Care Home: Crest Lodge

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What the care home does well Written information regarding the services and facilities provided by the home was up to date to provide prospective individuals and their representatives the appropriate information in order that they could make an informed choice about receiving care and support from the homes staff. The admission and assessment procedures ensure that prospective residents needs are fully identified to ensure staff have the skills and abilities to meet the individuals needs. The support and personal care that residents receive has been maintained and is based on the residents needs set out in their care plans. The monitoring of risk assessments has been maintained and well managed to ensure the safety of residents. Residents are encouraged to maintain bonds with family and friends and take part in social, cultural, religious and recreational activities and some residents are involved in the running of their home. Residents health care needs continue to be well met and the home provides a healthy and balanced diet. All areas of the home are clean. Residents care plans are up to date and the provision of personal care and support are well documented. Safe medication procedures support and promote residents safety and well being. The homes continue to be run in the best interests of the residents and their views and opinions and those of others associated with the home are sought. Residents welfare is promoted through monitoring of health and safety in the home. What has improved since the last inspection? All requirements made at the last inspection have been met. Residents rights to privacy and confidentiality have been improved. Residents have been more involved in menu planning and their choices more fully promoted regarding their meals. Improved procedures and policies are available in the home to promote the protection of residents from harm and to promote an open culture of raising complaints or concerns about the home. Improved suitable and appropriate bathing facilities have been provided to meet and promote the safety and well being of residents. The redecoration programme has benefited the residents to make their environment more homely. The homes induction, mandatory training and supervision of staff have improved to ensure that residents needs are met appropriately and safely. The recruitment practises of the home have improved to promote the protection and safety of residents. The management and administration of the home has been strengthened. What the care home could do better: Improvements need to be made regarding staff actively engaging with residents to assist and support them in achieving and aspiring to meet their goals. Residents are supported to exercise some choice in their daily lives yet this needs to be further developed to support residents to maintain their skills and abilities of daily living. Key inspection report Care homes for older people Name: Address: Crest Lodge Churt Road Hindhead Surrey GU26 6PS     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: Suzanne Magnier     Date: 0 7 1 2 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 Older People Page 2 of 33 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 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 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 Older People Page 3 of 33 Information about the care home Name of care home: Address: Crest Lodge Churt Road Hindhead Surrey GU26 6PS 01428605577 01428609234 crestlodge@carehomesofdistinction.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr L Hasham care home 33 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 past or present alcohol dependence past or present drug dependence mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users to be accommodated is 33. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Mental disorder, excluding learning disability or dementia (MD) Past or present alcohol problem (A) Past or present drug problem (D). Date of last inspection Brief description of the care home Crest Lodge is a large detached property located in Hindhead close to the amenities of Beacon Hill. The home is owned by Care Homes of Distinction and provides accommodation and nursing care to up to thirty three adults with mental health needs. The accommodation is arranged over two floors with the first floor being accessed by Care Homes for Older People Page 4 of 33 Over 65 0 0 0 33 33 33 1 5 0 1 2 0 0 9 Brief description of the care home stairs or passenger lift. All bedrooms are single and all have en suite facilities. There are appropriate numbers of bathrooms and separate shower rooms throughout the home. Communal facilities include a lounge, two dining rooms and a designated smoking room. The home has its own transport to support residents to access the local and wider community. There is a limited parking area at the home as attractive shrubs surround the building. A public bus stop is close by. The home has a patio area where residents can sit outside and enjoy their gardens. Crest Cottage is registered in conjunction with Crest Lodge to provide a transitional service between residential care and independent living to four individuals. The cottage has been refurbished and arranged into four self contained flats with a member of staff available to individuals througout a twenty four hour period. The home is located in the grounds of another registered service owned by Care Homes of Distinction yet is managed independently of the service apart from the catering provision. Care Homes for Older People Page 5 of 33 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 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: The Quality rating for the service is 2 star. This means that the people who use this service experience good quality outcomes. This report relates to the inspection of Crest Lodge and Crest Cottage and was an unannounced Key Inspection. Ms S Magnier Regulation Inspector carried out the inspections which in total consisted of six hours in Crest Lodge and two hours in Crest Cottage. As part of the inspection the commission invited an expert by experience from Help the Aged to be part of the visit for three hours to speak with residents and people visiting Crest Lodge about their experiences of the home. The expert by experience produced a report and the findings have been included within this document. For the purpose of the report the individuals