Care Home: Homecrest Residential Home

What the care home does well The home employs a well trained and extremely supportive staff team. The management structure is strong. Care plans are detailed and written in an easy to understand format. Service users are offered choices in all aspects of daily life and their preferences are respected. The home is clean and well maintained. Medications are dealt with appropriately to ensure that service users are protected. All staff are aware of their role and responsibilities and it is evident that there is a high level of respect for each other and the management. What has improved since the last inspection? Care plans are now updated on a regular basis and as the needs of the service users change. A high number of training events have taken place to enable staff to further develop their knowledge and understanding. What the care home could do better: The armchairs in bedrooms should now be replaced as their condition is deteriorating. A handrail at the ramp into the garden should be fitted to avoid the risk of accidents. CARE HOMES FOR OLDER PEOPLE Homecrest Residential Home 49/55 Falkland Road Wallasey Wirral CH44 8EW Lead Inspector Jeanette Fielding Key Unannounced Inspection 19th March 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Homecrest Residential Home DS0000033293.V345026.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Homecrest Residential Home DS0000033293.V345026.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Homecrest Residential Home Address 49/55 Falkland Road Wallasey Wirral CH44 8EW Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0151 639 7513 Norens LTD Lisa Marie Booth Care Home 34 Category(ies) of Dementia - over 65 years of age (34) registration, with number of places Homecrest Residential Home DS0000033293.V345026.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Thirty Four (34) adults over the age of 65 (DE/E) with dementia and may from time to time admit persons between the age of 60 and 65 years of age To accommodate one named service user under the age of 65 years Date of last inspection 12th February 2007 Brief Description of the Service: Home crest is a detached three storey building in a residential area of Wallasey. There is off-street parking at the front of the building and a patio/garden area at the rear. Homecrest is close to local shops, amenities and public transport facilities. Home crest is registered to provide care for up to 34 people Dementia over the age of 65 and may accommodate younger adults between the age of 60 and 65 from time to time. All communal facilities are on the ground floor and a lift serves all storeys. Homecrest is an accredited holder of the British standards Institute ISO 9001 and is also accredited for the ‘Investors in people’ award. Fees at Homecrest are £406.84 per week. Homecrest Residential Home DS0000033293.V345026.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means that the people who use this service experience good quality outcomes. This unannounced inspection was conducted on two days over a period of nine hours. The visit on the second day was to speak with service users and staff who had requested to speak with the inspector in their survey forms. This was the key inspection and was carried out as part of the regulatory process. As part of the inspection process, all areas of the home were viewed including many of the service users bedrooms. Assessments and care plans were inspected together with staff records and certification to ensure that health and safety legislation was complied with. Discussion took place with the registered manager, care staff, ancillary staff, service users and visitors to the home. The manager had completed a pre-inspection questionnaire which gave further insight into the home. An excellent response was received from staff and service user surveys that were sent and contained detailed and positive comments. What the service does well: What has improved since the last inspection? What they could do better: The armchairs in bedrooms should now be replaced as their condition is deteriorating. A handrail at the ramp into the garden should be fitted to avoid the risk of accidents. Homecrest Residential Home DS0000033293.V345026.R01.S.doc Version 5.2 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Homecrest Residential Home DS0000033293.V345026.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Homecrest Residential Home DS0000033293.V345026.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Full information regarding the facilities and services offered by the home are made available to prospective service users to enable them to make and informed decision regarding their care provider. Detailed pre-admission assessments are made on prospective service users to enable the home to ensure that they can meet the service users needs and prepare for their admission. EVIDENCE: The manager ensures that all prospective service users, and their relatives, receive a copy of the Service User Guide to give them the opportunity to make an informed decision regarding their care provider. Homecrest Residential Home DS0000033293.V345026.R01.S.doc Version 5.2 Page 9 A selection of pre-admission assessments were inspected, particularly of service users accommodated since the last inspection. Detailed pre-admission assessments are prepared for all prospective service users to ensure that the home is able to meet their individual needs and preferences. The assessments inspected were comprehensive and all health and psychological needs are clearly identified. Information is gathered from the service user, their family and any other health care professional involved in their care. Individual preferences are identified and recorded and are then included in the plan of care. Sufficient information is recorded to enable a comprehensive plan of care to be prepared. The home does not offer intermediate care. Homecrest Residential Home DS0000033293.V345026.