Care Home: The Crest Residential Home

What the care home does well What has improved since the last inspection? After a period without an appointed manager, the vacancy has now been filled. After a settling in period, she now intends to seek the views of people at the home and their families, so that it is run in people`s best interests. One person commented that they were `relieved to see that a manager is now in charge`. All staff have now received training about what to do if they suspect that a person has been abused. This will give them confidence to act quickly should such a situation ever arise, and will help to keep people safe and protected from harm. What the care home could do better: CARE HOMES FOR OLDER PEOPLE The Crest Residential Home 32 Rutland Drive Harrogate North Yorkshire HG1 2NS Lead Inspector Anne Prankitt Unannounced Inspection 22nd November and 20th December 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Crest Residential Home DS0000027960.V350243.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Crest Residential Home DS0000027960.V350243.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Crest Residential Home Address 32 Rutland Drive Harrogate North Yorkshire HG1 2NS 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) 01423 563113 01423 505933 www.bupa.co.uk BUPA Care Homes (GL) Ltd vacant post Care Home 31 Category(ies) of Dementia (31) registration, with number of places The Crest Residential Home DS0000027960.V350243.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 category: Dementia - Code DE The maximum number of service users who can be accommodated is: 31 11th and 18th December 2006 2. Date of last inspection Brief Description of the Service: The Crest offers personal care only for a maximum of 31 people who have dementia. It is situated in a quiet residential area close to Harrogate town centre. The property is a converted Edwardian house with accommodation on two floors that can be accessed by passenger lift. There are three sitting areas and a separate dining area. There are parking facilities at the front of the property, and attractive enclosed gardens to the side and the rear of the building. All of the bedrooms provide single accommodation. Thirteen have en suite facilities. The manager confirmed on 20th December 2007 that the current weekly charges range from £380 to £680. Additional charges are made for hairdressing, newspapers and chiropody. Information about the home is available within a brochure provided by BUPA Care Homes. There is a dedicated brochure about the home itself. There is also information on the internet. The inspection report is displayed in the main reception for those who wish to look at it. Details are also included in the home brochure about how the report can be accessed via the website address. The Crest Residential Home DS0000027960.V350243.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Before the site visit, the manager returned a self assessment called an ‘Annual Quality Assurance Assessment’, which provided information about The Crest. Surveys were sent to a selection of people who live at the home (three returned), their families (none returned), and some visiting professionals (three returned). A record has also been kept about what has been happening at the home since the last key inspection took place in December 2006. All of the information, including that which was gathered at the site visits, was used as part of this key inspection. Five hours preparation took place before the site visits, which were made over two days, lasting a total of approximately eight hours. The first unannounced site visit was cut short by the inspector because the manager was attending a conference, and there were not enough staff to help with the inspection, because they needed to concentrate on giving care to people living at the home. The manager was available for the second day, when the site visit was completed. The site visit consisted of an inspection of the communal areas, and a sample of private bedrooms. Kitchen and laundry services were also looked at. A selection of documents were looked at, including a sample of care plans, health and safety records, and staff records. The way that the manager collects information to check the quality of the home was also discussed. Some staff and people living at the home were spoken with, and observations were made to see how staff interacted with people, some of whom are not able to express their needs and wishes clearly. All of the information was used to get an impression about what it is like to live at The Crest. What the service does well: People’s needs are assessed before they are admitted. This helps to make sure that the home will be a suitable place for them to live, and to receive the care they need. One said ‘Oh yes, I like it here. I’ve always liked it. The staff are nice’. Another said ‘It’s very nice here – I have no complaints’. People have good care plans, which explain their needs in an individual way. This helps to make sure that their care will be person centred, and based on people’s needs and wishes. The Crest Residential Home DS0000027960.V350243.R01.S.doc Version 5.2 Page 6 Visitors can visit the home at any time. This helps people to maintain important social links with their families and friends. Staff are patient and respectful. One person said ‘People are very kind and considerate here. It helps’. Staff know that they must report any complaints or concerns about care to the right person, so that the proper action can be taken to put things right, and to protect people. The environment is very pleasant. It is kept maintained, clean and tidy. Everyone has their own single bedroom. This helps to protect their privacy. People have access to a pleasant dining area, and a choice of food. One person said that the food was ‘marvellous’, and said that they get ‘excited about mealtimes’. Another commented that