Care Home: The Crescent

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What the care home does well Staff have supported and enabled people to settle into their new home well. People appear happy living at The Crescent, both homes are well furnished and homely which means that people have a comfortable place to live. Staff demonstrate a clear understanding of how people with little or no verbal communication make their needs known through using signs and symbols to aid their communication skills so they are able to make decisions about their lives on a daily basis. People using the service are supported by a well trained and committed staff team, which benefits their care. Staff appear confident and competent in their roles and have developed positive relationships with the individuals they support. People lead busy lifestyles and are encouraged to develop their daily living skills, promoting their independence. Their healthcare needs are met because they are supported to gain access to advice from health professionals when they need to; ensuring their health and wellbeing is promoted. Comments received about what the service does well include: "Gives choice, puts the needs of service users first...training is regularly available and of a high standard...staff really do care and provide a homely environment" "It meets all the needs of service users including education, health, diet, communication, diversity and provides a homely environment" "I feel valued and supported by the management team, particularly my house leader who is always appreciative about my contribution" "Staff always appear to well interpret `X` needs and he appears happy and well settled" What has improved since the last inspection? This is the first inspection of the service since we registered it six months ago. What the care home could do better: As this is the first key inspection following registration and the service has only been operating for six months, an overall rating of "excellent" cannot be given as it is considered that the service needs to demonstrate a sustained level of performance over a period of time. However we are confident that the serviceThe CrescentDS0000073047.V375441.R01.S.doc Version 5.2 currently provides positive outcomes for the individuals who live at The Crescent, therefore no requirements have been made for improvement. Support plans, although very detailed, could be written in the first person, as if the individual is telling others about themselves. People told us the service could improve by: "Providing more opportunities for 1:1 stimulation in the house" "There is usually 2 staff on shift to support 5 students, which is adequate when in the house but for trips out I feel another member of staff would be beneficial" Key inspection report CARE HOME ADULTS 18-65 The Crescent 1a and 1b The Crescent Bomere Heath Shrewsbury West Midlands SY4 3PQ Lead Inspector Rebecca Harrison Unannounced Inspection 18th May 2009 10:30 The Crescent DS0000073047.V375441.R01.S.doc Version 5.2 Page 1 This report is a review of the 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. 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 home adults 18-65 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. The Crescent DS0000073047.V375441.R01.S.doc Version 5.2 Page 2 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 The Crescent DS0000073047.V375441.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Crescent Address 1a and 1b The Crescent Bomere Heath Shrewsbury West Midlands SY4 3PQ 01939 291841 01939 291841 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) Condover College Miss Amanda Jane Nuttall Care Home 5 Category(ies) of Learning disability (5) registration, with number of places The Crescent DS0000073047.V375441.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning Disability (LD) 5 The maximum number of service users to be accommodated is 5 2. Date of last inspection Not applicable – new registration Brief Description of the Service: 1A and 1B The Crescent is registered to provide accommodation and personal care for up to five adults with a learning disability. The service is one of three services owned and managed by Condover College. The home is pleasantly located in Bomere Heath, near Shrewsbury and consists of two purpose built semi-detached properties (known as Meadow View and Crescent View) that are internally linked. The Crescent is not suited to people with mobility difficulties. The property is in keeping with the local community and offers good access to local amenities and public transport. Each home has a small lounge and a kitchen/dining area. Single bedrooms with ensuite shower facilities are provided across the first and second floors of both properties. A large safe and secure garden area is provided to the rear of the property with lawned gardens and patio space. There is ample car parking facilities available to the front of the home providing space for the house vehicles, staff and visitor parking. People who use the service and their representatives are able to gain information about this service from the Statement of Purpose and Service User Guide, which are available in easy read formats. Inspection reports produced by CQC can be obtained direct from the provider or are available on our website at www.cqc.org.uk The range of fees charged range from £800 - £2200 per person per week based on an assessment of individual needs. The Crescent DS0000073047.V375441.