Care Home: Crest House Care Home

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What the care home does well The registered provider/manager ensures that she obtains detailed preassessments from prospective residents and these are used to assess if they home can meet the needs of the prospective resident and are also used to form the basis of an individual care plan. Care plans are informative and give staff good guidelines as to the level of care that meets the resident`s assessed needs. The home has good relationships with all external health care professionals, and residents` health care is well met. Staff were observed respecting the residents rights to privacy and dignity, and all personal hygiene care is carried out discreetly. There are a variety of activities on offer in the home and residents` are able to choose if they wish to participate or not. Links with the community are good and will improve even more once all the residents are registered to a transport service that caters for frail elderly and those who are disabled. Meals in the home offer residents` a varied, balanced and nourishing diet, and residents` have choices at all mealtimes. Special diets are catered for. Residents` and their visitors are aware of the complaints policy and procedure, and stated that they knew how to complain should the need arise. Crest House is welcoming and homely, and all rooms are in excellent decorative condition. The home is very clean and there are no offensive odours. There is a high standard of hygiene throughout, and attention to infection control procedures. Staff morale in the home is high, and there is very little staff turnover. During this key inspection the inspector received positive comments from residents and relatives about the registered provider/manager and this is reflected throughout this report. What has improved since the last inspection? The home provides a warm, comfortable and safe place for the residents` to live. All communal rooms and bedrooms are decorated and furnished to a high standard. Staff recruitment has improved since the last key inspection, and staff are appropriately vetted, by the registered provider/manager following up on references and obtained Protection of Vulnerable Adults register checks and Criminal Record Bureau checks. Window restrictors and hot water thermostatic control valves are provided throughout the home. CARE HOMES FOR OLDER PEOPLE Crest House Care Home 6-8 St Matthews Road St Leonards On Sea East Sussex TN38 0TN Lead Inspector June Davies Unannounced Inspection 15th April 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Crest House Care Home DS0000021080.V361081.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Crest House Care Home DS0000021080.V361081.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Crest House Care Home Address 6-8 St Matthews Road St Leonards On Sea East Sussex TN38 0TN Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01424 436229 `F/P` 01424 436229 cresthouse@btconnect.com Mrs Josephine Crawford Mrs Josephine Crawford Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Crest House Care Home DS0000021080.V361081.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The maximum number of service users to be accommodated is twenty-five (25) Service users must be older people aged sixty-five (65) years or over on admission 22nd June 2007 Date of last inspection Brief Description of the Service: Crest House is a care home registered to accommodate a maximum of 25 older people. The premises are a detached property set in its own grounds in a quiet residential area of St. Leonards on Sea. Local shops are nearby and bus routes run close to the Home. The nearest railway station is approximately half a mile away. The Home provides seventeen single bedrooms and four double rooms, currently used as singles, all rooms have en-suite facilities. The Home has steps up to the front entrance but there is also a sloped pathway and level access throughout the building, enabling wheelchair access. There is a passenger lift to all floors. Two conservatories, and a sitting room provide communal space. There is also a garden to the front of the Home and a paved area with raised flowerbeds, accessible from the conservatories. The Home welcomes prospective residents or their representatives to view the premises and discuss their needs with the Manager. Weekly fees, as at 3/05/06, range from £380 - £475. The fees include residents UK telephone calls but exclude hairdressing, chiropody, and any sundries. Information about the service, including the Commission’s inspection report, is available from the Manager on request. Crest House Care Home DS0000021080.V361081.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means that people who use this service experience good quality outcomes. This key inspection was carried out on the 15th April 2008 over a period of 7 hours. During this key inspection the inspector spoke with the registered manager, head of care, residents, staff and visitors to the home. A tour of the premises took place, there was an audit of medication and all relevant documentation relating to the key standards inspected was viewed. The inspector also took into consideration information obtained through the Annual Quality Assurance Assessment (AQAA) that was sent to CSCI prior to this key inspection. There was one outstanding requirement from the previous inspection relating to the registered provider/manager ensuring that a good quality assurance system is set up in the home, that will seek the views of the residents, relatives, friends and external stakeholders as well carrying out monthly monitoring of systems used in the home, and ensuring that Health and Safety and Fire risk assessments are carried out throughout every room in the home as well as externally. That a final report is published of the quality assurance findings and that this is made available to residents’, relatives, friends and to CSCI. What the service does well: The registered provider/manager ensures that she obtains detailed preassessments from prospective residents and these are used to assess if they home can meet the needs of the prospective resident and are also used to form the