they enjoyed their lunch, and that afterwards they just needed ‘a good sleep’. Good links with outside professionals have been forged. Their comments included ‘Very enthusiastic caring staff’, who ‘treat people with kindness and dignity’. One had observed that people were always ‘approached well by staff when needing guidance’ and that ‘high standards of personal hygiene were maintained’. What has improved since the last inspection? What they could do better: To reduce the risk from any unnecessary errors: • Staff could complete a risk assessment for people who want to look after their own medication to make sure that they continue to be safe and happy to do so. • Further training for staff in the safe handling of medication could be considered, to make sure that they are all up to date, and following current best practice, when looking after people’s medicines. • The general practitioner could be asked what medication staff are allowed to give without prescription or consultation, and for how long. • Further thought could be given as to how staff can be protected from distraction when they are administering medication to people. To help meet people’s spiritual needs, a representative of the Church of England denomination should be invited to visit the home. The Crest Residential Home DS0000027960.V350243.R01.S.doc Version 5.2 Page 7 To ensure that all staff are working in a safe way, the manager could check to make sure that none of the staff have missed any of the mandatory training provided by the company. She could also check to make sure that there is suitable first aid cover available at the home at all times to assist people in an emergency situation. Staffing availability should be kept under regular review to reflect changes in people’s needs so that the care that they get remains consistent. Recruitment files could be kept in better order, and a reference could always be requested from the applicant’s previous employer. This would help to check the reasons why they have left, and would give assurance that they are fit to work with vulnerable people. The kitchen could be cleaned to a better standard, so that it is maintained in good order for the preparation of people’s meals. 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 Crest Residential Home DS0000027960.V350243.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Crest Residential Home DS0000027960.V350243.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 People who use the service experience good quality outcomes in this area. They can be confident that their needs will be assessed before they are admitted. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The manager makes sure that each person referred to the home is visited before they are admitted so that a check can be made about what their needs are, and whether the home will be able to meet them. Information is also gathered from other professionals who have been involved in the person’s care. This helps to give a more detailed picture about what input will be needed to continue meeting the person’s needs once admitted. All of the information is written down, and is available to staff, so that they can begin to develop the person’s care plan. People are also invited to look round the home. Where this is not possible, their families are welcome to look round on their behalf. People are also provided with written information about what the home can provide. This helps The Crest Residential Home DS0000027960.V350243.R01.S.doc Version 5.2 Page 10 them to decide whether they will like the home, and whether it will be suitable for them. Since the last key inspection, changes to the registration certificate mean that the age from which people can be admitted to the home is no longer specified on the certificate. However, it is the expectation of the Commission that this information will be included in the Statement of Purpose, which explains to people in detail what the home provides, and to whom. The manager has agreed to include this information, which will inform those who are thinking of living at the home about the age range of people they are likely to be sharing their home with. All three of the people who returned their surveys thought that they had been given enough information about the home before they were admitted, and staff were satisfied that they were given good information to help them understand people’s needs, so that the right care could be provided from the offset. The home does not provide intermediate care, so standard six does not apply. The Crest Residential Home DS0000027960.V350243.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 People who use the service experience good quality outcomes in this area. People’s health care is generally well catered for. The company understands that staffing levels must be maintained so that care can be given consistently and in a person centred way. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The care plans contain good information about people’s physical, social and emotional needs, and any risks identified with their care. There is lots of guidance about the action that staff should follow which will help these needs to be met in an individual and personalised way if the plans are followed. People’s plans are regularly reviewed and updated with new information. Each one seen helped the reader to understand the individuality of each person, and how they should be offered support to help them remain independent where possible, and included. People have access to community health services, and three comment cards returned by visiting professionals were positive about the service that the home provided to their clients. Comments included ‘I feel that a high standard The Crest Residential Home DS0000027960.V350243.R01.S.doc Version 5.2 Page 12 of personal hygiene is maintained’, ‘Very enthusiastic caring staff’ who ‘Treat people with kindness and