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Detailed care plans are prepared for each service user and are reviewed and updated on a regular basis to ensure that service users are provided with the appropriate level of care. EVIDENCE: The care plans inspected were extremely detailed and included full information regarding the service users care needs together with information regarding their choices and preferences. The plans are prepared in an easy to read format and are accessible to all care staff to give them the information necessary to provide for the service users needs. Full information is recorded relating to washing and bathing, the ability of the service user to dress themselves, dietary needs, mobility and individual preferences with regard to daily living. Risk assessments are in place together Homecrest Residential Home DS0000033293.V345026.R01.S.doc Version 5.2 Page 11 with information on how to reduce or remove any potential risk to the service user. Daily records completed by the staff are detailed and provide evidence of the actual care given. Records are held of all visits to and by GP’s and other health care professionals together with any recommended changes to the service users care needs. All plans inspected were found to have been reviewed on a monthly basis and changes made to the care plans where necessary. The manager undertakes monthly audits of care plans and records of these audits are held in the home and were available for inspection. Only the manager and senior staff are permitted to administer medications to the service users. Training has been given to these staff and the manager takes responsibility for ensuring that the staff are competent. The home has comprehensive and detailed policies and procedures for the administration of medications. Medications were found to be dealt with by the staff in accordance with the home’s policy and procedure. All records relating to medications were completed accurately and storage areas were clean and organised. Service users spoken to during the inspection confirmed that personal care was given in the privacy of their bedroom or their bathroom. Staff spoken to were able to demonstrate that they were fully aware of the need to protect service users privacy and dignity at all times. Staff were observed to knock on bedroom doors and to wait for a response prior to entering. Homecrest Residential Home DS0000033293.V345026.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A high number of activities are available to service users to provide them with social stimulation. A choice of meals is offered to service users and a balanced diet is provided to promote good health. EVIDENCE: Daily routines within the home are, as far as possible, arranged to meet the preferences of the individual service users. An activity coordinator has been appointed and has introduced a high level of activities for the service users. A new large table has been purchased to enable a number of residents to participate in activities together, to avoid having to use the dining tables. This means that activities do not have to be stopped to prepare tables for meals which has previously resulted in disruption to the activities. New items have been purchased for the activities and service users were observed to be enjoying the number of activities on offer. Entertainers visit the home on a Homecrest Residential Home DS0000033293.V345026.R01.S.doc Version 5.2 Page 13 regular basis. Some service users are taken out by their family and some by staff to local shops and amenities. Ministers of religion visit the home to provide services for those service users who wish to participate. Visitors are welcome at the home at any time and may meet with the service users in one of the communal lounges or the service users own bedroom as they wish. The care files provide evidence that individual preferences and choices have been identified and the daily records show that these are respected and provided as much as possible. A varied diet is provided and a choice of meals is offered. Special diets can be made available on the advice of the GP or dietician or on the request of the service user. The meals served on the days of the inspection smelled appetising and were attractively served. Staff were observed to assist service users discreetly and aided them to take their meals in a dignified manner. The kitchen was clean and organised and a good supply of food was held. Fresh foods are delivered to the home several times each week and fresh fruit and vegetables are always available. Service users spoken to said that the food was lovely and this was confirmed in the questionnaires that were responded to by service users, relatives and staff. Homecrest Residential Home DS0000033293.V345026.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are protected from abuse through a robust complaints procedure and a well-trained staff team. EVIDENCE: The home has a robust complaints procedure which is displayed on the notice board in the foyer of the home and is detailed in the service user guide. No complaints have been received by the home since the last inspection. One relative was spoken to about complaints and confirmed that she knew who to make a complaint to, but had no concerns whatsoever about the home and the care given. Formal training on the protection of vulnerable adults has been given to all staff, with the exception of new staff. Training for these staff has been booked and will take place within the next three weeks. All staff within the home have read No Secrets and have been given in house training on the different types of abuse and of the action that they should take in the event of it being suspected. Staff spoken to during the inspection were able to demonstrate that they knew the different types of abuse and of the action they would take. Homecrest Residential Home DS0000033293.V345026.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 24 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is clean and well maintained and provides service users with a bright and pleasant environment in which to live. EVIDENCE: A full tour of the home was undertaken with the manager and deputy manager. This included communal areas, most bedrooms and ancillary areas. Some issues that were highlighted during the tour had been addressed by the second visit to the home. It was evident that staff and relatives had been involved with personalising bedrooms to make them homely with pictures, photographs and items of memorabilia. Some carpets were found to be developing worn patches and the Homecrest Residential Home DS0000033293.V345026.R01.S.doc Version 5.2 Page 16 manager confirmed on the second visit that arrangements had been put in place to have these replaced. A high number of armchairs in bedrooms have now become faded and worn, resulting in some cases, exposure of the infill. Staff had tried to make these chairs more attractive by covering them with throw-over covers. These armchairs now need to be replaced to provide a more pleasant and comfortable facility for the service users. A small number of chests of drawers had become damaged and would benefit from replacement. A hairdressing room has been provided for service users and was seen to be well used by the visiting hairdresser and was a place of chatting and laughter. All areas of the home were found to be clean and fresh and there were no unpleasant odours. The conservatory was extremely hot and staff explained that this room could not be used during summer afternoons as it became unpleasant. Consideration should be given to providing additional ventilation or a cooling system to given the service users the opportunity to use this area at all times. The garden at the rear of the home provides a paved area and lawns. The garden is bordered by shrubs and trees and seating is provided. The ramp from the rear door requires that hand rails be fitted to avoid the risk of accident from the edges and to aid service users who have mobility difficulties. The lounges are bright and pleasant and it was evident that service users could choose the area in which they spent their day. The lounges are homely and attractively decorated. The home is well maintained and any issues identified by the staff are reported to the maintenance person who deals with these as quickly as possible. Homecrest Residential Home DS0000033293.V345026.