Care Home: Crystal Hall Residential & Nursing Home

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What the care home does well The information gathered before admission was extremely detailed, providing staff with a clear picture of each individual, so that they were confident that the assessed needs of people could be fully met. The plans of care were extremely well written documents, providing staff with clear guidance about how the assessed needs of people living at the home were to be met and how people were to be supported to maintain their privacy and dignity. Residents had been involved in the care planning process and a review of care provided was conducted on a monthly basis to ensure that current needs were accurately reflected in the plan of care. A variety of external professionals had been involved in the care of people living at Crystal Hall Nursing Home to ensure that their health care needs were being appropriately met. A range of risk assessments were in place to ensure that systems were implemented to protect the health and safety of anyone on the premises. Sufficient information was provided to people about the use of the local advocacy services to act on their behalf, should they so require and people living at the home were able to have some control over their lives by managing their own finances, should they wish to do so. Activities were provided both in the home and outside, so that people were able to continue their leisure interests whilst living at the home and so that they were able to maintain links with the local community. The routine of the home was flexible and aimed to allow residents their freedom and independence by enabling them to have some control over their lives. Visiting arrangements were in place to suit the needs of individual residents and advocacy services were accessed for those wishing to have an independent person to act on their behalf. People were provided with a choice of nutritious and well balanced meals to ensure a good dietary intake. Meals were well presented to promote appetite and to aid in nutrition. Those requiring support with eating their meals were assisted in a discreet manner, whilst others were encouraged to eat independently. Safeguarding policies and procedures were in place, so that people knew what they should do if an allegation of abuse was received by the home. The home was tastefully furnished and pleasantly decorated to a good standard and the premises, both internally and externally were well maintained providing those living at Crystal Hall Nursing Home with a safe, clean, comfortable and homely environment in which to live. The home was pleasant smelling and effective infection control measures were in place to ensure that the health and safety of people was well protected. Robust recruitment practices had been adopted by the home so that prospective employees were thoroughly checked out before they started working at Crystal Hall to ensure that people living there were always protected from abusive situations. A lot of training had been provided for all staff so that they were kept up to date with current policies, procedures and legislation and so that they were sufficiently trained to meet peoples assessed needs. The registered manager holds relevant qualifications, has a lot of experience and is appropriately trained to manage the care home. People spoken to felt supported by the management of the home. Systems were in place to ensure that the quality of service provided was closely monitored so that any shortfalls identified could be promptly addressed. The health, safety and welfare of residents was protected by the policies, procedures and practices of the home so that any hazards, which could pose a potential risk, were minimised or eliminated. The home was well managed by a competent person and a team of skilled senior staff, who together had completed a wide range of training so that they were able to deliver the care required by the individual residents. Comments from people we spoke with at the time of our visit included: "This place is `the tops`"; "Crystal Hall is fantastic. I love living here"; "This is a five star hotel"; "The staff are all marvelous. I cannot complain about any one of them. They are all kind, caring and considerate"; "It is nice to see how the staff look after the older people". When asked what the service does well, staff members wrote on their comment cards: `The home adapts well to new clients with different needs and abilities. It offers a good package of care and also gives clients plenty of opportunities to participate in various activities and occupations of interest to them`; `We provide a high standard of care with well trained staff. Training is always available at all levels. We are a team that works well together from managers to cleaners`; `Crystal Hall keeps staff up to date with training. It supports staff and residents and works closely with outside agencies`. When asked what the service does well those living at the home wrote on their comment cards; `Organisation of activities`; `They (the staff) feed us, do our washing and they clean my room`; `The food is good and the nursing care is excellent. The nurses are cheerful an efficient. The nurses are especially good with the older residents`; `There is always a pleasant atmosphere. The food is good`. What has improved since the last inspection? The requirement issued at the last key inspection had been appropriately addressed and no further requirements were made on this occasion. The home continues to provide an excellent service for the people living at Crystal Hall and despite this excellent quality rating the