using the service are referred to as Care Homes for Older People Page 6 of 33 residents. The home had submitted their Annual Quality Assurance Assessment AQAA prior to the inspection, which was well written to inform the commission about the services and some details of document have been added to the report. The inspection was a thorough look at how well the homes are doing and took into account detailed information provided by the home and any information that the commission has received about the services since the last inspection on the 15th January 2009. The information contained in this report was gathered from speaking with a number of residents and care staff during the inspection. The commission received responses to questionnaires sent prior to the inspection which included eight from residents, four from health care professionals and nine from staff the comments of which have been included within the report. The inspector looked at how well the services were meeting the national minimum standards for Older People and has in this report made judgements about the standard of the services. Documents sampled prior and during the inspection included the homes Annual Quality Assurance Assessment AQAA, the homes Statement of Purpose and Service User Guide, residents care plans, risk assessments, medication procedures, staff files, a variety of training records, health and safety records and several of the organisations policies and procedures including the complaints and safeguarding procedures. No complainant has contacted the Commission with information concerning a complaint made to the service since the last inspection. One recent safeguarding referral regarding Crest Lodge had been investigated by the local authority multi agency safeguarding team and had been satisfactorily concluded. From the evidence seen by the inspector and comments received, the inspector considers that the home continues to be able to provide a service that meets the needs of people who have diverse religious, racial or cultural needs. The final part of the inspection was spent giving feedback to the registered manager by the inspector and the expert by experience regarding the findings of the visit. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? All requirements made at the last inspection have been met. Residents rights to privacy and confidentiality have been improved. Residents have been more involved in menu planning and their choices more fully promoted regarding their meals. Improved procedures and policies are available in the home to promote the protection of residents from harm and to promote an open culture of raising complaints or concerns about the home. Improved suitable and appropriate bathing facilities have been provided to meet and promote the safety and well being of residents. The redecoration programme has benefited the residents to make their environment Care Homes for Older People Page 8 of 33 more homely. The homes induction, mandatory training and supervision of staff have improved to ensure that residents needs are met appropriately and safely. The recruitment practises of the home have improved to promote the protection and safety of residents. The management and administration of the home has been strengthened. 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 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 9 of 33 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 10 of 33 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents have up to date information about the homes services and facilities in order that they can make an informed choice about moving into the home. The admission and assessment procedures ensure that residents needs are appropriately identified. The home does not offer intermediate care. Evidence: The Statement of Purpose and Service User Guide were sampled as a combined document for Crest Lodge and Crest Cottage. Both documents were up to date and written in plain English to describe the facilities and services offered by the registered service. It is suggested that the information within the documents regarding Crest Cottage be documented separately yet remain within the same document in order that the reader has clarity regarding the individual services. The AQAA identifies that the home have improved by inviting prospective residents for Care Homes for Older People Page 11 of 33 Evidence: several visits to the home to offer prospective residents the opportunity to familiarise themselves with the home. Two care plans of residents who had been recently admitted to the home were sampled and evidenced that well documented assessments had been made by the registered manager to ensure that the needs of the resident could be met by the homes staff. The home does not offer intermediate care. Care Homes for Older People Page 12 of 33 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. The support and personal care that residents receive has been maintained and is based on their needs set out in their care plans. Improvements need to be made that staff actively engage with residents to assist and support them to achieve and meet their goals. The monitoring of risk assessments has been maintained and continues to be well managed to ensure the safety of residents. Residents rights to privacy and confidentiality have been improved. Safe medication procedures support and promote residents safety and well being. Evidence: Three care plans were sampled and it was evident that those residents newly admitted to the home had had their care plan developed from the pre assessment documentation. The care plans were well written to allow the reader to gain an overview of the persons medical, emotional, social and lifestyle preferences. There was evidence to support that residents had been involved in the content of their plans and had been encouraged to maintain an interest and where possible sign the plans. Care Homes for Older People Page 13 of 33 Evidence: The staff team have remained consistent and comprise of a multi racial mixed gender staff group. The registered manager advised that there have been some new staff and that where possible gender based care is provided and staff continue to be aware of residents individual preferences. It was observed that in general staff supported residents in a sensitive way ensuring the residents rights to privacy and dignity. The expert by experience reported that they observed a resident being supported kindly and respectfully by a staff