Care Home: The Crescent

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What the care home does well The relative, friend or advocate of a person said "best of all is the friendly, safe, caring home they provide" and "they do a fantastic job". The environment is comfortable and homely. Due to the small size of the home, people living there receive care and support that is individual and personal. The manager and her family have known some of the people living there for a long time and clearly know their needs very well. What has improved since the last inspection? We saw that the Requirement made at the June 2006 inspection around medication records has been fully addressed. In the AQAA, the home told us that improvements made in the last twelve months included new decking in the garden, a new fish aquarium and having a big Birthday celebration for one of the people living there. CARE HOME ADULTS 18-65 The Crescent 2 Grayham Crescent New Malden Surrey KT3 5HP Lead Inspector Jon Fry Key Unannounced Inspection 30th June 2008 10:15 The Crescent DS0000013412.V366468.R01.S.doc Version 5.2 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 The Crescent DS0000013412.V366468.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 Adults 18-65. 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. The Crescent DS0000013412.V366468.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Crescent Address 2 Grayham Crescent New Malden Surrey KT3 5HP 020 8287 2490 F/P 020 8287 2490 zhecrescent@aol.com 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) Mrs Maya Patten Mrs Maya Patten Care Home 4 Category(ies) of Learning disability (0), Mental disorder, registration, with number excluding learning disability or dementia (0) of places The Crescent DS0000013412.V366468.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th June 2006 Brief Description of the Service: The Crescent provides care and support for up to four people who have a learning disability or mental health issue. The home is situated in a quiet residential area of New Malden but is only a short walk away from the town centre, which offers a range of shops, pubs, restaurants and transport facilities. The home offers two bedrooms on the ground floor and two further bedrooms for individuals on the first floor. A copy of the home’s Service User Guide and Statement of Purpose can be obtained on request from the owners. The Crescent DS0000013412.V366468.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 stars. This means the people who use this service experience good quality outcomes. One inspector spent approximately three hours in the home. We spoke to two people who live at the home, the owner / manager and her husband who also works at the home. We looked at records and documents kept at the service including two people’s care plans. The home completed an Annual Quality Assurance Assessment (AQAA), which gave us information about the home and the people who live and work there. We received one survey back from a relative, friend or advocate of a person who lives there. What the service does well: What has improved since the last inspection? We saw that the Requirement made at the June 2006 inspection around medication records has been fully addressed. In the AQAA, the home told us that improvements made in the last twelve months included new decking in the garden, a new fish aquarium and having a big Birthday celebration for one of the people living there. The Crescent DS0000013412.V366468.R01.S.doc Version 5.2 Page 6 What they could do better: 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. The Crescent DS0000013412.V366468.R01.S.doc Version 5.2 Page 7 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 DS0000013412.V366468.R01.S.doc Version 5.2 Page 8 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2. 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. Good information is available about the home and the service it provides. Assessments are carried out to make sure that the service can meet people’s needs before they move in. EVIDENCE: There have been no new admissions since the last inspection of the home in June 2006. The admission procedure for the service says that people are encouraged to visit the home before moving in and gives a trial period of ninety days. We looked at the care files for two people and saw that the original assessment information was there for both of these individuals. Both people had reviews within the last year with their care managers to make sure their needs continue to be met. We think that the home could look at the assessment process it uses to see how assessments could be made more person centred. People who may want to come to live there or their family / representatives could be encouraged to The Crescent DS0000013412.V366468.R01.S.doc Version 5.2 Page 9 complete questionnaires about their life or a person centred plan could be started at this stage. The home has a User Guide that provides good information about the service. There is a picture on the front of this document and we have recommended that the home keeps looking at ways of making the guide more accessible to people who may want to use its service. Lots of photographs may help to do this and be reasonably easy for someone to put together. The Crescent DS0000013412.V366468.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. 