providers and management team continue to improve standards still further, which is commendable. The addition of another 15 bedrooms has extended the premises and it was quite evident that extensive work had taken place to improve the environment for the people living at the home. It was also evident that a lot of thought and planning had gone in to the design of some unusual features both inside and outside of the home.Staff had received training in relation to safeguarding vulnerable adults since our last key inspection, so that they were aware of the procedure to follow should they receive an allegation of abuse. What the care home could do better: The management of risk taking could be improved by providing clear guidance for staff, within a risk management framework, about strategies that need to be implemented, so that any potential harm to people living at the home is minimised. Any hand written entries on the Medication Administration Records could be signed, witnessed and countersigned so that the possibility of transcription errors is reduced. Staff working at the home need to receive regular training updates in relation to safeguarding vulnerable adults, so that everyone is aware of current legislation and guidelines. Plans of care could have focused more on people`s abilities and how they could be supported to maintain their leisure interests whilst living at Crystal Hall. The care records on occasions could have given staff more specific guidance by not using vague terminology. When asked what the service could do better two staff members told us that the home could provide staff with an area for them to have their breaks and take time out during their working day. Others wrote on their comment cards, `To provide more specific training around mental health for care staff` and `There is nothing we could do to make the home better. However, we strive to maintain our standards`. Key inspection report Care homes for adults (18-65 years) Name: Address: Crystal Hall Residential & Nursing Home Whittingham Hall Whittingham Preston Lancashire PR3 2JE     The quality rating for this care home is:   three star excellent 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: Vivienne Morris     Date: 0 9 0 3 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 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 Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 33 Information about the care home Name of care home: Address: Crystal Hall Residential & Nursing Home Whittingham Hall Whittingham Preston Lancashire PR3 2JE 01772861034 01772861661 Crystalhall@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Crystal Hall Limited Name of registered manager (if applicable) Miss Margaret Mary Fyffe Type of registration: Number of places registered: care home 60 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of people who can be accommodated is 60. The registered person may provide the following categories of service only: Care Home with nursing - code N. To people 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 - code MD. Date of last inspection Brief description of the care home Crystal Hall is a 60 bedded Care Home, offering both personal and nursing care to people who suffer from a mental illness. The home is a period farmhouse with purpose built extensions and is located in a rural area of Preston. Crystal Hall is within walking distance of shops, a public house and places of worship. The home is also on a bus route. There are well maintained grounds surrounding the property, which include an Care Homes for Adults (18-65 years) Page 4 of 33 Over 65 0 60 Brief description of the care home external aviary, enclosed courtyard and Japanese ornamental garden. The home provides a range of services and activities for the people living there and staff are able to meet a diverse range of needs, led by a team of experienced managers. The fees at the time of this key inspection ranged from £461 to £900 per week. Additional charges were being incurred for hairdressing and private chiropody. Care Homes for Adults (18-65 years) 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: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection of Crystal Hall took place on 9th May 2007. The quality rating for this service is three star. This means that people who use this service experience excellent quality outcomes. The site visit to Crystal Hall formed part of the inspection process and was conducted over one day in March 2010. It was unannounced, which means that the managers, staff and people living at the home did not know it was going to take place. During the course of the site visit, discussions took place with those living at the home, staff and managers. Relevant records and documents were examined and a tour of the premises took place, when a random selection of private accommodation and all communal areas were seen. We received comment cards back from five people who work at the home and who all provided us with positive comments about the service. We also received comment Care Homes for Adults (18-65 years) Page 6 of 33 cards back from nine people living at Crystal Hall and three relatives. Some comments made by the people involved in our survey are incorporated in to this report. Every year the provider completes a self assessment, known as an AQAA, which gives information to the Commission about how the service is meeting outcomes for the people living at the home and how the quality of service provided is monitored. It also gives us some numerical information about the service. Some of this information from the AQAA is incorporated in this report. We observed the activity within the home