member and that there was an atmosphere of involvement and care pervading in the home. There seemed to be exceptional understanding and patience exercised by the staff in their approach to the residents. There was no apparent tension or need to hurry and in general there was a positive approach to listening to the residents and giving residents time to think through situations without haste. The three care plans and health care reports sampled were well documented and included records of attended health care appointments which included visits by the resident to their general practitioner and other visits from health care professionals. The care plans evidenced that residents care and health needs are regularly reviewed and where necessary specialist health care professionals are consulted regarding the best interests of the resident. Written comments received from health care professionals included that the home always ensures residents who require my services have the opportunity to see me. What they could do better is to employ more English speaking staff as unsafe communication for example if medication needs changing or instructions are not always understood. The staff manage a range of problematic behaviours, provide good responses to situations preventing escalation and management of risk and maintain good communication. The expert by experience reported that one resident was delighted to tell them that they shave every day. The expert by experience complimented the resident on their smart appearance and the resident explained that someone helps me, they are so kind. Residents written comments about the care they receive included Crest Lodge provides a nice place to live, the administration is good and the food I appreciate it, its good to be here. They take all the responsibility to cater for me. They make my stay happy but I would like to see the GP more. This home runs well under good management and good staff working as a team. I get the best care promoting privacy, dignity and independence. I am very happy at Crest Lodge. The home takes care of me since I am blind I cant do most things. They treat me well and give good care. Care Homes for Older People Page 14 of 33 Evidence: The staff and managers are very good to me I always get an option and choice. Whilst sampling the care plans it was noted that residents had identified their own goals which for one resident included wanting to build up their self confidence and get out and about more. For another resident they had told staff that they enjoyed some things like motor cars which was potentially a way for staff to have meaningful engagement by talking with the resident about their interest. It was noted that although these goals had been identified and documented within the residents care plan there was limited information to record if the residents key worker had spent time with the resident to support them in achieving their goals or that the goal was part of the active support that the resident received. It has been required that arrangements be made for the goals and aspirations of residents be further explored and that staff actively engage with residents to assist and support them in achieving and aspiring to meet their personal goals. During the previous inspection several residents spoken with were unsure of the name of the name of their key worker and an improvement was noted that residents knew who their key worker was and said that they would go to them if they had any worries or concerns. The AQAA identifies that the home have improved in all residents in addition to having a named nurse, have a key worker who is the first line of contact in personal care and social activities. The three care plans sampled contained comprehensive risk assessments which had been documented following assessments of hazards in the residents lives. The risk assessments were clear in detailing the hazards and the actions that staff or the residents representative should take in order to minimise the risk and promote the residents safety and wellbeing. Several residents twenty four hour daily records were sampled and it was noted that the records contained terms for example usual fine or normal day to inform how the residents day had been. The statements were discussed with the registered manager who agreed that there needed to be improvement regarding how the homes daily records were written to include accurate information regarding how the resident experienced their day rather than it be documented from a staff members view point. It was observed during the inspection that arrangements had been improved and strengthened regarding staff awareness of peoples rights to confidentiality of their information. Crest Cottages medication policy and procedures were confirmed to be sound and the Care Homes for Older People Page 15 of 33 Evidence: four medication administration charts sampled were well recorded and demonstrated the way the resident preferred to take their medicines, the medication side effects, the purpose of the medicine and each section in the file contained the residents photograph and any known allergies. The medication cupboard was located in a safe and secure area within the home and a monitored dosage system remains in place. Procedures regarding the safe handling, administration and disposal of medicines have been maintained. The carer in charge advised that no controlled medicines were stored or administered at the home. The organisation confirms within their policies and procedures that residents have the right to refuse to take their medicines and procedures are in place for reporting an event if a resident refuses to take their prescribed medication. The carer in charge at Crest Cottage confirmed that where possible and following the completion of a robust risk assessment a residents rights to independence regarding taking their own medication would be promoted. Care Homes for Older People Page 16 of 33 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported to exercise some choice in their daily lives yet this needs to be further developed to support residents to maintain their skills and abilities in daily living. Residents are encouraged to maintain bonds with family and friends and take part in social, cultural, religious and recreational activities and some residents are involved in the running of their home. The home provides a healthy and balanced diet and residents have more opportunity to participate in menu planning and have more choice