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 the people who use this service experience good quality outcomes. This was the first inspection of The Crescent since we registered it six months ago. We were at the home for nearly six hours. The inspection was unannounced therefore people who live and work at the home did not know that we were visiting. A range of evidence was used to make judgements about this service. We met three people who live at The Crescent, spoke with two staff, the manager and two senior managers from the organisation. We looked at some parts of the home and sampled a number of records to include care records, complaints and protection, staff training, recruitment and health and safety records. We received four surveys from people who live at The Crescent and these were completed with the support of people who know them well. Two members of staff also completed surveys for us but we did not receive any comments from health or social care professionals about their views on the service. We looked in depth at the care and services offered to two people who live at the home. People who use the service were unable to tell us in detail about their experiences of living at The Crescent, due to their communication difficulties. We therefore spent time observing how they are supported and looked at their support plans, risk assessments, daily records and other information such as dream books and life stories, that they were happy to share with us. This helped us gain information and understand their experiences and the quality of care they receive. We looked at the outcomes for people living at the home and information to produce this report was gathered from the findings on the day of our visit and also the information that we have received, or asked for, since the service was first registered. The responsible individual completed an Annual Quality Assurance Assessment (AQAA) document for us, as requested. The AQAA is a self-assessment and a dataset that is filled in once a year by all providers. It informs us about how they are meeting outcomes for people using their service and is an opportunity for them to share with us areas that they believe they are doing well. The AQAA provided us with detailed information about the service and helped to determine a judgement about the quality of care the home provides. The Crescent DS0000073047.V375441.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: As this is the first key inspection following registration and the service has only been operating for six months, an overall rating of excellent cannot be given as it is considered that the service needs to demonstrate a sustained level of performance over a period of time. However we are confident that the service The Crescent DS0000073047.V375441.R01.S.doc Version 5.2 Page 7 currently provides positive outcomes for the individuals who live at The Crescent, therefore no requirements have been made for improvement. Support plans, although very detailed, could be written in the first person, as if the individual is telling others about themselves. People told us the service could improve by: Providing more opportunities for 1:1 stimulation in the house There is usually 2 staff on shift to support 5 students, which is adequate when in the house but for trips out I feel another member of staff would be beneficial 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. The Crescent DS0000073047.V375441.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Crescent DS0000073047.V375441.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,4 and 5 People using the service experience excellent quality outcomes in this area. People are provided with the information they need to make an informed choice about whether the service is able to meet their needs. Their needs are assessed and they are provided with a contract which details what they can expect from the service. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Information about the service is readily available in the Statement of Purpose and Service User Guide. The documents are available in a range of formats and provide people with information to help them understand the services that are provided. The five people who live at the home were known to the provider before admission, because they have previously lived in the providers other registered establishments. People told us in the surveys we received that they received information about the home, viewed pictures and visited the site on a number of occasions and stayed overnight to ensure the service was right for them. Outcomes of all visits undertaken were available on the files of the two people we looked at in depth and these showed us that people were very much The Crescent DS0000073047.V375441.R01.S.doc Version 5.2 Page 10 involved in the assessment and admission process. Consideration was also given about the compatibility of individuals prior to admission to ensure individuals had a choice of who they wished to live with. Each individual has a signed contract explaining their rights and terms and conditions of their placement, this helps them to understand about what they can expect from the service. The Crescent DS0000073047.V375441.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 People using the service experience excellent quality outcomes in this area. Support plans are detailed and inform staff about the needs of the individuals they support, their personal preferences and aspirations providing an individualised service. People are enabled to maintain choice and control and take measured risks to lead the lives they choose and develop their independence. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: People can be confident that their needs are met because they have detailed support plans in place in addition to person planning books, dream books and life stories. These ensure that the staff supporting them are familiar with their assessed needs, their wishes and aspirations. One person shared their care records with us and there was clear evidence that he has contributed to the The Crescent DS0000073047.V375441.R01.S.doc Version 5.2 Page 12 development of his support plan and attended a meeting with people close to him to review his needs, his placement and the progress that he has made to date. Information has been developed using a range of formats to make it easier for him to understand for example by using photographs, signs and symbols that he is familiar with to aid his communication. The AQAA stated We set clear achievable targets that have been broken down into small achieveable stages to ensure that the resident can achieve and gain in confidence and self esteem. This was clearly evident on the records of the two people we looked at in depth. We spoke with two members of staff on duty and they demonstrated a clear understanding of peoples needs, which was consistent with the information held on the files of the individuals we case tracked. People living at The Crescent have very limited verbal communication and therefore use signs, symbols, photographs, body language and facial expressions to make their needs known, communicate their choices and reinforce their speech. Communication passports have been developed with individuals identifying their preferred method of communication. We observed staff and residents using signs and speech to effectively communicate with one another throughout the inspection. One resident also helps train new staff to develop their skills in sign language and he indicated to us that he really enjoys this role. People are able to access the service of an independent advocate, and have active family involvement and a designated key worker to represent their best interests. Regular house meetings are held to ensure individuals are consulted with and have an active role in the running of their home. The minutes of a recent house meeting were available and items discussed include the complaints procedure, meal planning, advocacy, leisure, holidays, the garden, fire drill and the role of CQC. Records seen on the files of the two people we case tracked show that people are able to make choices and that their views are listened to and acted upon with the support of those close to them. Support plans state We always presume that someone has the ability to make an independent decision unless we have the evidence to prove they do not… One person we case tracked is unable to access the community independently and reasons to support this are clearly stated and kept under review. Risk assessments were available on the files sampled. These show that individuals are not stopped from taking risks as part of everyday living but that systems are in place to minimise the risk of harm to them. This enables people to lead the life they choose. For example the files of the two people we looked at in depth contained detailed risk assessments covering household tasks, the community, maintaining safety, health and behaviour management. The AQAA states We have ensured that the risk assessment system does not limit the opportunities for spontaneous activities…All risk assessments are agreed and reviewed by a committee of trained staff. The Crescent DS0000073047.V375441.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12,13,14,15,16 and 17 People using the service experience good quality outcomes in this area. People are provided with opportunities to participate in a range of leisure activities and develop their life skills because staff support and promote their personal development. Important relationships are maintained and people are provided with a choice of meals in accordance with their own preferences, cultural and dietary needs. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: We sampled all of the records held on behalf of the two people we looked at in depth. These showed that people are provided with a variety of opportunities to develop their social and independent living skills. Staff spoken with considered people lead active lifestyles and are encouraged and enabled to partake in daily living tasks and also access the community. During our visit The Crescent DS0000073047.V375441.R01.S.doc Version 5.2 Page 14 three people were out at the main college campus and the other two people were later supported to attend Telford College where they are studying animal welfare. Due to one person needing to see a doctor that morning, it meant the other person missed part of his college day; however he appeared happy to spend time with us while he waited and shared his care records, activity timetable and daily diary with us. This showed us that he leads a busy lifestyle and activities undertaken include shopping, horse riding, drama, a barge trip, a party, a trip to an amusement park and trips to other places of interest. He also shared a number of photographs of a recent tag-rugby event that he was part of, which was one of his aims. The home provides two vehicles for people to access the community and people also use public transport such as the train and the Ring and Ride transport service. Discussions held indicate staffing is flexible to support individual or group activities although feedback we received suggests that people may benefit from greater opportunities for 1:1 activities. People living at the home are supported to maintain relationships that are important to them for example family are invited to attend any meetings held and regular contact is maintained via telephone calls and visits. One of the people we case tracked recently went abroad on holiday with his family, which was one of his goals. It was reported that that positive relations have been developed with the local community. People using the service are provided with opportunities to meet up with friends at colleges, parties and the local youth club and swimming club they attend. Personal planning books include people who are important to individuals. The AQAA identifies that the service could improve by providing accessible computers for the residents to access emails and the introduction of web cam. One person we met enjoys carrying out household tasks such as vacuuming, stacking the dishwasher, doing his laundry and making drinks. Records sampled told us that routines are very important to people as any changes can cause individuals to respond