and tracked the care of two people during the site visit, not to the exclusion of other people living at Crystal Hall. The total key inspection process focused on the outcomes for people living at the home and involved gathering information about the service over a period of time from a variety of sources. The Care Quality Commission had not received any complaints about this service during the last twelve months. Care Homes for Adults (18-65 years) Page 7 of 33 What the care home does well: The information gathered before admission was extremely detailed, providing staff with a clear picture of each individual, so that they were confident that the assessed needs of people could be fully met. The plans of care were extremely well written documents, providing staff with clear guidance about how the assessed needs of people living at the home were to be met and how people were to be supported to maintain their privacy and dignity. Residents had been involved in the care planning process and a review of care provided was conducted on a monthly basis to ensure that current needs were accurately reflected in the plan of care. A variety of external professionals had been involved in the care of people living at Crystal Hall Nursing Home to ensure that their health care needs were being appropriately met. A range of risk assessments were in place to ensure that systems were implemented to protect the health and safety of anyone on the premises. Sufficient information was provided to people about the use of the local advocacy services to act on their behalf, should they so require and people living at the home were able to have some control over their lives by managing their own finances, should they wish to do so. Activities were provided both in the home and outside, so that people were able to continue their leisure interests whilst living at the home and so that they were able to maintain links with the local community. The routine of the home was flexible and aimed to allow residents their freedom and independence by enabling them to have some control over their lives. Visiting arrangements were in place to suit the needs of individual residents and advocacy services were accessed for those wishing to have an independent person to act on their behalf. People were provided with a choice of nutritious and well balanced meals to ensure a good dietary intake. Meals were well presented to promote appetite and to aid in nutrition. Those requiring support with eating their meals were assisted in a discreet manner, whilst others were encouraged to eat independently. Safeguarding policies and procedures were in place, so that people knew what they should do if an allegation of abuse was received by the home. The home was tastefully furnished and pleasantly decorated to a good standard and the premises, both internally and externally were well maintained providing those living at Crystal Hall Nursing Home with a safe, clean, comfortable and homely environment in which to live. The home was pleasant smelling and effective infection control measures were in place to ensure that the health and safety of people was well protected. Robust recruitment practices had been adopted by the home so that prospective employees were thoroughly checked out before they started working at Crystal Hall to ensure that people living there were always protected from abusive situations. A lot of training had been provided for all staff so that they were kept up to date with current policies, procedures and legislation and so that they were sufficiently trained to meet peoples assessed needs. The registered manager holds relevant qualifications, has a lot of experience and is appropriately trained to manage the care home. People spoken to felt supported by the management of the home. Systems were in place to ensure that the quality of service provided was closely monitored so that any shortfalls identified could be promptly addressed. The health, safety and welfare of residents was protected by the policies, procedures and practices of the home so that any hazards, which could pose a potential risk, were minimised or eliminated. The home was well managed by a competent person and a team of skilled senior staff, who together had completed a wide range of training so that they were Care Homes for Adults (18-65 years) Page 8 of 33 able to deliver the care required by the individual residents. Comments from people we spoke with at the time of our visit included: This place is the tops; Crystal Hall is fantastic. I love living here; This is a five star hotel; The staff are all marvelous. I cannot complain about any one of them. They are all kind, caring and considerate; It is nice to see how the staff look after the older people. When asked what the service does well, staff members wrote on their comment cards: The home adapts well to new clients with different needs and abilities. It offers a good package of care and also gives clients plenty of opportunities to participate in various activities and occupations of interest to them; We provide a high standard of care with well trained staff. Training is always available at all levels. We are a team that works well together from managers to cleaners; Crystal Hall keeps staff up to date with training. It supports staff and residents and works closely with outside agencies. When asked what the service does well those living at the home wrote on their comment cards; Organisation of activities; They (the staff) feed us, do our washing and they clean my room; The food is good and the nursing care is excellent. The nurses are cheerful an efficient. The nurses are especially good with the older