Care Home: The Crescent

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What the care home does well The Crescent is an established home with a stable staff team. The Crescent offers care and accommodation to vulnerable adults in a relaxed and informal atmosphere that promotes independence and is also providing support as required. The people who use the service were clearly comfortable within this environment and are observed to relate well to the staff. Residents like the central location of the home in Newquay, that enables them to access activities within the local community. The home is offering residents a choice in living style, daily routines and meals. Residents are living in a safe environment and contact is made with various agencies as required.The CrescentDS0000009012.V377533.R01.S.docVersion 5.3 What has improved since the last inspection? Various improvements to the environment have been completed with more planned. A new Roof has been installed. A programme of replacing carpets and redecoration has commenced. The majority of bedroom doors have been renewed to current fire standard requirements. The senior staff are qualified to a good standard and are committed to improving compliance with the standards and regulations. Registration has been increased from 14 to 15. This has provided an additional rehabilitation flat which is being put to good use. A car has been provided to the home to facilitate better transport opportunities. What the care home could do better: As stated improvements to the environment are in hand. It is nevertheless important to keep this area under constant review given that the Crescent is an old style building which will always need maintenance, upkeep and refurbishment. Records should clearly state the start dates for staff so that a judgement can be made that POVA checks are in place prior to employment. Care plans would benefit from more direction to staff. It is recommended that that all staff details, recruitment, training and supervision is kept on an individual file pertinent to the staff member in question.The CrescentDS0000009012.V377533.R01.S.docVersion 5.3 Key inspection report CARE HOME ADULTS 18-65 The Crescent 1 Island Crescent Newquay Cornwall TR7 1DZ Lead Inspector Mike Dennis Key Unannounced Inspection 22nd September 2009 09:00 The Crescent DS0000009012.V377533.R01.S.doc Version 5.3 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 DS0000009012.V377533.R01.S.doc Version 5.3 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 DS0000009012.V377533.R01.S.doc Version 5.3 Page 3 SERVICE INFORMATION Name of service The Crescent Address 1 Island Crescent Newquay Cornwall TR7 1DZ 01637 874493 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) Mr Michael Westmore Samantha Crosswood Care Home 15 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (15) of places The Crescent DS0000009012.V377533.R01.S.doc Version 5.3 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 either gender whose primary care needs on admission to the home are within the following category: 2. Mental Disorder (Code MD) The maximum number of service users who can be accommodated is 15 2nd October 2007 Date of last inspection Brief Description of the Service: The Crescent is registered as a residential care home that provides personal care and accommodation to 15 individuals who suffer from a mental illness. The Crescent is a three storey Victorian building that is situated in Newquay, overlooking the sea. The town centre is within easy walking distance, as are the bus and train stations. There is accommodation for 12 Service Users in the main house and more independent living for three in the annexe flats, which are attached to the main building. The property is a former hotel situated in close proximity to Newquay town centre. There is no designated car park and parking on the road may be particularly difficult in the summer months. The location offers service users easy access to local amenities and shops. Newquay has its own cottage hospital that acts as an outpatient centre for all aspects of medical care, including mental health care. The Crescent DS0000009012.V377533.R01.S.doc Version 5.3 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 a key unannounced inspection to monitor the care standards at the home. The inspection took place on the 22nd. September 2009. It began at 09:00 and was completed by 16:30. We had the opportunity to speak with service users, staff, inspect records, and case tracked 4 service users. A tour of the premises was undertaken. During the course of the day we observed the residents being attended to by staff in a courteous and professional manner. Residents were seen to be fully occupied in various interests and activities. Various records, policies and procedures were inspected and found to be satisfactory. We visited all parts of the building and noted a satisfactory standard of hygiene. Residents expressed satisfaction with all aspects of the home. They were keen to show off their bedrooms and talked about the contents ranging from photographs, pictures, ornaments, toys etc. They also explained their lifestyles in some depth, explaining what they did at voluntary work placements, day centres etc. From observation and discussion it was apparent that service users lead a varied lifestyle Staff in the home currently undertake the domestic tasks as well as caring ones. What the service does well: The Crescent is an established home with a stable staff team. The Crescent offers care and accommodation to vulnerable adults in a relaxed and informal atmosphere that promotes independence and is also providing support as required. The people who use the service were clearly comfortable within this environment and are observed to relate well to the staff. Residents like the central location of the home in Newquay, that enables them to access activities within the local community. The home is offering residents a choice in living style, daily routines and meals. Residents are living in a safe environment and contact is made with various agencies as required. The Crescent DS0000009012.V377533.R01.S.doc Version 5.3 Page 6 What has improved since the last inspection? What they could do better: As stated improvements to the environment are in hand. It is nevertheless important to keep this area under constant review given that the Crescent is an old style building which will always need maintenance, upkeep and refurbishment. Records should clearly state the start dates for staff so that a judgement can be made that POVA checks are in place prior to employment. Care plans would benefit from more direction to staff. It is recommended that that all staff details, recruitment, training and supervision is kept on an individual file pertinent to the staff