negatively and display behaviours that are inappropriate. We saw very detailed daily accounts on peoples files and how people can make choices within their routine. This information told us about peoples preferences for example when and how they are supported to rise and retire, carry out their personal care, choose their meals etc. Likes and dislikes for leisure, meals and drinks are documented so staff are familiar with individual preferences. The AQAA states We ensure that dietary requirements take into account religious needs and wishes. People we spoke with indicated that they are involved in menu planning, shopping and basic meal preparation. Fresh fruit and vegetables were readily available in both homes and people have been supported to create a vegetable patch in the garden, which is proving sucessful. Individuals on healthy eating programmes are weighed weekly and a record of all food eaten is maintained as a way of maintaining good health. Discussions held evidence that peoples cultural needs and special dietary requirements are catered for and staff spoken with provided examples of The Crescent DS0000073047.V375441.R01.S.doc Version 5.2 Page 15 specific food provided for individuals. Themed nights have also been introduced providing opportunities for people to experience different cultures. The Crescent DS0000073047.V375441.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 People using the service experience excellent quality outcomes in this area. People receive personal support from staff in the way they prefer. Their health needs are closely monitored and regularly reviewed ensuring their good health and well being. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: People receive the level of support they need to ensure their personal and healthcare needs are met in a way they prefer, promoting their dignity and privacy. One person helps train new staff to manage his specific medical condition, which is also clearly detailed in his support plan. People we met were well presented promoting their self esteem. We looked at the healthcare records of the people we case tracked. Their healthcare needs were clearly identified and the action required stated in their care records. The AQAA states We monitor the residents health care needs well and ensure that any changes in mood, behaviour and wellbeing are The Crescent DS0000073047.V375441.R01.S.doc Version 5.2 Page 17 responded to and actioned. This was clearly evidenced during our visit when one person was supported to access a health appointment that had swiftly been arranged, as staff were concerned about his health. Records show that people attend routine health check ups such as the dentist and doctors in addition to specialist appointments to ensure their health needs are met. Health Action Plans have been developed which is an individualised plan about what the person must do to stay healthy. Staff spoken with demonstrated a good understanding of peoples health needs and considered peoples health is closely monitored and their needs met. We looked at the medication arrangements for the people we case tracked and found that records were in good order. People who are prescribed medication are supported by staff who receive training to ensure they are competent to administer medication. Medication reviews are held to ensure individuals are on the correct medication and dosage required to maintain their health. Staff have detailed information about peoples medication, the reasons for the prescribed medication and common side effects, so that they can be alert to any possible effects a drug may have. There have been no medication errors since the service was registered and we were informed that arrangements have been made for a community pharmacist to visit the home to undertake a medication audit shortly. The Crescent DS0000073047.V375441.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People using the service experience good quality outcomes in this area. Arrangements are in place to ensure that people living at The Crescent are represented and that they are protected from potential abuse ensuring their wellbeing. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: People living at The Crescent have access to information about how to make a complaint, which has been developed in a format that they can understand. The AQAA states We discuss the complaints procedure in house meetings with the residents at a level appropriate to individual needs this was clearly evident in minutes of the meetings held which reports that the manager has spoken with residents about who to approach if they are feeling sad or unhappy about anything and that people may wish to use the symbol card available in their rooms to alert staff. Feedback received in surveys indicate that people know who to approach if they have concerns about the service and staff know how to ensure concerns or complaints are appropriately dealt with, although to date neither the service or the commission have received any complaints. Observations made evidence that staff are familiar with the needs of the people they support and are well tuned into any changes in mood. Staff have access to local policy and procedures in relation to adult protection and have either received training in safeguarding or are booked to attend the The Crescent DS0000073047.V375441.R01.S.doc Version 5.2 Page 19 next available course so that they know how to recognise signs of abuse and report this, ensuring people living at the home remain safe. No referrals have been made under safeguarding adult procedures since the home was registered and the staff spoken with during our visit demonstrated and an understanding of how to respond to any allegation of abuse or neglect in addition to whistle blowing procedures. Both people we case tracked need help to manage their money and records seen evidence that their money is looked after appropriately and regularly audited. Staff spoken with considered financial arrangements safeguard people in their care. Most staff have either attended or are booked to attend training in the management of actual and physical aggression. Guidelines were available on the files sampled to ensure staff adopt a consistent approach when supporting individuals, whose behaviours may challenge the service. The Crescent DS0000073047.V375441.