the information we had about the service to help us decide what we should do during our inspection. Care Homes for Adults (18-65 years) Page 6 of 31 Surveys were sent out to people who live at the home, their relatives, healthcare professionals and staff. Twelve surveys were returned, three from people who live at the home, three from relatives, three from healthcare professionals and three from staff. Information from the surveys has been included in the report. One inspector was at the home over two days. The first day from 9:30 to 13:00 and the second day from 9:30 to 12:15. We spoke to two people who live at the home, three staff and the registered manager. We looked around the home and observed how staff interact with people who live at the home. We looked at care plans, risk assessments, daily records and staff records. Feedback was given to the registered manager at the end of our visit. Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: Better arrangements could be put in place to ensure that all prescribed medication is administered correctly as directed by the prescribers instructions. This will help to make sure that peoples health and wellbeing is improved and maintained. Care Homes for Adults (18-65 years) Page 8 of 31 Any incidents of threatening or challenging behaviour that affect other people who live at the home could be managed through safeguarding procedures. This will make sure people who live at the home are safeguarded and are getting the right support. The Care Quality Commission (CQC) could be notified of more significant events that affect the health and welfare of people who live at the home. This will make sure the regulatory authority receives appropriate information and can monitor the service. Daily records contain some very good information about what people who live at the home have been doing but sometimes not enough information is recorded. Daily records could contain more information to show that peoples care needs are being met. Use of the homes vehicle could be more carefully monitored. This will make sure people who pay for the vehicle are getting fair access and value for money. The area manager visits the home very regularly and is good at monitoring the service but people who live and work at the home have not seen the visit reports. A copy of each report could be sent to the home. This will help make sure the quality of the home is properly monitored. 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 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 Adults (18-65 years) Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 31 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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. Systems are in place to make sure peoples needs are thoroughly assessed before they move into the home and people are fully consulted and involved in deciding where they want to live. Evidence: At the last inspection we made a judgement that people experience excellent outcomes in this outcome group. We said, People are fully informed and have their needs fully assessed so that they can exercise choice about living in the home. No people have moved into the home since the last inspection so the admission process has not been used. One person is currently considering whether they would like to move into the home and has visited several times but this is only in the early stages. The manager confirmed that have recorded each visit and would be making sure comprehensive assessments are carried out before any decision is made. In the AQAA the manager told us, The moving in process is planned to suit the individual needs of both the potential new resident and also of others already living in Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: the home. Alongside the formal visits and risk assessments it includes short and longer informal visits, sleepovers, meals, chats etc (all dependent on the expressed individuals needs). Great emphasis is placed on trying to find out a persons personal aspirations and expectations and from the outset a record is kept of how visits have been for all concerned and how it might be possible to meet these. We have not received any information that indicates the outcome would be any different from our findings at the last inspection. Care Homes for Adults (18-65 years) Page 12 of 31 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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 who live at the home play a very active role in planning their care and support, and make decisions about their lives. Evidence: We spoke to two people about what it is like to live at the home. They both said they are happy and can make decisions about what they do. One person said they decide when to go to bed and just have to ask for things and the staff help. Another person said they have meetings and talk about what they want to do. The home holds making it happen meetings where people discuss what they would like to do and what action needs to happen to help them achieve what they want. Some people had action plans from the meetings on the back of their door. We observed interaction between staff and people who live at the home and joined people at lunchtime. During our visit the atmosphere was very relaxed and people chatted freely. Staff were polite and treated people with respect. Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: Staff have very good knowledge about the people who live at the home. They talked about peoples specialist needs, likes, dislikes and daily routines, and what they told us matched what was recorded in peoples care records. Staff said the home provides a very good service. One staff member said, People are involved with everything in the home, including how the home is run, choosing shopping, menus, outings etc. They have a very full life with good activities. Another staff said, Diversity is what people are or think. We are very person centred and have lots of little meetings with people to check what they want. In the AQAA the manager said, Clients are involved at all stages and their independence is promoted by use of the independence and involvement page. This means that at any time we can be certain that we are doing all we can as a team to fully meet the stated needs and choices of each individual. We looked at three peoples care records. Each person has several documents that help identify their wishes and needs, which we have referred to as the care records. The care records have excellent information about peoples needs and aims, and have points of action that help the person achieve their aims. They are very detailed and are reviewed