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users are given care by a well trained and committed staff team. EVIDENCE: The staff rota shows that sufficient staff are employed and deployed to meet the needs of the service users. Staff training continues and all staff either hold or are working towards NVQ level 2 qualifications. Six care staff are working towards NVQ at level 3. Ten of the staff are appointed first aiders, having undertaken the relevant training. Staff confirmed, both to the inspector and in the survey forms, that a high number of relevant training events are organised and that this has enabled them to provide a high level of care to the service users. Details of forthcoming training events were displayed for all staff and it was evident that staff were enthusiastic and willing to take all training opportunities. A key worker system is in place and the key workers have been given responsibility for preparing pen picture of the service users to identify their lifestyles and their individual preferences. Much of this information is gathered Homecrest Residential Home DS0000033293.V345026.R01.S.doc Version 5.2 Page 18 from friends and family and enables staff to understand the service users more effectively. The staff confirmed that they work closely as a team and are well supported by the manager and deputy manager. All staff said that the manager had an open door policy and could be approached on any subject. Regular supervision is given to all staff and comments from the survey include ‘we have supervision which informs us of our strengths and weaknesses and gives us an aim. We also get praise’. ‘Management are always looking at any improvements that could be made to benefit the service users. Any problems or concerns are dealt with quickly and effectively. Staff can speak freely with the management. Both the manager and deputy are very approachable for any reason.’ The home has a robust recruitment procedure. An application form is required to be completed prior to interview. A record is held of the interview. Two references are taken and checks are made with the Criminal Records Bureau and the Protection of Vulnerable Adults register. All staff are required to follow a detailed induction programme and staff confirmed that they work with an experienced member of staff during this time. A record of the induction training is held on the staff files. Staff files were organised and contained all information as required together with evidence of training undertaken. Homecrest Residential Home DS0000033293.V345026.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The strong management structure ensures that staff and service users are protected. EVIDENCE: The manager is experienced and is about to complete her NVQ 4 in management. She is supported by a deputy and a well trained staff team. Staff spoke highly of the manager and of her aims to provide a high level of care to the service users whilst respecting their individual choices and preferences. Homecrest Residential Home DS0000033293.V345026.R01.S.doc Version 5.2 Page 20 The manager has an open door policy for all staff, service users and relatives and ensures that all are given full information at all time. Homecrest was awarded ‘Investor in People’ status in March 2004 and is also accredited by the British Standards Institute (BSI) and holds ISO 9001 certification. The BSI conducts six monthly quality assurance inspections. Questionnaires are regularly sent to service users and relatives to enable the manager to identify areas for improvement and to gather the views of those who are involved in the home. Records show that information gathered has been used to improve the service. Events are organised to raise money for outings for service users and for the purchase of games and activities for the service users. Systems are in place to ensure that service users finances are protected. Staff are supervised by the manager on a regular basis and annual appraisals are undertaken. The manager and deputy work with the staff to provide care to the service users and this gives them the opportunity to monitor and supervise the staff with a hands on approach. Staff confirmed that they had full access to the home’s policies and procedures and that they were encouraged to read these on a regular basis. A written statement for maintaining safe working practice is included in the homes policies and procedures and work based risk assessments are undertaken, documented and regularly updated. Tests are made on the fire detection equipment as required and is duly recorded. Training on fire prevention and fire drills is given to all staff on a regular basis. All contracts, tests and safety certificates inspected were found to be well maintained and up to date. A representative of the owner visits the home on a regular basis but does not complete a record of these visits as required. Homecrest Residential Home DS0000033293.V345026.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 X X X 3 X 4 STAFFING Standard No Score 27 4 28 4 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 3 3 X 3 3 X 3 Homecrest Residential Home DS0000033293.V345026.R01.S.doc Version 5.2 Page 22 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard OP19 OP37 Regulation 16(2)(c) 26(2) Requirement The Registered Person must ensure that worn bedroom armchairs are replaced. The Registered Person must ensure that monthly written report on the conduct of the home is prepared. The Registered Person must ensure that handrails are fitted to the ramp at the rear of the home. Timescale for action 30/06/08 30/04/08 3. OP19 13(4) 30/05/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Homecrest Residential Home DS0000033293.V345026.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection North West Regional Contact Team Unit 1, 3rd Floor Tustin Court, Port Way Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Homecrest Residential Home DS0000033293.V345026.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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