basis of an individual care plan. Care plans are informative and give staff good guidelines as to the level of care that meets the resident’s assessed needs. The home has good relationships with all external health care professionals, and residents’ health care is well met. Staff were observed respecting the residents rights to privacy and dignity, and all personal hygiene care is carried out discreetly. There are a variety of activities on offer in the home and residents’ are able to choose if they wish to participate or not. Links with the community are good Crest House Care Home DS0000021080.V361081.R01.S.doc Version 5.2 Page 6 and will improve even more once all the residents are registered to a transport service that caters for frail elderly and those who are disabled. Meals in the home offer residents’ a varied, balanced and nourishing diet, and residents’ have choices at all mealtimes. Special diets are catered for. Residents’ and their visitors are aware of the complaints policy and procedure, and stated that they knew how to complain should the need arise. Crest House is welcoming and homely, and all rooms are in excellent decorative condition. The home is very clean and there are no offensive odours. There is a high standard of hygiene throughout, and attention to infection control procedures. Staff morale in the home is high, and there is very little staff turnover. During this key inspection the inspector received positive comments from residents and relatives about the registered provider/manager and this is reflected throughout this report. What has improved since the last inspection? What they could do better: While medication is generally well managed the practice of placing boxed medication into weekly dosset boxes must cease, and dividers must be placed between each residents monthly administered record, this divider should also have a recent photograph of the resident attached to it. The staff application form must require the full employment history of the applicant and there should be written explanations for any gaps in employment. Crest House Care Home DS0000021080.V361081.R01.S.doc Version 5.2 Page 7 Staff mandatory training must be kept up to date and all staff must receive mandatory training within the first six months of their employment. The quality control system must be implemented within the home to ensure that all residents are receiving the bests standards of care. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Crest House Care Home DS0000021080.V361081.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Crest House Care Home DS0000021080.V361081.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3 and 6 People using this service experience good quality outcomes in this area. Residents move into the home knowing that their needs can be met and that their independence will be maximised and promoted. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager confirmed that she carries out an assessment of all residents prior to admission. The inspector viewed pre-admissions assessments and found that they contained sufficient information on which the registered manager would be able to judge if the home could meet resident’s care needs. The information contained within these pre-admission assessments related to physical care needs, personal care needs, mental health, dislikes and preferences and provided sufficient information on which to base plans of care. Crest House Care Home DS0000021080.V361081.R01.S.doc Version 5.2 Page 10 Two residents stated, ‘I do things for myself, but staff are always available to help when I need them.’ ‘Staff know what I need help with, they are very kind.’ The home does not offer intermediate care. Crest House Care Home DS0000021080.V361081.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10 People using this service experience good quality outcomes in this area. Residents’ know that their personal goals are reflected in their individual plans and that potential risk is managed. The care planning system is clear and consistent which adequately provides staff with the information they need to satisfactorily meet the residents’ needs. The health needs of residents’ are well met with evidence of good multi disciplinary working taking place on a regular basis. The medication at this is home needs to improve to ensure that residents’ are not placed at risk. Personal care is offered in a way that protects residents’ privacy and dignity and promotes independence. This judgement has been made using available evidence including a visit to this service. Crest House Care Home DS0000021080.V361081.R01.S.doc Version 5.2 Page 12 EVIDENCE: Care plans viewed for three residents’ show that they were all based on the pre-admission assessment and added to as they staff get to know the residents’. Each care plan has risk assessments that are individual to the residents’ and also generic risk assessments relating to mobility and moving and handling. One resident has an exercise bicycle in their room, which he/she uses regularly and a comprehensive risk assessment relating to this is available in this resident’s care plan. There is evidence in each care plan that they are reviewed on a monthly basis. Care plans are signed by the resident and/or their relative, close friend or solicitor. Each care plan has a personal hygiene care chart, and this is signed by staff regularly when carrying out personal hygiene tasks for the resident, such as bathing, washing, hair care etc. None of the residents’ in the home have pressure areas, and the care manager stated that if there were concerns, staff would report immediately to the district nurse. There is evidence of good recording in relation to external health care professionals who visit individual residents and these visits are recorded in the daily record. Residents’ nutrition is monitored on a regular basis, with each resident being weighed each month. Where a resident is experiencing hearing problems an audiology test is arranged. Residents’ have the opportunity for regular weekly exercise with Music to Movement every Tuesday. Two residents said, ‘I could not wish for better care than I receive in this home, I can always see my doctor when I need to.’ ‘I have seen my Dr. recently, I have had my eyes tested since I have lived here, and I see the chiropodist regularly.’ One relative said, ‘My mothers health has improved tremendously since she has been in this home.’ Another relative said, ‘Mother has gained in confidence since she has lived in this home.’ An audit was carried out of medication in the home. Monthly Administration Records were all signed and showed that medication has been administered according to the prescribed times. The inspector did note that medication delivered to the home in boxes and not in blister packs was placed into weekly dosset boxes, which were in the process of being filled by the head of care and a carer, this can cause problems where a resident chooses not to take a medication placed into this box, as to how the staff would identify the tablet that the resident does not wish to take. The guidelines from the Royal Pharmaceutical Society states ‘Some care providers who have been unable to get medicines in the Monitored Dosage System have allowed care workers to re-package medicines in compliance Crest House Care Home DS0000021080.V361081.R01.S.doc Version 5.2 Page 13 aids. This is also known as ‘secondary dispensing’. Repackaging of medicines by care workers should not take place in care homes. The risk of making a mistake is too great.’ While the home does not use any controlled drugs the medication cupboard does contain an appropriate controlled drugs cupboard. Policies in regard to the administration of medication will need to be reviewed in relation to the requirement being made. There is an up to date list of staff trained to administer medication together with a sample of their signatures. Monthly administration records should also have a divider sheet between each residents MAR sheet/s and should contain a recent photograph. Throughout this key inspection the inspector observed that care staff respect the residents’ rights to privacy and dignity, and ensure that toilet, bathroom and bedroom doors are closed whilst personal hygiene care is being carried out. All residents’ in the home have their own private telephone in their bedroom. The manager confirmed that residents’ see their doctor or any other professional in the privacy of their own bedroom. Two residents’ said, ‘The care staff are very good, I do not need much help, but I do need help to bathe and the care staff always ensure that the bathroom door is closed.’ ‘I do need some help from staff, but I never feel embarrassed, they always make sure they do the right thing.’ Crest House Care Home DS0000021080.V361081.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 People using this service experience good quality outcomes in this area. Activities and links with the community are good and support and enrich residents’ social opportunities. The meals in this home are good offering both choice and variety and catering for special diets. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents are able to make choices in regard to their daily living, when to get up and when to go to bed. There are many activities in the home that residents can participate in if they wish to. The inspector noted that residents are able to have their own choice of newspapers and magazines, large print and ordinary print books are available via the library service. Some of the activities on offer are Tuesdays – Music to Movement; Saturdays – making flowers, making jewellery, painting and drawing; a knit and chatter activity, Crest House Care Home DS0000021080.V361081.R01.S.doc Version 5.2 Page 15 where some of the residents make jumpers for children in Africa. Bingo is played weekly and the home has a variety of board games. One game particularly enjoyed by the residents is called ‘Doreen’s Day Out’. At the present time the registered provider/manager is in the process of signing up to ‘Catch the Hat’, which is a transport service similar to ‘Dial a ride’ but especially for frail elderly, disabled people including those who need to access the community in wheelchairs. This is being arranged to enable residents’ to get out more as and when they wish to. Two residents’ go to their local church on a regular basis. A curate from the local church visits the residents’ regularly, and residents’ spoke highly of him, saying that when he visited they always had a nice chat and a laugh. A Roman Catholic priest visits one of the resident’s on a regular basis. For several years now the home has arranged for funeral service for resident’s who have passed away to be held in the home. The residents’ in the home appreciate this as many of them would not like to attend the crematorium as they see it a very impersonal. Families seek permission from the registered provider/manager for a funeral service to be carried out in the home. A communal lounge, dining room and conservatory are made into a small chapel on these occasions. While residents’ can make the choice about attending a funeral service in the home, many of them wish to do so. A relative said ‘I do wish they would organise for my mother to get out more.’ The majority of residents’ in the home have made arrangements of their next of kin or solicitor to manage their finances for them. At the present time none of the residents’ need to access an advocacy service, but the registered provider/manager said that she would find this service should the matter arise. From a tour of the home the inspector noted that residents’ are encouraged to personalise their own bedrooms with small items of furniture, ornaments, pictures and photographs. Residents ‘are able to have access to their own care plans if they wish to and in accordance with the Date Protection Act 1998. The communal dining room and communal lounge are open plan. Tables are nicely set and look attractive, with a small vase of natural looking silk flowers on each table. Staff ask each resident what their choice of meal is, and this is done on a daily basis and recorded into a menu book. The lunch time menu on the day of this key inspection was – braised pork steaks, potatoes and fresh vegetables or cheese and egg salad, and another alternative if a resident did not like this choice, the sweet was – fruit crumble and custard, cheese and biscuits, jelly or yoghurt. Supper is a cooked dish or a sandwich, whichever each resident prefers. There are two roast meals on the menu each week. None of the residents’ require liquidised meals. The home does cater for diabetic and low fat diets. Mealtimes are unhurried and residents’ are able to take their time eating their meal. Crest House Care Home DS0000021080.V361081.R01.S.doc Version 5.2 Page 16 Crest House Care Home DS0000021080.V361081.