regularly to make sure the information is correct. The people we spoke to who live at the home were familiar with their care records and said staff talk to them about the help they need and what they would like to do. They told us about different things that they like to do and about other people who are important to them. All the information they talked about was recorded in their care records. Staff make daily notes about what people have been doing. The records are detailed and generally show how peoples needs are being met. However some things are not recorded so it is not always possible to tell from the records if peoples needs are always met. For example one persons care record said they should have a foot care session every Thursday evening. The manager said the person has a foot care session every week but it is not recorded in their daily notes. Care Homes for Adults (18-65 years) Page 14 of 31 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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 have an enjoyable and varied lifestyle. Evidence: People told us they enjoy living at The Crescent and do lots of different things. One person said they enjoy going out on their own and with other people who receive a service from St Annes. People told us they like going to their day services. On the first day of our inspection some people had gone to their day services, one person was visiting a relative with staff support, and others were going out to a planned afternoon activity. Daily notes told us that people go out on a frequent basis. When asked what the home does well, in the AQAA the registered manager said, The range of activities enjoyed by the people who live here is varied and individually tailored to increase their community presence and provide stimulation and personal development. Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: We received comments from two sources that suggested on occasions activities can be limited/cancelled because of staffing levels although they did not think it was a big problem. We received surveys from three relatives. They provided some very good feedback about the home. When asked what the home does well, one survey said, It is a very well cared for house. My relative is very happy there, and it has good food.. Another survey said, Looks after the people staying there very well indeed. And another survey said, A very happy home. One person talked about a new budgeting scheme that has recently been introduced and said it is very good. The manager said it is very successful and has given the person more independence and responsibility but enough support so they can live the lifestyle they choose. Routines are flexible and each person makes choices about their routine. We talked to people who live at the home about daily living skills. They told us staff do some jobs, which includes cooking meals, and they do other jobs such as setting/clearing the table and some cleaning around the home. Staff said the home is good at involving people in daily living and at promoting independence. In the AQAA the registered manager said, Meals are nutritious and varied and residents are supported to have a healthy diet as well as exercise personal rights to choose. Staff support clients to be adventurous in trying out new foods as well as promoting new and long established likes and dislikes. People who live at the home meet with staff once a week and decide what they would like to eat for the following week. A menu is written and it is recorded who has chosen which meal. People who live at the home then go shopping with staff. Any changes to the menus are recorded. The menus we looked at were nutritious and varied. People who live at the home said they enjoy the meals. Care Homes for Adults (18-65 years) Page 16 of 31 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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. Peoples health and personal care needs are very well met. Safe medication systems are in place but these are not always followed which could lead to medication errors. Evidence: People who live at the home said they get good support with personal care. One person said they manage their own care but staff will help when they ask. Another person said they like going shopping with staff to buy new clothes. People also said they get good support if they are unwell. Staff said the home is good at meeting peoples personal, healthcare and specialist needs. Personal profiles provide excellent information about how personal and healthcare needs should be met and identify what is important for the persons holistic well-being. Staff explained that one persons personal care needs have recently changed and they now use a shower rather than a bath. The persons care records clearly reflected the Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: changes. People have health action plans which identify how their healthcare needs should be met. The plans are very well written so everyone can understand each persons healthcare needs. People also have monitoring forms to make sure healthcare needs are being met. The forms showed us that people have regular involvement with healthcare professionals. We received extremely positive feedback from three healthcare professionals. They all said the care service always seeks advice and acts on it to meet peoples social and healthcare needs, and the care service always respects peoples privacy and dignity. One professional said, This service continues to provide outstanding care for residents. Care is efficient and competent but also compassionate. Another professional said, They treat their clients with the utmost respect and can always answer questions on their clients behalf if needed. To me the service seems excellent. And another professional said, They work in collaboration with other agencies and with a person centred approach. They show respect for the clients. We looked at medication systems. The medication storage area was clean, tidy and well-organised making it easy for staff to work carefully and efficiently. Prescriptions are routinely checked by staff before the medicines are delivered. This good practice enables staff to check for any omissions and changes to make sure all the correct medicines are received. Medication administration records (MARs) identify the number of stock that is held at the home and staff said they check the number of tablets to make sure they correspond with the MARs. The MARs are hand written but we found that some of the information recorded did not match what was written on the medicine container. One person was prescribed two types of painkillers. The instruction on the medicine container for each painkiller said they should take 1-2 tablets every 4-6 hours, and they may cause drowsiness. The handwritten MAR said for each painkiller, 2 tablets 3 x daily. This does not provide accurate instruction for administration. One person was prescribed a 50mg and 25mg dose of the same medication. This should be recorded as two administrations because they are different tablets but they were being recorded as one 75mg administration. A printed MAR would have prevented this from happening because it would have been recorded as two administrations. Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: CQC guidance states that printed MAR charts are not essential but they are better than handwritten charts. This is because there is less risk of error due to incorrectly transcribing the details from another document. But if a handwritten MAR is the only available option, there must be a robust system to check that the MAR is correct before it is used. We found that the current system is not robust. In the AQAA the manager said, Every member of permanent staff has completed the NCFE Safe Handling of Medicines training. Only permanent staff or those who have been assessed as competent can administer medication. Staff surveys said they are given training that gives then enough training about healthcare and medication. Care Homes for Adults (18-65 years) Page 19 of 31 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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 who live at the home are encouraged to talk about concerns and they are listened to. In the main, people are protected from abuse although incidents of physical aggression are not always seen as abuse which does not safeguard people. Evidence: Surveys from people who live at the home said they know who to talk to if they are unhappy and know how to make a formal complaint. Staff said the home has good systems in place to deal with any concerns. They said they would pass on any concerns to the manager and they are confident she would always take appropriate action. In the AQAA the manager said, There is a comprehensive compliments and complaints procedure that has been reviewed and updated this year. It is made available to people in an easy to read and pictorial form. Regular house meetings are held and staff regularly explain the procedure to people who live at the home and discuss aspects of their protection in different ways. People are regularly encouraged to express any dissatisfaction they might have and active steps are taken to resolve issues raised. The feedback we received confirmed that people are encouraged to voice opinions and talk about any concerns, however, we found evidence that occasionally incidents have taken place where a person who lives at the home has threatened or hit another person who lives at the home but this has not been managed as a safeguarding incident. Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: Staff were able to say what action they would take if they suspected abuse or had an allegation of abuse made to them. They were also able to describe the different types of abuse. The manager was familiar with safeguarding procedures although acknowledged that two incidents that took place in July 2009 and October 2009 should have been dealt with as safeguarding incidents. Another safeguarding incident occurred in 2008 where the safeguarding procedure was followed and managed appropriately. People who live at the home make a contribution of up to £60 a month towards the cost of the homes vehicle. Staff confirmed that everyone gets good use of the vehicle, and the vehicle is used on a very regular basis. The vehicle records do not show who has travelled in the vehicle so it is not possible to establish whether people are getting value for money. We looked at financial systems for people who live at the home and found that these are satisfactory. Monies are stored securely in a safe. We checked personal allowances for two people and their balance sheets and monies were correct. Care Homes for Adults (18-65 years) Page 21 of 31 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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 live in a pleasant, well equipped, clean, comfortable and safe environment. Evidence: Surveys from people who live at the home told us the home is always clean and tidy. One person said it is nice and clean, another person said the home is good because it is clean and tidy. In the AQAA the manager told us, The home is clean, comfortable and safe. Each person living here has been able personalise their bedroom and have a say about the decor of communal areas. There is an Infection Control risk assessment and staff are vigilant about prevention of infection. Staff have completed Infection Control training. When we looked around the home it was clean, tidy and appeared to be well maintained. Shared areas including the kitchen, two lounges and two bathrooms are generally well decorated, furnished and equipped although wallpaper was coming away from the wall in one bathroom. The manager was aware of this and said it would be sorted promptly. People said they are happy with their bedrooms and staff always knock before they go in. Bedrooms are decorated and furnished to peoples personal tastes. Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: In the AQAA the manager gave us good examples of how they meet peoples individual needs. They said, Each persons own room has equipment individually assessed for them if required. Within communal rooms equipment is also provided that meets the assessed needs of each person. For example a range of differently sized armchairs to suit differently sized people. We removed a door handle and replaced it with a knob to meet particular circumstances. There is an assisted bath so that people can choose to bath or shower and both shower rooms have walk in showers. We saw various aids and adaptations when we looked around the home. Care Homes for Adults (18-65 years) Page 23 of 31 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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 receive good quality care that is delivered by a competent and caring staff team. Evidence: We received very positive information about everyone who works at the home. People who live at the home said they are happy with the staff. One person said, The staff are lovely. They help me. Its great. Another person said, We just have to ask and they help us. A relative survey said, I am very happy with the management and staff care at the Crescent and my relative receives the best possible attention. Another