member in question. The Crescent DS0000009012.V377533.R01.S.doc Version 5.3 Page 7 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 DS0000009012.V377533.R01.S.doc Version 5.3 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 DS0000009012.V377533.R01.S.doc Version 5.3 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective users of the service are given the information they need in order to make an informed choice about living in the home. All have contracts of care and are able to visit the home prior to moving in. EVIDENCE: The registered manager and deputy manager were available to discuss the admission process for the last persons admitted to the home. Four people have been admitted since the last inspection. Detailed referral forms were completed prior to these admissions to the home to form a Core Assessment. We observed comprehensive pre assessment information gathered that included contributions from appropriate services. A gradual introduction to the home was carried out. This included a full assessment, introduction to other people living at the home and meeting the staff. The registered manager stated that the majority of service users had lived at the home for 10 years or more, enjoying a stable living environment. The Crescent DS0000009012.V377533.R01.S.doc Version 5.3 Page 10 The statement of purpose/service user guide is available to all of the people who use the service. Each person signs their own individual contract of care. All persons living at the home had a signed Contract of Care. The Crescent DS0000009012.V377533.R01.S.doc Version 5.3 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): 6,7,8 and 9 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Comprehensive care plans exist, are reviewed regularly and contain personal goals and assessed needs incorporating a risk management framework. EVIDENCE: The records of 4 service users were inspected and showed that appropriate information is organised to provide for the welfare of service users. The service user plans are based upon the assessment record and developed in conjunction with the service users who sign them. Care Plans are completed and any potential restrictions on choice are discussed and agreed with the service user. The Crescent DS0000009012.V377533.R01.S.doc Version 5.3 Page 12 The plan covers various aspects of social, physical and psychological care. The records demonstrated that the home was monitoring closely the needs of service users and that risk assessments and reviews with other agencies had occurred to protect service users at the home. The registered manager stated that multidisciplinary reviews usually occur on an annual basis. Review of care plans are also conducted by the home’s staff at least every 6 months. The records indicated that that residents were consulted on, and participate in aspects of life in the home. Residents are also supported to take risks as part of their independent lifestyle. Residents confirmed that this was the case and we observed people leaving and entering the home to engage in various pursuits with the support and knowledge of staff. We discussed with the manager possible ways of being more precise in documenting the direction of care for the benefit of enabling staff to fulfil their care role. The Crescent DS0000009012.V377533.R01.S.doc Version 5.3 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: 11,12,13,14,15,16 and 17 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are experiencing a satisfactory lifestyle both within the home and outside in the wider community according to their abilities and wishes. Support systems are in place to allow appropriate leisure activities and relationships. Resident’s rights are respected and appropriate relationships sustained. A healthy diet is provided. EVIDENCE: The registered manager stated that the home is actively supporting residents to maintain their interest in a choice of activities. They receive various levels The Crescent DS0000009012.V377533.R01.S.doc Version 5.3 Page 14 of support to identify practical or social life skills that they wish to develop and participate in the preparation of food, washing up and tidying their rooms. The location of the home in the centre of Newquay facilitates integration into the local community and residents are encouraged to maximise their independence and continue with existing interests and hobbies. Residents are encouraged to participate in college courses, (link to learning), occasional work placements, Church services, attend the library, exercise groups, and information about community activities are made available to the people who use the service. Residents value their freedom of choice and stated they are able to make choices about how they spend their time; They all have a key to their room and the front door. We were informed that ‘in house’ parties were arranged, ie; Christmas, birthdays, B.B.Q’s etc. as well as trips out using various forms of trans port. A car is now available to the home Some residents regularly attend local drop in centres. Food is prepared by staff on duty with help and input from residents. The Crescent DS0000009012.V377533.R01.S.doc Version 5.3 Page 15 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical care needs of residents are noted and addressed by supportive community medical staff and the home’s carers. EVIDENCE: All Residents are registered with a General Practitioner from 3 local surgeries. The records evidence regular specialist input from various support services as required, such as Community Psychiatric Nurses, Social Workers, Chiropodist and Dentist. Newquay has its own cottage hospital that acts as an outpatient centre for all aspects of medical care, including mental health care. Currently there is only one resident holding and managing their own medication. This is done through a risk management format and is kept under The Crescent DS0000009012.V377533.R01.S.doc Version 5.3 Page 16 review. Each person is provided with lockable facilities in their room for safekeeping of medication. Staff administer medication to the other residents via the monitored dosage system. These staff have been appropriately trained. We inspected the medication processes, policies and procedures and found them to be correct. The Crescent DS0000009012.V377533.R01.S.doc Version 5.3 Page 17 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. We have made this judgement using a range of evidence, including a visit to this service. Residents are listened to and the home is pro-active in obtaining their views. Any form of abuse is not tolerated. EVIDENCE: The registered manager and the staff have attended appropriate protection of vulnerable adults training. Appropriate policy and procedures are available and included in staff induction