residents; There is always a pleasant atmosphere. The food is good. What has improved since the last inspection? The requirement issued at the last key inspection had been appropriately addressed and no further requirements were made on this occasion. The home continues to provide an excellent service for the people living at Crystal Hall and despite this excellent quality rating the providers and management team continue to improve standards still further, which is commendable. The addition of another 15 bedrooms has extended the premises and it was quite evident that extensive work had taken place to improve the environment for the people living at the home. It was also evident that a lot of thought and planning had gone in to the design of some unusual features both inside and outside of the home. Care Homes for Adults (18-65 years) Page 9 of 33 Staff had received training in relation to safeguarding vulnerable adults since our last key inspection, so that they were aware of the procedure to follow should they receive an allegation of abuse. 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 Adults (18-65 years) Page 10 of 33 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 11 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health, personal and social care needs of people are thoroughly assessed before they move into the home to ensure that the staff team can fully meet all their requirements. Evidence: We tracked the care of two people living at Crystal Hall Nursing Home during the course of our visit to this service. Records showed that extremely detailed information had been gathered from a wide range of sources about the needs of people before they were offered a place at the home. The assessments conducted were very well written showing that the needs of people had been thoroughly assessed to ensure that the staff team were confident in providing the care and support needed by each individual. We received nine comment cards from people living at Crystal Hall, eight of who told us that they received enough information about the home befire they moved in so they could decide if it was the right place for them to live. Care Homes for Adults (18-65 years) Page 12 of 33 Evidence: When asked what the service does well the Managing Director wrote on the self assessment, All potential service users are initially assessed by senior, experienced, trained staff and their assessment is thereafter discussed during a multi disciplinary meeting to ensure suitability of the placement and that Crystal Hall can meet the needs of the service user. Overnight stays are offered prior to the initial one months trial placement, after which time, if the service user wishes to take up a permanent placement, the required funding and contracts are put into place. Care Homes for Adults (18-65 years) Page 13 of 33 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are effectively planned for, their rights are upheld and they are supported to make informed decisions about the routines of daily life. Evidence: Care plans seen had been generated from information obtained before people were admitted to the home and they were extremely well written, person centered documents, providing staff with very detailed and clear guidance about the needs of people and how they could best provide the care and support required. The plans of care had been reviewed and any changes in need reflected well, so that staff were provided with up to date information about the needs of people in their care. One of the people whose care we tracked had declined the opportunity to be involved in the care planning process. However, the other resident had been fully involved in the planning of his care and he had signed an agreement indicating he was happy with the content of his care plan. Care Homes for Adults (18-65 years) Page 14 of 33 Evidence: We noted that occasionally within the care records vague statements were used, such as, as required and when necessary, which did not provide staff with specific guidance and could be interpreted differently by different members of staff. Although the care plans seen were excellent documents, the home could now progress in moving towards including things people are able to do and how they can be supported in maintaining their leisure interests whilst living at the home. A wide range of risk assessments had been conducted, so that any potential risks were identified. However, these could have provided clearer guidance for staff as to how identified risks should be appropriately managed. Care records showed how those living at the home were able to make decisions about taking risks within a risk management framework and with the involvement of an advocate as deemed necessary. People spoken with told us that the routines of the home were flexible and, in general, they were able to choose what they wanted to do and how they wished to spend their days. This information was supported by care records, policies and procedures of the home and through observation. Where decisions made were assessed as being potentially hazardous to themselves or others then full documentation was maintained. We received comment cards from five people working at Crystal Hall who all told us that, in general, they are given up to date information about the needs of people in their care. Care Homes for Adults (18-65 years) Page 15 of 33 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Social and recreational activities are provided in accordance with residents expectations and the rights of people are upheld. Residents receive wholesome food and the special dietary needs of people are met. Evidence: Crystal Hall allowed people