relative survey said, The staff are very good indeed. A health professional survey said, I have always found them ready to engage with enthusiasm and with the residents best interests at the fore. We spoke to three staff and received three staff surveys. Everyone said the staff team has a good understanding of their role and works very well together. Staff said staffing levels are satisfactory. In the AQAA the manager said, We have an adequate, well trained and diverse staff team with a balance of skills, knowledge and experience so that we can meet peoples needs. The home is staffed to meet peoples needs and shifts are flexible so that we Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: can nearly always accommodate unusual outings and holidays etc. In the AQAA they also said 50 of the staff team have NVQ level 3. We talked to staff about training. Everyone said they have received all the necessary training in the last twelve months and staff records confirmed that staff have attended a varied range of training courses. It was difficult to tell if all staff have completed all the relevant training because training is only recorded on an individual record so we would need to look at every record to establish if all training is up to date. The manager said she is in the process of introducing a new system that will show that the teams training needs are met. The manager said she discusses training with each staff member during individual supervision. Supervision records confirmed this. In the AQAA the manager said all the people, who have started work in the home in the last 12 months have had satisfactory pre-employment checks. One staff who has started work said they had gone through a thorough process and could not start work until all the checks had been completed. Staff surveys also said their employer carried out checks, such as a criminal check and references, before they started work. We did not look at pre-employment records because these are held at St Annes head office. Care Homes for Adults (18-65 years) Page 25 of 31 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. 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 is very well managed which has resulted in people receiving very good care that meets their needs. Some information has not always been passed to relevant agencies so a multi disciplinary approach has not always been used, which could lead to people not receiving the best support. Evidence: The registered manager is fully qualified and very experienced in the management of care services. She has been the registered manager of the home for a number of years. The manager was present during the inspection and it was evident from discussions and observations that she knows people very well and has a good understanding of person centred care. People who live at the home told us they see the manager a lot and talk to her about what they like to do. Staff told us they are very happy with how the home is managed. They said she is approachable and provides good leadership. Everyone said Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: they feel very supported. People who live at the home said they have meetings and talk about the house, meals and outings. Everyone said the manager and staff listen when they make suggestions. Staff said the home is good at measuring quality and monitoring the quality of the service. In the AQAA the manager said everyone works together to complete their team plan that gives a focus for improvements over the annual cycle. At least once a month a representative of the organisation should visit the home to make sure it is being properly managed. These are called Regulation 26 visits. A report of the visits should be kept at the home so they can implement any recommendations and use the visit reports as part of their quality monitoring process. The last visit report available was dated September 2008. Staff and the manager said the area manager visits very regularly and is good at monitoring the service although they had not seen the visit reports. The visitors book confirmed that the area manager has visited the home regularly. The home must tell CQC about any event which affects the well-being or safety of any person who uses the service including any serious incidents of threatening or challenging behaviour in which a person is harmed or at risk of harm. St Annes has notified us of some significant events but they have not told us about two of the incidents that we referred to earlier in the report. In the AQAA the manager told us they do monthly safety checks of the building to make sure it is safe and gave us examples of what they do. We looked at health and safety records and spoke to staff, which confirmed good systems are in place that make sure health and safety is properly managed. A food hygiene visit was carried out by the local authority in October 2008. The manager said the recommendations in the report have been met. Care Homes for Adults (18-65 years) Page 27 of 31 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 Adults (18-65 years) Page 28 of 31 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 1 20 13 Arrangements must be put in place to ensure that all prescribed medication is administered correctly as directed by the prescribers instructions. This will help to make sure that peoples health and wellbeing is improved and maintained. 31/12/2009 2 23 13 Incidents of threatening or challenging behaviour that affect other people who live at the home should be managed through safeguarding procedures. This will make sure people at the home are safeguarded. 31/12/2009 3 42 37 The Care Quality 31/12/2009 Commission (CQC) must be notified of significant events that affect the health and welfare of people who live at the home. Page 29 of 31 Care Homes for Adults (18-65 years) 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 This will make sure the regulatory authority receives appropriate information and can monitor the health and welfare of people who are living at the home. 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 6 23 Daily records should contain enough information to show that peoples care needs are being met. Use of the homes vehicle should be more carefully monitored. This will make sure people who pay for the vehicle are getting fair access and value for money. Regulation 26 visits reports should be made available in the home. This will help make sure the quality of the home is properly monitored. 3 39 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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. 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