dignity’, ‘Caring atmosphere’. There have been some issues surrounding the assessment of people’s mental capacity, associated with their ability to safely leave the home unsupervised. There was reference made within the records seen that this issue had been discussed with the multi disciplinary team and family members. Review of such matters as part of the care plan review will help to make sure that people’s capacity to make decisions is always taken into account. In respect of this, the manager said that she would always make sure that, in an emergency situation, a member of staff escorted people to hospital if family members were not available to assist. People living at the home who returned their survey said that staff act and listen to what they say, but they thought that they only usually or sometimes got the care that they needed. One commented that personal care was not always forthcoming, and that personal items, such as spectacles, sometimes go missing. Another person said that they would like a bit more help, but commented that they were sometimes unable to find someone to ask for this. However, a third person was generally happy and felt well cared for. People seem to have linked these perceived shortfalls to staff availability. People thought that staff were ‘often too busy’, and that they had noted that staff were ‘overstretched’. This was noted on the first site visit, when staff struggled to meet people’s individual needs as described in those care plans looked at. This was brought to the attention of the manager on the day. The company acted quickly to remedy this within twenty four hours. The manager gave assurance that increased staffing levels would be maintained with the use of agency staff, until such time that permanent staff, which are currently being sought, are recruited. This will help to make sure that care is maintained at an acceptable level, and in accordance with people’s plans of care. However, people were treated with dignity, and were spoken to with respect and good humour. People responded well to this, and the atmosphere on the second site visit, when improvements in staffing numbers had been maintained, was calm and relaxed. One person said ‘Oh yes, I like it here. I’ve always liked it. The staff are nice’. Another said ‘It’s very nice here – I have no complaints – I just need a good sleep after my lunch’. Another person commented that staff were ‘very kind and respectful’, and that there were ‘always enough’ of them. One more person concluded ‘People are very kind and considerate here. It helps’. Staff normally manage people’s medication on their behalf. However, staff must make sure that where people have been given responsibility for looking after their own medication, this must only happen after a risk assessment has The Crest Residential Home DS0000027960.V350243.R01.S.doc Version 5.2 Page 13 been completed, and which is regularly reviewed, so that checks can be made that it is still safe for the person to do so. This had not happened in one case, although staff were confident that the person had the ability to do so. There was no evidence to confirm that the general practitioner has agreed which medication can be given without prescription. It was agreed that he should be consulted so that a clear homely remedies agreement can be available for staff to follow. The training that staff have received in the safe handling of medication currently consists of training supplied by the chemist on how to use the system supplied. The manager agreed that this could be improved upon, and intends to source further training for them. This will help staffs’ general understanding about the safe handling of medication. There have been four medication errors reported in the last year. Three of the four errors had occurred because staff administering the medication had been distracted. The manager has agreed to look at ways in which these situations can be avoided in the future. This will help to reduce avoidable errors. The Crest Residential Home DS0000027960.V350243.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 People who use the service experience good quality outcomes in this area. Important links between people and their families are respected. The pending appointment of an activities person will help to make activities more person centred. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: A new activities organiser has been appointed to fill the current vacancy. She is due to take up post in January 2008. However, over the festive period, a number of group activities had been organised, such as a Christmas party, and a carol singing evening. To assist in meeting people’s social needs, an activities person from another home owned by the company visits each Friday. Other than this, care staff, who currently have responsibility for making sure that day to day activities take place, said that activities are planned on an ‘ad hoc’ basis, and take place when staffing allows. People’s individual choices are well recorded in their care plan, with detailed information about how they like to spend their time. When the new activities person takes up post, the manager has plans in place to link activities with people’s recorded interests. This will help to make sure that the activities meet individual social and recreational needs in the future. However, staff explained The Crest Residential Home DS0000027960.V350243.R01.S.doc Version 5.2 Page 15 how they try to make sure that people’s daily lives meet with their individual wishes. Despite the limitations of current planned activities, out of the three people who returned their surveys, one thought that activities were always available, and another thought they usually were. The third thought that activities were not applicable to them. The manager is looking at how people’s spiritual needs are being met. Currently a Roman Catholic priest visits regularly. Preliminary arrangements