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 People using this service experience good quality outcomes in this area. Residents know their complaints will be listened to. Staff have a good knowledge and understanding of adult protection issues, which protects the residents’ from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints policy and procedure is displayed in the entrance hall and is included in the statement of purpose and service user guide. There has been one complaint to the home since the last inspection, and this has been appropriately logged in the complaints book together with the investigations and response to the complainant. Residents’ spoken with said that they would know how to complain, but had no reason to do so. There have been no adult protection issues since the last key inspection. The home has regularly reviewed policies and procedures for the safeguarding of vulnerable adults together with the local authority Multi-Agency Policy and Procedures for Safeguarding Vulnerable Adults. The whistle blowing policy and procedure has been reviewed. All staff are made aware of these policies Crest House Care Home DS0000021080.V361081.R01.S.doc Version 5.2 Page 18 and procedures when starting work at the home and are also made available to existing staff who have access to the policies and procedures files. The majority of staff have received Protection of Vulnerable Adults training. The registered provider/manager ensures that they receive POVA first checks and Criminal Records Bureau checks prior to new staff starting employment. Small amounts of personal monies are kept in the home for some of the residents, and this is properly managed and kept safely in the home. There is a policy and procedure in place relating to ‘Gifts for Staff’. Crest House Care Home DS0000021080.V361081.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26 People using this service experience excellent quality outcomes in this area. The standard of the environment is excellent providing residents with a comfortable, attractive and homely place to live. Staff adhere to infection control procedures to ensure that residents are not placed at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The location and layout of the home is suitable for its stated purpose. The home provides a comfortable and homely place for the residents to live. From a tour of the building the inspector found that maintenance is carried out on a Crest House Care Home DS0000021080.V361081.R01.S.doc Version 5.2 Page 20 regular basis. Both communal rooms and bedrooms are decorated and furnished to a high standard. The back garden is safe and secure and laid as a paved patio area, with plants in pots, and residents have free access if they choose, to this area. The home complies with the requirements of the local fire safety officer and a recent visit from environmental health proved excellent. Bathrooms and toilets are fitted with suitable aids. All rooms in the home have call bells in situ. Hot water outlets are fitted with thermostatic control valves. The whole premises is clean and hygienic and there are no offensive odours. There are systems in place throughout the home to prevent the spread of infection. Staff are provided with sufficient facilities for hand washing and liquid soap and paper hand towels are provided. Staff are also provided with disposable aprons and disposable gloves to be used for personal hygiene tasks. Clinical waste is placed into the appropriate yellow sack and then put into the external clinical waste bin. The laundry has an industrial washing machine with sluicing programmes and an industrial tumble drier. The laundry room was clean and well ordered and in good decorative order. Policies and procedures are in place for the control of infection, and dealing with spillages. Crest House Care Home DS0000021080.V361081.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 People using this service experience good quality outcomes in this area. Staff morale is high resulting in an enthusiastic workforce that works positively with the residents’ to improve their whole quality of life. Staffing numbers are kept under review to ensure that the assessed needs of the residents’ are met. Recruitment practices are good ensuring the residents’ receive care from appropriately vetted staff. Staff training needs to improve to ensure that staff have the skills and knowledge to ensure that residents’ are cared for safely at all times. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There are only 15 residents’ residing in the home at the present time although the home is registered for 25. Crest House Care Home DS0000021080.V361081.R01.S.doc Version 5.2 Page 22 Staff rotas showed that there are two staff on duty throughout the day as well as the care manager (during day time shifts), sufficient staff are on duty to meet the needs of the residents’. Two residents’ said – ‘There are always enough staff are duty.’ The staff are always there when we need them.’ Due to the low numbers of residents’ at the moment the registered provider/manager does not employ any domestic staff, but this is being kept under review. Two cooks are employed in the home. 41 of care staff have an NVQ qualification with further staff hoping to achieve this qualification in the near future. The inspector viewed the files of three staff and found that the application form needs to be updated to ensure that it requires a full employment history. All files had appropriate Criminal Records Bureau checks and Protection of Vulnerable Adult First checks, two written references and two forms of identification in each file. New members of staff are given the General Social Care Council code of conduct. From the training certificates seen at this key inspection is was found that the following staff have received up to date training for Moving and Handling 75 ; Fire Safety 75 ; Food Hygiene 55 ; First Aid 33 ; Infection Control 66 ; Medication 50 ; POVA 55 . A requirement has been made for all staff to complete or update their mandatory training. The care manager was able to show the inspector a recently acquired ‘Skills for Care’ induction pack, purchased from a training agency, but to date this has not been used, as the home has had no new staff to induct since the purchase of this induction pack. Crest House Care Home DS0000021080.V361081.