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 People using the service experience good quality outcomes in this area. People are provided with a homely, clean and comfortable place to live where they feel safe and secure. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The properties are semi-detached, purpose built and are similar to a number of other residential houses in the area. A large drive way to the front of the properties provides space for the house vehicles and staff and visitor parking. Accommodation is provided across three floors with lockable interlinking doors between the two properties. Three people live in 1A (Meadow View) and two people live in 1B (Crescent View). People are provided with their own room and the two people we case tracked were happy to show us their bedrooms and the shared areas in each home. It was evident that people are happy with their rooms, which staff have helped them to personalise to reflect their own individuality and these are equipped to meet their needs. En-suite facilities are The Crescent DS0000073047.V375441.R01.S.doc Version 5.2 Page 21 provided however there is no separate communal bathroom, thereby not offering a choice of bath or shower to the occupants of either home. This is clearly stated in the Statement of Purpose which says This is not the home for any resident which wants to have baths instead of showers as there are not options of having baths fitted. The manager also told us that people were advised about this prior to admission so that they could make an informed choice about the suitability of the environment. We were told that people accommodated do not require any specialist equipment to aid their mobility such as passenger lifts or hoists, therefore these are not provided. Staff are aware of peoples sensory needs for example the manager ensured that a resident turned the light on in a dark area of the home when he showed us his bedroom, due to his impaired sight. Two of the people we met indicated that they are happy with the facilities available. The shared areas in both properties were homely, comfortable and decorated to a high standard. We were told that people were involved in choosing the décor of their home and the choice of furniture, which is different across the two homes. In addition to the lounge and kitchen/diner, people have access to a large enclosed rear garden providing a vegetable patch, patio area and seating. People we met indicated that they enjoying living at Meadow View and Crescent View and appeared relaxed and happy. Rendering to the rear elevation of the building is due to be completed shortly. Both homes were spotlessly clean during our unannounced visit. People are supported to maintain a clean environment with the support of staff and a domestic member of staff. Laundry equipment is provided within the kitchen areas and this has been agreed with Environmental Services. Substances hazardous to health is appropriately stored and good infection control measures are in place to protect the people who live there. The Crescent DS0000073047.V375441.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34 and 35 People using the service experience good quality outcomes in this area. Staff work positively with the people they support and receive good training opportunities to equip them with the skills and knowledge to meet the individual needs of the people living at The Crescent. People have confidence in the staff because the necessary checks have been done to make sure that they are suitable to care for them. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: During our visit we observed staff communicating using residents preferred communication methods and people smiled when staff interacted with them. People we met appeared relaxed in the company of the staff on duty and the atmosphere within the home was comforting and relaxing. Staff spoken with demonstrated a good understanding of the individual needs of the people they support and have developed positive relationships with people using the service. One member of staff spoken with told us that they have obtained a The Crescent DS0000073047.V375441.R01.S.doc Version 5.2 Page 23 care qualification known as NVQ at level 3. The manager reported that two other staff have commenced the award. The minimum staffing ratio is one member of staff to three people using the service plus an additional staff member is made available to cover activities, trips out, 1:1 time and to support people to attend health appointments etc. On arrival to the home two members at staff were supporting three people on the main college campus and one member of staff was at the home supporting two people. The manager was also on duty undertaking clerical duties. Feedback we received indicates people consider staffing is sufficient to meet the needs of the individuals who use the service, although people would benefit from more opportunities for additional 1:1 time. This should therefore be given some consideration in the best interests of people using the service. We randomly selected the files of three staff that have been recruited to support the individuals living at The Crescent. This was to make sure that checks are undertaken so staff are suitable to work with vulnerable adults. The files evidence that with the exception of staff photographs, all of the checks that we require were undertaken prior to new staff commencing work for example a Criminal Records Bureau check and two written references. Feedback gained from staff indicate that