to live the lifestyle they preferred. Strong links were evident with local colleges and community based schemes, encouraging people to maintain links with the local community. A local college provided on site activities, such as gardening and cookery courses for those wishing to join in and people living at the home were able to access courses which interested them, with staff support as was needed. A planned programme was in place at the home, which incorporated weekend and evening activities, so that people could participate in sessions of their choice. A Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: number of people living at the home had an appointed advocate, so that they were supported to make decisions and choices by an independent person. Information was readily available about local advocacy, should they wish to use this service. Assessments had been conducted, as deemed necessary, to make sure that people were not being deprived of their liberty so that they could continue to make their own decisions within a risk management framework for as long as possible. Several organised groups had been developed by the home, such as, todays news, reminiscence group, healthy living group and walking group. One person said, I dont have time to get bored. I am a member of five different groups. I like reading the newspapers provided by the home and then discussing various topics in the todays news group. Records of participation in activities or group sessions were maintained to ensure that any individual did not become isolated. It was pleasing to see that two people owned their own vehicles and two others got around on bicycles. One resident was very proud of his own potting shed in the garden, which showed that independence and a choice of lifestyle was being promoted at the home. One person delighted in telling us about a fancy dress party held at the home, adding, Henry VIII was there and Elvis too. Records showed that relatives and friends were encouraged to maintain contact with people living at Crystal Hall with little restriction on visiting arrangements and that people were supported to maintain relationships with those they chose to do so. One person told us that his family did not live locally, but he was supported to keep in touch with them regularly by telephone. We saw that people visiting the home were made to feel welcome and were greeted appropriately. One resident said, Theres certainly enough going on. Trips out are organised in the better weather and we can walk to the shops or pub in the village if we want to and another told us , I go to the shops in the local village for the people who cannot get there for themselves. Staff were seen knocking on peoples bedroom doors before entering to ensure that privacy and dignity was consistently maintained and staff spoke to those living at the home in a courteous manner. It was also pleasing to hear some friendly banter showing that residents had a good rapport with staff and those living at the home seemed to enjoy a bit of fun with the staff. A four weekly menu was in place and the menu of the day was clearly displayed so that people could see what was for lunch on the day of our visit. We observed lunch Care Homes for Adults (18-65 years) Page 17 of 33 Evidence: being served and discussed meals with the chef and those living at the home. It was clear that people were able to have a choice of meals served and that the chef was prepared to serve an alternative meal as was required. The menu for those needing a soft diet was shown as softs. We felt that this could have been worded differently to avoid labeling this group of people. The dining room was pleasant with nicely presented dining tables, condiments being available and beverages provided. The food served looked appetising, nutritious and hot. The menu coincided with the meal options available and those spoken with told us that the meals are always very good. Staff supported people to eat their meals as needed in a discreet and gentle manner. Fresh fruit and vegetables were delivered daily by local businesses and we were told that, in the main, fresh food is always served, providing people with a wholesome diet. The catering facilities were clean, tidy and well organised by competent catering staff. Good records were maintained and the recent Environmental Health Officers report had awarded a 5 star rating, which is commendable. One resident said, The food is always excellent. I really enjoy it. Crystal Hall was in the process of completely reorganising the provision of activities for the entire home. Additional staff had been appointed to deliver a personalised activity programme. A rehabilitation kitchen and laundry had been developed, so that those needing domestic rehabilitation support were assisted in maintaining their independence. A pleasant games room was available for people living at the home, which incorporated a wide screen television, pool table, bar and darts board. We were told that darts competitions were organised regularly, which were enjoyed by all participants. A library and computer room had been developed, which had a wide range of books and a seating area, so that people could spend some quiet time here if they wanted to do so. A hairdressing salon was available at the home and we were told that a hairdresser visits regularly, although people were able to visit the hairdresser in the local village if they preferred, when they would be supported to make their own appointments if they were able and wished to do so in order to promote independence and choice. People living at the home were encouraged to help with cleaning their own living Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: space in order to promote independence and so that people took some responsibility for their personal environment. We noted that some wall clocks were set at incorrect times, which did not aid in reality orientation for the people living at the home. The Managing Director told us, We fully support service users with social care planning and encourage service users to pursue old as well as new hobbies, interests and leisure activities. We provide an expansive and well balanced menu to suit all service users. We ensure the ethos of the Home is always maintained to create a relaxed routine and atmosphere at all times and we create a stimulating environment allowing service users the choice and opportunity to socialise in either groups or on an individual basis. One person living at the home was eager to show us her bedroom and a painting she had won in a raffle, which had been painted by a member of staff. Another resident was proud to show us the paintings he had done in the art class and to tell us about the gardening classes provided by a local college. All nine people living at Crystal Hall who sent us comment cards indicated that, in general, they were able to make decisions about what they did each day and what they wanted to do at each time of each day. Care Homes for Adults (18-65 years) Page 19 of 33 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of people living at the home are consistently met and their privacy and dignity is always respected. Evidence: The plans of care seen were extremely detailed and person centered, showing how people living at Crystal Hall were supported to meet their personal, physical, emotional and health care needs. A lot of information was available to demonstrate that a variety of external professionals were involved in the care of people living at the home to ensure that they received the health care needed. A wide range of assessments had been conducted to identify any potential risks to those living at the home. However, these could have been more detailed in relation to how health care risks could be best managed. Records showed that people were able to choose how they wished to be supported, such as, one lady living at the home preferred only female staff to attend to her personal care needs and another person preferred to have a bath rather than a shower. Records also demonstrated that independence was promoted and that privacy Care Homes for Adults (18-65 years) Page 20 of 33 Evidence: and dignity was an important aspect of life at Crystal Hall, which was also reflected within the policies and procedures of the home. People spoken to told us that if they were not well, staff would seek advice from the Doctor. One person living at the home told us, They (the staff) look after us really well. In general, medications were managed well. Policies and procedures were in place to support good medication practices and thorough records were maintained. However some hand written entries on the Medication Administration Records had not been signed, witnessed and countersigned in order to avoid any transcription errors. When asked what the service does well the Managing Director wrote on the homes self-assessment, We ensure safe working practices in all aspects of health care and we respect privacy and dignity issues at all times. One person living at Crystal Hall told us how poorly he was when first admitted to the home and that the staff at Crystal Hall got him back on his feet and now he is much better. Care Homes for Adults (18-65 years) Page 21 of 33 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints are well managed and people living at Crystal Hall are protected by the policies, procedures and practices adopted by the home. Evidence: A complaints procedure was in place at the home, which was also included in the Statement Of Purpose and which was prominently displayed in a variety of locations, so that people were aware of what they needed to do should they wish to make a complaint. However, this needed to be updated to show the contact details of the authority responsible for dealing with complaints about the service. A record of complaints received was maintained with reference to how complaints had been investigated. However, it is recommended that a numbered page record book be utilised for this purpose , in order to avoid loose leaf pages being mislaid or removed. People spoken to told us that they would know what to do if they were unhappy with something about the service they received. Several people told us that they had no complaints about Crystal Hall. One person said, Everything is wonderful and another commented, I have no complaints. It is great living here. Policies and procedures were in place in relation to the protection of vulnerable adults. However, these needed to be reviewed and updated to include current guidance about reporting any allegations of actual or suspected abuse to the Care Quality Commission and immediate suspension or removal of any alleged perpetrators. Care Homes for Adults (18-65 years) Page 22 of 33 Evidence: Training had been provided for staff in relation to the protection of vulnerable adults. However, this was some time ago and guidelines change frequently, so staff need to receive current information about safeguarding the people in their care. We were told that the frequency of updates had been discussed with the training provider, who told the home that updates were not necessary once the initial training had been provided. However, we consider that staff need to be given the opportunity to keep up to date with current legislation and guidelines and therefore suggest