regarding their meals. Evidence: Throughout the inspection it was observed that residents were comfortable, animated and engaged with each other, with the inspector and the expert by experience. The general atmosphere in the home was orderly and the pace unrushed and staff were observed to be were attentive to the needs of residents. The expert by experience reported that there are two dining rooms and one doubles up as an activity room. There is a comfortable sitting room, which on the day of the inspection was used by one resident. Seven residents were out at a local day centre. In the smoking room four residents were content with cheerful music playing. The chairs in the smoking room were robust cast iron garden chairs with arms. The Care Homes for Older People Page 17 of 33 Evidence: extractor fan was successfully preventing the smell of smoke affecting the adjacent sitting room. There was a pervasive atmosphere of expectation as residents sat at tables in the activity centre. There were on the notice boards, displays of recent pictures and cut shapes by participants making an attractive up to date display. The residents were clearly well known to each other and friendly comments were made as some went away and came back during the activity session. The session was quite long but the participants remained interested. There was evidence to support that residents were able to make some decisions as toward the end of the session one resident was seen to be tired yet declined the offer to rest as they were concerned they might miss the Bingo session due to occur before lunch and another suggestion regarding some pattern shapes the resident told the carer that she had already decided what to do with the shapes. One resident stated this is good here, I like doing things. The expert by experience noted that the resident was very cheerful and smiling and said how happy they looked and the resident replied You get good days and bad days. It was observed that the residents in the smoking room were happy, relaxed and chain smoking. They said how nice the room was since it had been decorated and that they could play their compact discs in there. It was observed that the activity plans were displayed on the notice boards throughout the home and residents spoken with were familiar with the activities being held each day. The home AQAA advises that residents are encouraged to part of their local community where possible and are encouraged to visit the local shops, post office, pubs and restaurants. Written comments received from residents regarding the activities provided by the home stated that more entertainment like how they do every end of month, music from Nelson. Otherwise I am fine with the music, television and games. I need more freedom and also stick to the rules. The AQAA advises that the home continues to encourage residents to maintain contact with family and friends if they choose to. Residents spiritual and religious beliefs are acknowledged by the staff and residents are given the opportunity to attend a church service held in the home each week. One written comment from a resident stated that staff support me with my religious beliefs and take me to church. Written comments received from health care professionals about the activities and the home in general stated the home provides social activities, a homely atmosphere and residents individual needs are met. Care Homes for Older People Page 18 of 33 Evidence: It was observed that following the previous inspection that arrangements regarding advising residents of the meals offered by the home have been strengthened in order that residents are aware what meals are being offered and what choices are available to them. The expert by experience reported that the menus were displayed on laminated cards on the dining tables and reported that they are nicely mounted on small wooden blocks and there was a clear choice in the menus and residents individual choice could be exercised. The menu was varied and interesting. The meal was hot and well presented and tasty. It was reported that one resident requested cream yet there was none available for their desert. The expert by experience reported that she was advised that the menu choices were made by residents at the breakfast time each day and at the lunch time small choices were possible as one resident requested and received chips with their curry instead of rice. The two dining areas remain bright and spacious with small tables to seat up to four people. The registered manager confirmed that alternative restaurant style dining arrangements will be available following the proposed development and plans for the home to merge with Crest House. During the breakfast meal staff were observed to be attentive in the serving of the meal and choices of the menu were observed. Several residents said that they enjoyed their breakfast. Whilst touring the premises it was observed that a small table in the corridor had been prepared for a residents breakfast and the registered manager advised that the resident often preferred to eat their meals on their own rather than having meals in the communal dining area. The expert by experience reported that the resident had chosen to eat their lunch at a small table in the corridor but afterwards was observed watching the other residents eating in the dining room. It was observed both at breakfast and during the midday meal that residents were not always given the opportunity to maintain their skills for example putting butter or marmalade on their own toast or bread and butter, not being supported to cut up their own meal, put milk or sugar in their own tea or coffee as this was attended by a staff member. There was also indiscreet interactions by staff which included calling people across the dining room by their full name as opposed to their first or preferred name or requesting them across the dining room to eat their meal. One resident was annoyed about the manner of a staff member and advised that they needed to buy some ear muffs to blot the noise out. The interactions were observed as being undignified and did not reflect that the staff member was aware of how the residents might feel to be spoken to in such a manner. The observations were discussed with Care Homes for Older People Page 19 of 33 Evidence: the registered manager who advised that they would be addressed with staff following the inspection. It has been required that arrangements must be made that residents are addressed and