they consider recruitment procedures are robust and safeguard people use a service. One person we met has helped with the recruitment and selection of new staff, which was evidenced on the interview records seen on the files we sampled. This shows that people play an active role in choosing the people employed to work with them. The AQAA states A comprehensive training package is available which has a balance of external and internal trainers, which all staff have access to…The induction training of new staff is important and the home recognises that the input given during the probation period is vital to the success and experience of each member of staff. This was reflected in discussions held with staff on duty and was also reflected in the surveys that we received. Comments include: We have development days which are very useful and cover a range of areas to include disability awareness, cultural and religious needs Im really impressed with the training provided, Ive had all my mandatory training in safe working practices in addition to adult protection, disability awareness, safe handling of medicines, and infection control and Im booked to attend makaton (sign language) shortly Im kept up to date with new legislation through weekly staff meetings, monthly supervision and appraisals Training is regularly available and to a high standard The Crescent DS0000073047.V375441.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 People using the service experience good quality outcomes in this area. People have confidence in the service because it is managed by a competent, trained and experienced manager. People benefit from the quality assurance systems used to ensure their views are listened to and are kept safe by the health and safety arrangements in place. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: People using the service benefit from a manager who is experienced, qualified and demonstrates a good understanding of their individual needs. The manager has numerous years experience in working in the care sector and has attended lots of training courses relevant to her role. Staff were complimentary about how the service is managed and feedback received includes: The Crescent DS0000073047.V375441.R01.S.doc Version 5.2 Page 25 I feel valued and supported by the management team, particularly my house leader who is always appreciate of my contribution Amanda is great; she is firm but fair and is approachable The manager is very approachable The manager has received training in the new legislation concerning Deprivation of Liberty Safeguards and it was reported that staff are due to receive training at a conference arranged for September. The manager reported that the organisation has a policy regarding this legislation; however this was not readily available. We were advised that no individuals are currently restricted or subject to authorisation. Records seen on the files sampled evidence that people using the service are provided with choices and their rights promoted. The AQAA completed by the responsible individual is detailed and reflects the strengths and areas for improvement. It states The views of the residents are listened to and acted upon during house meetings and their views are taken into account in the development of the service. People have been supported to complete questionnaires to enable them to give their views and relatives and stakeholders are to be surveyed shortly. This will help assess how the service is currently performing and evaluate outcomes for people and aid future planning. Minutes of review meetings held on the files for the two people case tracked evidence that relatives are happy with the service provided and the progress their relatives have made to date. The AQAA indicates that the service is planning to make further changes to promote equality and diversity and provide and develop further forums to promote the views of the residents and continue to work alongside an external advocacy service. Health and safety and maintenance checks are generally undertaken at the required frequency to ensure that the equipment is safe and in full working order. We advised the manager to ensure there are no gaps in the testing of fridge and freezer temperatures and also advised that water temperature checks should be tested on a more frequent basis to assist in the prevention of people accidentally scalding themselves. Service certificates were assessed as part of registration so we did not review these on this occasion. Staff receive training in food hygiene, fire safety, first aid, infection control procedures and moving and handling to ensure safe working practices. The manager reported that the home has complied with recommendations made by both the fire and environmental health departments. We were advised that the organisation has a maintenance department who are quick to respond, ensuring a safe environment for people using the service. The Crescent DS0000073047.V375441.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 4 3 x 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 4 35 4 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 3 x 3 x 3 x x 3 x Version 5.2 Page 27 The Crescent DS0000073047.V375441.R01.S.doc Are there any outstanding requirements from the last inspection? N/A – new service 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA40 Good Practice Recommendations Policies relating to the Mental Capacity Act deprivation of liberty safeguards should be made readily available so staff have an understanding of how this legislation may affect people who live at the service. The Crescent DS0000073047.V375441.R01.S.doc Version 5.2 Page 28 Care Quality Commission West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway, Birmingham B1 2DT National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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. 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