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. Individual care needs are well documented within their care plans. These documents could however be made more person centred and accessible to the individual they are about. EVIDENCE: We saw that each person living there has a care plan. We looked at the plans for two people and saw that these looked at the support required with individual diet, their personal care, their mobility and their emotional / social needs. Both care plans had been reviewed regularly but we saw that some of this information had been first written in 2004. We have strongly recommended that the home look at writing new plans with people which are more person centred and accessible to them. There are many formats now available for The Crescent DS0000013412.V366468.R01.S.doc Version 5.2 Page 11 person centred plans and these could be used with individuals to make a new care plan for them. The home should also look at making the care plans more goal focussed. This may help to support people with achieving their own plans and dreams both long term and short term. We would suggest that goals could be reviewed every three to six months with the person to see if they have been achieved. New goals, both large and small, could then be talked about and added to the plan. We saw that risk assessments are included in people’s plans and these look at how people can live their life independently. The manager told us that people were generally semi-independent, just needing supervision and support in certain areas. Again risk assessments could be updated to reflect the person’s life now and the things they do as some were written in 2004. The Crescent DS0000013412.V366468.R01.S.doc Version 5.2 Page 12 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): 12, 13, 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. People can take part in daytime activities of their choice and are supported to keep in contact with family members and friends. EVIDENCE: We saw that people are involved in community activities, going out shopping, going to a local pub, seeing family or friends and attending day centres or the local Church. One person attends work-based activities all week and another individual attends groups at the local Church each week. The religious needs of two people are met through being able to attend Church each Sunday. The Crescent DS0000013412.V366468.R01.S.doc Version 5.2 Page 13 The manager told us that they had a barbeque recently to celebrate someone’s Birthday and this was also talked about by one person who lives there. A relative, friend or advocate who returned a survey said “they encourage them to be active and to go out and about daily”. One person goes out shopping each day by themselves and also regularly goes for lunch with another individual at a local pub. Individuals are able to watch TV and listen to music either in their bedrooms or in the communal lounge. Everyone is encouraged to be involved in domestic tasks. People told us they do their chores each day and sometimes help with the cooking. People we spoke to said that they enjoyed the food on offer to them. A weekly menu is in place and this included dishes like liver and bacon, lasagne, pizza and casseroles. We saw that menus are discussed in the meetings held for the people who live there. The Crescent DS0000013412.V366468.R01.S.doc Version 5.2 Page 14 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. 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. People are supported to stay healthy. Medication is managed well by the home. EVIDENCE: We saw that people are registered with the local GP and other health care professionals as needed. Care plans showed that everyone’s health is monitored and things like individual weight recorded each month. As stated previously, the home should look at how care plans could be improved to be more accessible to the individual. Available workbooks could be used with people about staying healthy and help them be in control of healthcare decisions. Medication is managed well. We saw that administration records are kept up to date and that items are securely stored. The staff at the home are trained in how to give medication and procedures available to give guidance where The Crescent DS0000013412.V366468.R01.S.doc Version 5.2 Page 15 needed. Again, workbooks and accessible materials could be used with people about their medication to develop the service provided. The Crescent DS0000013412.V366468.R01.S.doc Version 5.2 Page 16 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. 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. The service has a complaints procedure that is clearly written. Policies for safeguarding are available for staff to use. EVIDENCE: The manager said that there have been no complaints or Safeguarding allegations since the June 2006 inspection of the home. Staff have training in Safeguarding and the home has the Local Authority procedures to use should they need to. We have recommended that the complaints procedure be looked to see if it can be made more accessible to individuals. Pictures and photographs of people who individuals could speak to could be used. The home helps people to manage their own money. We saw that there were good systems to make sure this was done safely. Records of money held were accurate and one person who lived there talked to us about how they get their money each week. The Crescent DS0000013412.V366468.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 27 and 30. 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. People live in a safe, homely and well-maintained environment. EVIDENCE: We saw that the environment is comfortable and homely. There is a pleasant communal lounge, communal kitchen and dining area and a well-kept garden for people to use. A new wooden decking area has been provided within the last year for people to use when out in the garden. We looked at two people’s bedrooms. These were decorated and furnished to a satisfactory standard and were personalised to the individual. The home was clean and hygienic when we visited. The Crescent DS0000013412.V366468.