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35 and 38 People using this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered provider/manager and care manager have City and Guilds advance Management Course and the Care Manager has a training qualification, which allows her to train staff in moving and handling. Residents’, staff and visitors’ spoke highly of the management in the home, and praised the homely and welcoming atmosphere that is created within the home. Two residents’ said – ‘The manager is very good, she is sensitive to all Crest House Care Home DS0000021080.V361081.R01.S.doc Version 5.2 Page 24 our needs.’ ‘I cannot speak too highly of the manager she is a lovely person, and her caring attitude is passed onto the staff.’ The quality assurance system needs to be developed further to ensure that there is a good quality monitoring system in place. The last resident surveys were carried out in 2007 and there was also a Christmas and New Year Food Survey carried out in 2007. While relative quality questionnaires are available in the main hallway of the home, none of the relatives have responded, and the registered provider/manager needs to be more pro-active in ensuring that she seeks the views of relatives and friends who visit the residents’. No surveys have been carried out with external stakeholders such as General Practitioners, District Nurses, Care Managers, Chiropodists, Opticians, Dentists, the hairdresser, and visiting entertainers or any other person who visits the home in a professional capacity. There is no monthly recording of monitoring of systems used in the home – care plans, reviews, daily records, medication, cleaning, food cooking and presentation etc. The registered provider/manager needs to ensure that a regular Health and Safety and Fire risk assessments are carried out in every room in the home and also externally and that these are recorded. Residents’ meetings are held monthly and a raffle is included with this meeting, this raffle raises money and residents’ decide what they wish to do with the money. Once this quality assurance system is set up within the home the results must be published and made available to the residents’, relatives and CSCI. The above has an outstanding requirement from the previous key inspection on 22nd June 2007 with timescale of 10/07/07 not met, for a good quality assurance system to be developed at Crest House, the results of which must be published with a copy forwarded to CSCI. Failure to comply with this requirement can lead to enforcement action being taken. No personal allowances are managed by the registered provider/manager, but relatives from time to time bring in small amounts of money for their resident to pay for chiropody and hairdressing. Each resident has their own cashbook and all incoming and outgoing money is recorded in this book, where money is spent receipts are retained. Both monies and cash books are kept safely and securely in the home. From information contained within the Annual Quality Assurance Assessment and this Key inspection all appliances used in the home have up to date maintenance certificates. Fire points are checked weekly and records kept. Emergency lighting was last tested in February 2008. The registered provider/manager has had thermostatic control valves fitted to all hot water outlets, but hot water temperatures are not regularly checked and temperatures recorded. Crest House Care Home DS0000021080.V361081.R01.S.doc Version 5.2 Page 25 Windows are fitted with opening restrictors. Regular Legionella checks are carried out by the home. The home has an accident book and staff record all accidents to residents appropriately. Health and Safety policies and procedures are regularly reviewed. Crest House Care Home DS0000021080.V361081.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 4 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 1 X 3 X X 3 Crest House Care Home DS0000021080.V361081.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13 (2) Requirement The registered person must ensure the receipt; storage, administration and return of medication should be within the Royal Pharmaceutical Guidelines for Care Homes, in that medication should not be secondarily dispensed into compliance aids. There should be a divider between each resident’s monthly administration records, with a recent photograph of the resident attached. The registered person must ensure that the application requires a full employment history and that there is a written explanation of any gaps in employment. The registered person must ensure that all staff complete and update their mandatory training this includes, moving and handling, fire safety, first aid, food hygiene, infection control, POVA and medication. The registered provider will DS0000021080.V361081.R01.S.doc Timescale for action 09/06/08 2. OP29 Schedule 2 (6) 09/06/08 3. OP30 18(1)(a) 07/07/08 4. OP33 24(1) 07/07/08 Page 28 Crest House Care Home Version 5.2 (2)(a-c) implement a good quality control system and make the Annual Quality Monitoring Assessment available to the commission RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP25 Good Practice Recommendations While all hot water outlets in the home are fitted with thermostatic control valves, delivering hot water at 43ºC, these should be regularly monitored and recorded, and any adjustments made when water is delivered below or above this temperature within 2ºC Crest House Care Home DS0000021080.V361081.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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