training. Information regarding the complaints process is available to residents at the home. The home assists residents with the safe storage of valuables and the records and balances inspected were accurately maintained. Records of incidents are maintained and appropriate action has recently been initiated to protect residents when necessary. Residents informed that they were aware of these processes. The complaints procedures require updating to include the contact details of the Department of Adult Care Support and that of the Care Quality Commission. (This task had been completed by the end of the inspection) The Crescent DS0000009012.V377533.R01.S.doc Version 5.3 Page 18 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): 24,25,26,27,28 and 30.People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment is suitable for those people who fall within the registered category. The environment will be less suitable for those of advancing age and with mobility problems. EVIDENCE: There is a large smoking lounge on the first floor with a television and a dining room with lounge area on the ground floor with another television. The bathrooms at the home have been refurbished and the registered manager stated that an improvement to some bedrooms has been completed. Some areas have been re-carpeted and a complete new floor constructed in one bedroom. Other areas have been decorated. Major expense has provided a new roof. The Crescent DS0000009012.V377533.R01.S.doc Version 5.3 Page 19 The registered persons have an improvement plan and standards within the home are improved as and when necessary, finances allowing. The residents are physically ambulant and the home does not provide a passenger lift or specialist equipment. All residents have a single room and these rooms are personalised. Service Users stated approval of their accommodation and the privacy that it gives them. All individuals have a front door and bedroom key. The registered manager assisted me in a tour of the premises. She pointed out the fact that the new fire doors previously have now been upgraded with intumiscent strips. A further improvement sees a second rehabilitation flat having been registered and brought into use. The Crescent is situated in a prime position overlooking the harbour and beaches of Newquay. It is however an older style building with narrow corridors and does not lend itself to structure remodelling. The premises appear a little tired and maintenance and redecoration require constant attention. The home is deemed suitable for it’s registered client group but as people become older their needs must be under constant review to ensure the available facilities will meet their needs. The Crescent DS0000009012.V377533.R01.S.doc Version 5.3 Page 20 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): 32,34,35 and36 People using the 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 people who use this service benefit from a staff team who have been properly recruited and receive training and supervision to enhance their skills. EVIDENCE: The current rota shows that there are three members of staff on duty for most of the day and a sleeping night support worker is provided. There were 3 members of staff on duty on the day of the unannounced inspection. The staff undertake generic roles with no designated laundry, domestic, maintenance or catering staff. The support staff exhibited appropriate skills and attitudes in their interactions with service users. The support staff have completed appropriate NVQ training opportunities at various levels, first aid, food and hygiene and protection training. The Crescent DS0000009012.V377533.R01.S.doc Version 5.3 Page 21 The records regarding staff recruitment and supervision meetings are appropriately maintained. Supervision is carried out in order to ensure that all staff receive supervision at least 6 times per year. All staff have undergone Criminal Records and POVA checks. It is not clear from the records when staff actually started work at the home. It is important to demonstrate that no new staff member commences work prior to a satisfactory POVA check. We also recommend that a staff file is maintained for each individual member of staff rather collective file as is the case in some areas. The maintenance of the building is contracted out to various professionals. The Crescent DS0000009012.V377533.R01.S.doc Version 5.3 Page 22 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): 37,38,39,40,41,42and43 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents views are sought in the promotion and development of this home. Policies and procedures are reviewed as necessary and appropriate records are kept. The health, safety and welfare of the service user is promoted. EVIDENCE: The registered provider has many years experience of managing The Crescent on a daily basis but is now living out of the area. A registered manager has been approved to take day-to-day control of the home. The registered The Crescent DS0000009012.V377533.R01.S.doc Version 5.3 Page 23 manager has achieved a National Vocational Qualification Level 4 in Care and has completed the Registered Manager’s Award. The registered provider is completing Regulation 26 visits to the home to monitor care standards and reports are available to the Commission for Social Care Inspection. Annual Quality Assurance assessments have been undertaken. The fire precautions have been improved by the introduction of smoke detectors and new fire doors. Electrical wiring checks have occurred recently. Appropriate staff training and instruction in fire precautions occur and support staff complete safety checks. The Crescent DS0000009012.V377533.R01.S.doc Version 5.3 Page 24 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 3 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 2 25 3 26 3 27 3 28 3 29 2 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 3 3 3 3 3 Version 5.3 Page 25 The Crescent DS0000009012.V377533.R01.S.doc Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA34 Regulation 19, Schedule 2 Requirement The records must clearly demonstrate that staff only commence employment following a positive POVA check being received. Timescale for action 01/11/09 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 YA6 Good Practice Recommendations It is recommended that the care plans clearly state the goals identified and subsequent progress made or not as the case may be. Clearer direction of care for staff would be welcome An individual staff file for each staff member is recommended. 2 YA41 The Crescent DS0000009012.V377533.R01.S.doc Version 5.3 Page 26 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA 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. 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