that people working at the home are updated annually. The Managing Director told us that the service has improved in the last twelve months by the development of formal training for all staff on recognising and handling the subject of abuse. All five staff members who sent us comment cards said that they would know what to do if someone had concerns about the home. All nine people living at Crystal Hall who sent us comment cards told us that they would know how to make a complaint and that they would know who to speak to if they were not happy about something. They also said that the care staff and managers always treated them well and listened to them, acting on what they said. Two of the three relatives who returned comment cards said that they would know how to make a complaint if they needed to do so and that, in general, the service had responded appropriately when concerns were raised. We had not received any concerns, complaints or safeguarding issues about this service since our last key inspection of 9th May 2007. Care Homes for Adults (18-65 years) Page 23 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, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a safe and well maintained environment for people to live in, which is homely, clean and hygienic. Evidence: During the course of this key inspection we toured the premises, visiting a random selection of private accommodation and all communal areas of the home. Since our last key inspection there had been extensive structural improvements to the environment, including 15 additional bedrooms, all with en suite facilities. Other areas of the home had also been updated and improved, despite the environment being rated as excellent at our last inspection. Extensive work was going on within the grounds of the home at the time of our visit, to make the surrounding areas more pleasant for those living at Crystal Hall. A Japanese ornamental garden and indoor tropical forest had already been developed, which was very unusual and of great interest to the people living at the home and their visitors. People spoken to were happy with their private accommodation. The bedrooms were of a very good size, many with double beds. They were personalised with tasteful furnishings and good quality bedding. The home throughout was clean, tidy and Care Homes for Adults (18-65 years) Page 24 of 33 Evidence: pleasant smelling, providing those living at Crystal Hall with a homely environment in which to live. It was evident that the providers were committed to providing excellent environmental standards for the people living at Crystal Hall. We were told that a team of estates staff were employed to look after the maintenance of the environment so that the home is kept in good repair for the people living at Crystal Hall. The self-assessment shows what improvements are planned for the next twelve months, including, complete construction of a second modern and spacious kitchen, complete construction of purpose built therapeutic areas to include large domestic kitchen facilities, Cognitive Behaviour Therapy suite, Occupation Therapy suite and Activities room. Clinical waste was being managed appropriately with infection control policies and procedures in place and relevant training for staff provided so that the possibility of cross infection was minimised. The laundry department was well organised and fit for the purpose of the home and the people living there to ensure that linen and clothing was laundered appropriately. We were told by the people living at the home that, in general, the home was always clean and fresh. Care Homes for Adults (18-65 years) Page 25 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, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff working at the home were appropriately trained and in sufficient numbers to meet changing needs of residents and the recruitment procedures safeguarded those living at the home. Evidence: We looked at two staff records during the course of our inspection to assess the recruitment practices adopted by the home. All relevant checks had been conducted for prospective employees before they commenced work to ensure they were fit to support the vulnerable adults living at Crystal Hall. When people were appointed before Criminal Record Bureau (CRB) disclosures had been obtained because of exceptional circumstances, records showed that they were supervised until their CRBs had been received. Staff also received annual appraisals, so that any individual training needs could be identified and work performance could be assessed. A matrix was in place, showing that staff were provided with a wide range of training courses, which were updated as required and 79 of care staff had achieved a recognised qualification in care to ensure that people living at the home were supported by a skilled work force. Induction records were evident on staff files along with certificates of training, showing that people working at Crystal Hall were provided with the necessary information to allow them to do the job expected of them. People Care Homes for Adults (18-65 years) Page 26 of 33 Evidence: spoken to confirmed that enough training was provided, so that staff were up to date with new ways of working and so they could maintain their professional development. We saw recorded evidence that the home had verified with the Nursing and Midwifery Council that registered nurses were eligible to practice. The homes self assessment told us what the service does well in relation to staffing considerations to ensure that those living at Crystal Hall receive the care and support required by the numbers and skill mix of staff