spoken with in a manner which reflects consideration to their thoughts and feelings. Care Homes for Older People Page 20 of 33 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. Improved procedures and policies are available in the home to promote the protection of residents from harm and to promote an open culture of raising complaints or concerns about the home. Evidence: The home has a clear complaints policy and procedure which is available to residents or any person associated to the home in order that their views, opinions and complaints are recognised and acted upon. The AQAA advises that one complaint has been received by the home and satisfactorily concluded using the homes complaints procedures. The home has continued to promote the involvement of a local advocacy agency to support residents of their rights to have their opinions and concerns listened to. The home have a copy of the current local authority multi agency safeguarding protocols and the registered manager demonstrated that they were aware of the reporting procedures for safeguarding vulnerable adults. The home have been subject to one safeguarding vulnerable adults referral since the previous inspection. The commission have not been fully informed regarding the outcome of the referrals and request that written confirmation of the status of the Care Homes for Older People Page 21 of 33 Evidence: referrals be sent to the commission following receipt of this report. Three staff files of people newly recruited to the home were sampled and the records confirmed that the staff were booked onto a course to attend safeguarding vulnerable adults training in order that they are aware and ensure that residents living at the home are protected from harm and abuse. The home has a whistle blowing policy and procedure, which is available to staff in order to safeguard residents in their care. Care Homes for Older People Page 22 of 33 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. All areas of the home are clean. Improved suitable and appropriate bathing facilities have been provided to meet and promote the safety and well being of residents. Improvements and a redecoration programme have benefited the residents to make their environment more homely. Evidence: The AQAA identifies that the homes environment has improved due to the by undertaking an extensive redecoration and refurbishment programme and providing new staff facilities. Following the previous inspection the hallways throughout the home have been redecorated and some framed pictures and homely ornaments purchased to make the home feel less institutionalised. Several residents commented that they felt their home was brighter and that they enjoyed the new decoration as it made them feel better. A new reception area has been developed and the residents smoking room has been redecorated and robust cast iron garden chairs with arms were available for residents to use. It was observed that there were rusty metal cigarette bins for residents to Care Homes for Older People Page 23 of 33 Evidence: extinguish their cigarettes in which were unsightly and consideration should be given to replacing them. It was confirmed following the inspection that these had been removed and replaced with more appropriate ash trays. A pane of glass in a window and the window bar needed to be replaced or removed and this was brought to the maintenance persons attention who promptly attended to the repairs. The expert by experience reported that the building is complicated with many interconnecting corridors yet they were impressed by the fact that there are a number of sensory impaired residents who were able to successfully negotiate their way around their home. During the previous inspection residents had advised that they thought there were insufficient bathroom facilities in the home. Following the inspection the home have redeveloped an existing bathroom into a large walk in shower room which has a sitting facility. It was confirmed that the residents were happy to have the improved bathing facilities. The registered manager advised that due to the planned merger of the adjoining Crest House with Crest Lodge a great deal of building work was being undertaken. Part of the reorganisation would be the proposal for the home to have a large restaurant style dining area as opposed to the two separate dining areas. In addition some rooms within Crest House will be single accommodation and have en suite facilities. Following the inspection the commission have advised the registered provider to submit a major variation application regarding the proposed changes of the homes registration. The home was clean and orderly throughout and no malodours were detected. Care Homes for Older People Page 24 of 33 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. Staff in the home were in sufficient numbers on the day of the inspection to support the residents. The homes induction, mandatory training and supervision of staff have improved to ensure that residents needs are met appropriately and safely. The recruitment practises of the home have improved to promote the protection and safety of residents. Evidence: The homes staff are currently supporting thirty three residents and there is a stable staff team. The level of staffing was observed to meet the needs of the residents and the pace of the home was unrushed and calm. The expert by experience reported that the residents seemed relaxed and happy in their relationships with the staff. It was observed that as residents and staff passed each other in the corridors they acknowledged each other warmly. All the staff and residents were aware that one resident was restless and on edge and the resident was supported in a calm and paced manner. In general the staff were observed as skilled in supporting residents in their care and were knowledgeable regarding the specific needs of the residents to ensure their safety and well being and to offer reassurance. However as previously reported some Care Homes for Older People Page 25 of 33 Evidence: staff members need to be more aware of their approach and manner toward residents which can be interpreted as authoritarian and lacking in dignity and respect for the resident. Nine written surveys from staff were received by the commission and the comments included that the home has got a care and person centred plan which reflects the needs of the residents and their representatives are consulted regularly. Arrangements are in place to ensure