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36. 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 staffing levels are sufficient for meeting the needs of people living there. There are good recruitment procedures in place that help to protect individuals. EVIDENCE: The home is currently a wholly family run service. The manager, her husband and their daughter and son are the staff team and the rota showed that there are no other staff members currently used. Staffing levels are adequate for supporting the people living there as people are semi-independent in many areas of their lives. We looked at the recruitment records for one member of the family. These included all the necessary information such as a Criminal Record Bureau (CRB) check. The Crescent DS0000013412.V366468.R01.S.doc Version 5.2 Page 19 This staff member had completed the NVQ Level Two award and we saw that they had received training in Safeguarding Adults, manual Handling, First Aid, Food Hygiene and medicines. The manager’s husband is a qualified nurse and the other staff member also has the NVQ Level Two qualification. We have recommended that the home look at accessing training around person centred planning. This may be important to properly facilitate person centred plans for each person living there. Records showed that staff members continue to receive supervision regularly since the June 2006 inspection took place. The Crescent DS0000013412.V366468.R01.S.doc Version 5.2 Page 20 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. 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. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed. Health and Safety checks are carried out satisfactorily to help keep people safe. EVIDENCE: The manager is very experienced having run this home for a number of years and has completed the Registered Managers (RMA) qualification. As stated previously, the service is very much a family run business with the manager’s husband and family also working there. People who live there we spoke to clearly know the family very well and we saw interaction between people was very relaxed during our visit. The Crescent DS0000013412.V366468.R01.S.doc Version 5.2 Page 21 Each person living there is able to access someone outside of the home who they could talk to if they needed to. These are either members of their own family or members of the local Church. Regular meetings are held in the home for the people who live there. We saw minutes of these meetings and things talked about included menus, Health and Safety and energy conservation issues. The service also sends out surveys and has an annual development plan in place. We have recommended that the home think about having someone outside of the home chairing the meetings for people who live there. This is another way of making sure that individuals are able to regularly talk to someone independent of the service. This is good practice especially given that the service is wholly family run. Health and Safety is well managed. We saw that regular checks take place for areas such as fridge temperatures, fire, gas and electrical safety. The Crescent DS0000013412.V366468.R01.S.doc Version 5.2 Page 22 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 X 3 3 4 X 5 X 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 3 26 X 27 3 28 X 29 X 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 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X The Crescent DS0000013412.V366468.R01.S.doc Version 5.2 Page 23 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. 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 YA1 Good Practice Recommendations The manager should keep looking at making the user guide for the home even more accessible to people. More photographs of important people and places could be used to personalise it to the service and may make it more useful to people. The assessment format could be reviewed to be more person centred. Using questionnaires, life story work and starting person centred plans at the assessment stage could be considered. It is strongly recommended that care plans be looked at to see if better more accessible formats could be used. Care plans could be made more person centred and goal focussed. Reviews could centre on achieving hopes and dreams for the individual and goals be used as steps to achieve these. 2. YA2 3. YA6 The Crescent DS0000013412.V366468.R01.S.doc Version 5.2 Page 24 4. 5. 6. 7. 8. YA19 YA20 YA22 YA35 YA39 Accessible health action plans could be used with individuals. Formats and templates could be obtained from the Valuing People website. Workbooks and accessible materials could be used to help people understand and possibly take responsibility for the medication they use. The complaints procedure could be made more accessible to each individual through using picture formats and more use of photographs. It is recommended that staff access training on facilitating person centred plans for individuals. The home should consider having someone independent to chair the meetings for people who live there. The Crescent DS0000013412.V366468.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 The Crescent DS0000013412.V366468.R01.S.doc Version 5.2 Page 26 - 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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