working at the home. All five staff members who sent us comment cards told us that their employer carried out all relevant checks before they started working at the home to ensure that they were fit to work with vulnerable people. These staff members also told us that their induction programme covered everything they needed to know very welland that they were provided with all the training they need to do the job expected of them. Care Homes for Adults (18-65 years) Page 27 of 33 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a strong management team and effective systems in place for monitoring the quality of service provided. The health, safety and welfare of people living at the home is well protected. Evidence: The manager of Crystal Hall had recently been registered with the Care Quality Commission. Information gathered demonstrated that she managed the home in the best interests of the people living there, ensuring that their health, safety and welfare were well protected by the policies, procedures and practices adopted by Crystal Hall. There was a strong belief in openess and transparency to ensure that people involved in the home were kept informed of any relevant issues. Information available to interested parties had been updated to reflect the current management arrangements of the home so that people knew who to contact should the need arise. A variety of methods were used to monitor the quality of service provided, so that any shortfalls could be dealt with promptly and in a timely fashion. A range of meetings were held regularly so that people were kept up to date with current issues and so Care Homes for Adults (18-65 years) Page 28 of 33 Evidence: that topics could be discussed openly. The Commission had been informed of any notifiable event which adversely affected the well-being of the people living at the home, including deaths and injuries. Continuous self monitoring was evident through use of a risk management framework, involvement of a professionally recognised quality assurance system and audit trails. Recent feedback had been received from relatives of people living at Crystal Hall and staff members to measure success in achieving the aims and objectives of the home. An annual development plan was in place, which reflected aims and outcomes for people using the service. Records showed that a company representative conducted regular inspections at the home, so that any strengths or weaknesses could be identified and where necessary swiftly rectified. Accident records were clear and maintained in line with data protection so that any confidential information about people is not accessed by unauthorised parties. During our tour of the premises no hazards were seen and the building was very well maintained so that people living at Crystal Hall were kept safe. Records showed that staff had received Health and Safety training so that they were aware of any safety precautions expected by the home. The maintenance records were concise and well kept showing that a wide range of internal checks took place regularly to promote peoples health and safety. We checked a random selection of service certificates, which showed that the systems and equipment used in the home were tested in accordance with the products recommendations to ensure they were safe for use. Regular fire drills had been conducted, fire safety training provided and fire equipment had been appropriately serviced to ensure that staff knew what action to take in the event of a fire and to ensure that fire fighting appliances were well maintained. The homes self assessment told us what the service does well, We continue to have an experienced and motivated management structure, who implement strategies to safeguard, protect and fully support service users rights and best interests at all times. We fully support both service users and staff and promote open reporting through regular meetings and also ensure that any issues raised are actioned effectively and appropriately. Care Homes for Adults (18-65 years) 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 Adults (18-65 years) 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 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 Care plans should focus more on peoples abilities and how they can be supported to maintain their leisure interests whilst living at the home. Vague terminology should be avoided within the care records, so that staff are always provided with specific guidance about how the needs of people can be accurately met. Risk assessments should be extended to provide staff with clear guidance about how identified risks could be best managed. It is recommended that the menu for those needing a soft diet is worded differently to avoid labeling this group of people. Risk assessments should show what staff need to do in order to eliminate or reduce the potential element of risk to people living at the home. Any handwritten entries on Medication Administration Records should always be signed, witnessed and countersigned in order to reduce the possibility of transcription errors. Page 31 of 33 2 6 3 9 4 17 5 18 6 20 Care Homes for Adults (18-65 years) 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 7 22 The complaints procedure should show contact details for the relevant social services office so that people know who to contact should they wish to make a complaint. It is recommended that people working at the home complete training in relation to the protection of vulnerable adults at least annually. 8 23 Care Homes for Adults (18-65 years) 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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