that peoples choice, lifestyle preference ethnic and cultural needs are identified and promoted and staff demonstrate a knowledge and understanding of the residents welfare and support needs. The home has got an efficient manager who always welcomes new suggestions and making a good atmosphere to work. Home always promotes the residents privacy dignity and choice. The home has put an effort and standard of living better for the residents and has managed to make patients feel at home, relaxed mind. The patients are treated well and respected, good environment for living in. I enjoy working at Crest Lodge it provides friendly atmosphere to employees and provides training yet it could improve with more training. Crest Lodge is a very homely place with many users of different ages and needs. We hope we keep them to feel that they lead a normal life as possible. The home provides a good menu and always a choice of meals. The home provides a range of activities, social outings and users in wheelchairs are provided with a minibus with hoist. Written comments from staff about what they thought the home could do better included was to make sure all staff employed by the home are suitably vetted and receive appropriate training. Employ people who speak English. Weve just got a staff room, employ specialist therapists everyday for example physio, occupational therapist, activities organiser and a psychologist. The home lacks a nice working environment and it is very divided There are too many carers and other staff unable to speak good English leaving the elderly users confused and not able to express their needs. The staff will talk their own language when working with their patients and users. More outings to the seaside during the summer months would be good. Some of the comments received regarding staff members concern about their colleagues command of English language and staff speaking in their mother tongue were addressed with the registered manager during the inspection who confirmed that the matters had been addressed at staff meetings and staff should be aware that the practise of speaking another language in the presence of residents does not promote good, trusting and professional working relationships with residents or colleagues. It was also confirmed following the inspection that the organisation continue to supply English lessons to all overseas staff. Care Homes for Older People Page 26 of 33 Evidence: Three staff recruitment files were sampled which evidenced that the home undertakes safe vetting practises concerning the recruitment of staff in order to ensure the safety and protection of residents. The registered manager confirmed that all staff undertake the Skills for Care Induction programme which assists staff to have a better knowledge and understanding regarding the standard of care they provide and identifies any support needs that staff may have which can be addressed in their support and supervision sessions. The staff mandatory training was discussed and the registered manager confirmed and records sampled evidenced that training, which is organised centrally, had been attended and where gaps were identified training for staff had been booked. The AQAA advises that 15 staff of the 16 care staff have achieved their National Vocational Qualification in Level 2 or above in order to ensure staff are well supported in providing a high standard of care for the residents. The AQAA identifies that the home have improved by promoting an emphasis on staff taking greater care of and concern for residents. Improved emphasis has been placed on training, overseen by the training manager. The commitment to ensuring that all staff have an NVQ qualification and, where appropriate, adaptation training for those who are eligible. Care Homes for Older People Page 27 of 33 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home has been strengthened and is robust. The home continues to be run in the best interests of the residents and their views and opinions and those of others associated with the home are sought. Residents welfare is promoted through monitoring of health and safety in the home. Evidence: The registered manager has been in post for several years. Following the previous inspection some of the aspects of the management of the home have been strengthened and all the requirements made at the previous inspection have been met in order to continue the improvement of the service to benefit the care and support the residents receive. Arrangements regarding the protection of residents finances have been maintained by the home administrator and these will be sampled during the next inspection. Care Homes for Older People Page 28 of 33 Evidence: It was observed during the inspection that all staff maintained the correct procedures that chemicals were stored appropriately and safely under the control of chemicals hazardous to health guidelines. It was noted that fire fighting and moving and handling equipment had been regularly serviced and fire and water temperature safety records had been maintained. Confirmation was seen that the home continues to seek residents and their representatives views and opinions about the service through the quality assurance procedures. A current insurance indemnity, gas and electric certification were sampled and the current certificate of registration of the home displayed. Hand washing facilities remain available throughout the home, clinical waste disposal continues to be appropriately managed and measures are in place for the control of spread of infection in the home to promote a safe environment for residents. Care Homes for Older People Page 29 of 33 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 30 of 33 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 7 12 Arrangements must be made for the goals and aspirations of residents be further explored. In order that staff actively engage with residents to assist and support them in achieving and aspiring to meet their personal goals. Arrangements must be made that residents are addressed and spoken with in a manner which reflects consideration to their thoughts and feelings. In order to reflect residents rights to dignity and respect at all times. 31/03/2010 2 14 12 31/03/2010 Care Homes for Older People Page 31 of 33 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 Care Homes for Older People Page 32 of 33 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). 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