have also been made for a representative of the Church of England faith to visit. These should put into place as soon as possible. Relatives are made welcome to the home at any time. This helps people to maintain contact with people who are important to them outside the home. People said that they like the food. One commented that the food was ‘marvellous’, and said that they get ‘excited about mealtimes’. Another commented that they had enjoyed their lunch, and that afterwards they just needed ‘a good sleep’. The meal was well presented on the day of the site visit. The menu was displayed, and it offered choice. The dining room was very pleasant, and offered nice views across the garden. People were not rushed with their meal, which was staggered, so that staff had enough time to give people the right attention and supervision. The kitchen is open over a twenty four hour period so that staff can make snacks for people if they are hungry during the night. There is also fresh fruit available for people to enjoy. Staff explained the steps that are taken when people have specific dietary needs, or where special attention needs to be given to their diet. The manager explained that she was in the process of making a referral to the dietician for one person about who she had some concerns. This will help to make sure that good nutrition is maintained. The Crest Residential Home DS0000027960.V350243.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use the service experience good quality outcomes in this area. People are protected by staff who will listen to and act upon their complaints. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The complaints procedure is clearly posted in a public area of the home. Two complaints have been made direct to the home since the last key inspection. The records identified that complaints received are taken seriously, and are dealt with and investigated by the most appropriate person. Despite this, only one of the three people who returned their surveys always knew who to speak to if they were not happy. Two did not know how to make a complaint. One said that they were not really sure who to contact, but assumed now that there was a manager in post that this would be a ‘good point of reference’. The new manager is beginning to make herself known to families and people living there after a settling in period. This should help to restore good communication systems at the home, as she will be a visible point of contact. She is planning regular meetings with people and their families to assist in this process. Staff knew what to do if a complaint was made to them. They were also confident about what action they should take if they suspected that anyone living at the home was not being treated properly. They have all received training in abuse awareness, and they and the manager understood that any such matters must be reported to the local authority for investigation. This will help to protect people. The Crest Residential Home DS0000027960.V350243.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People who use the service experience good quality outcomes in this area. People live in a well maintained and comfortable environment. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The home is situated on the outskirts of Harrogate town centre, which benefits from a range of facilities. It has enclosed garden areas, and room for cars to park at the front of the building. The accommodation is on two floors, and there are three communal sitting areas for people to choose from. The communal areas are very pleasant and well decorated, and care has been taken to provide fresh flowers, table lamps, nice ornaments and chair cushions. This makes the environment more interesting for the people who live there. Bedrooms are located on both floors, and a passenger lift is available to allow easy access for those who need access to the first floor. Those bedrooms seen contained personal possessions, and were individualised. Memory boxes The Crest Residential Home DS0000027960.V350243.R01.S.doc Version 5.2 Page 18 containing photographs are posted outside each door so that people can see easily which is their room. Communal rooms, such as bathrooms and dining area are signposted in writing, braille and also pictorially. This helps to keep people orientated and independent. A maintenance man is available to deal with in house maintenance, and regular checks of equipment. Outside contractors are used where appropriate for annual services of equipment that he is unable to complete. This helps to keep the home maintained to a safe standard. The laundry is situated on the first floor of the building, away from any food preparation areas. The housekeeper was satisfied with the equipment available, which included sluicing facilities and personal protective clothing. She was satisfied with the information that she gets from staff to help her reduce the risk from cross infection. The home has recently been closed following an outbreak of diarrhoea and vomiting, which affected both people living at the home and staff. The manager followed the advice of the community infection control nurse during this time to make sure that appropriate action was taken in the best interests of people living there. The home has now reopened. The Crest Residential Home DS0000027960.V350243.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 People who use the service experience good quality outcomes in this area. The previous shortfall in staffing has been addressed so that people’s care can be delivered in a safe and consistent way. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: Care staff levels on the first site visit were not sufficient to maintain regular observation of communal areas as directed by the responsible individual. Nor did they allow staff to meet some of the aims of those people’s care plans looked at. Staff spoken with said that they did not always have time with the current staff numbers available to make sure that this always happened. One commented that they had been ‘struggling with the staff numbers’. This was discussed with the responsible individual and manager on the day. Immediate action was taken to restore the care staff numbers to the level that the company had previously set as being appropriate. On the second site visit, staff commented that staffing levels were being better maintained. Staff noted an improvement, with one commenting positively that they had sufficient time to make sure that people were offered choice in their daily lives. Where agency staff are used, the manager has been successful in securing regular staff, to help make sure that people receive continuity of care. The atmosphere at the home was more relaxed, and staff were more readily available. This will help to make sure that people are given the correct level of The Crest Residential Home DS0000027960.V350243.R01.S.doc Version 5.2 Page 20 care at all times. Assurance has been given that these staffing levels will be maintained. There is an ongoing programme in place to assist staff in working towards National Vocational Qualifications in care. This will help to make sure that people receive care from well qualified staff. Only one member of staff had been employed directly by the home since the last key inspection. This happened before the new manager took up post. Some of the information that had been gathered at the time of their recruitment was missing from their file. This was later obtained. However, there was no reference from the person’s previous employer, and one of the returned references was not dated, therefore it could not be established when it had been received. The manager needs to make sure that all recruitment files are up to date, to include all the information that has been collected when deciding whether the relevant staff member is a fit person to provide care. She should also make sure that a reference is always sought from the previous employer, so that she can check that the person has not left their previous employment for any reasons of misconduct relating to the care of people. The manager gave assurance that this would be the case in all future employment. New staff undergo a period of induction, and staff receive a range of training to assist them in their work. As well as mandatory training, a number have also received training in dementia awareness. One staff member has completed training so that she can help staff have a better understanding of the Mental Capacity Act, and how it may affect people living at the home, and the staff who support them. This will help staff to understand the problems that people suffering from dementia may encounter, and will assist them in giving the right support and care. The Crest Residential Home DS0000027960.V350243.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 People who use the service experience good quality outcomes in this area. The newly recruited manager wants to run the home in a professional way, and intends to seek the views of people who live at the home and their families about the way that it is run. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The manager has been in post since September 2007, therefore is new to the service. She has previous experience in the management of care homes. She is also a registered nurse, and has completed the Registered Manager’s Award. She has applied to the Commission for Social Care Inspection to become registered manager for the home. The manager has already undergone a range of training, including dementia awareness. She intends to use the knowledge she has gained when developing individual activities for people when the new activities person takes up post. The Crest Residential Home DS0000027960.V350243.R01.S.doc Version 5.2 Page 22 Staff are getting to know her, and felt generally that she was ‘supportive’, ‘approachable’ and a ‘good listener’. Internal checks are made, for example, to make sure that care plans are kept up to date, that the medication system is running properly, and that the kitchen is well run. The responsible individual for the company visits the home regularly to check that it is running smoothly, and leaves an action plan where improvements are needed. The company sends out an annual survey to people’s relatives to ask about how they think the home is running. The most recent survey was carried out at the end of 2007, and the results are awaited. These will be fed back to relatives, with any action that is being taken as a result of their collective comments. The manager realises that people’s views about the way that the service is running needs to be further developed, and relatives and residents meetings, which were held regularly by the previous activities person, reconvened. These are planned for when the new activities person takes up post. In addition, it is the intention that smaller group meetings will be held, to help people to voice their opinions. It is not routine that surveys are sent to visiting professionals who are involved in people’s care. But the responsible individual recognises that this information would be useful as the service develops, and intends to seek their opinions also. This will help further in checking that the service is run in the best interests of the people who live at the home. The manager said that the home does not deal with people’s money. Relatives are sent an invoice for all transactions made on people’s behalf. However, individual lockable facilities can be provided if people want to keep their personal effects locked away. Information provided by the home beforehand, and a sample of safety certificates seen at the site visit, confirmed that the home is kept maintained. In-house checks are made of the fire system, and the company provides staff with mandatory training to help them to work in a safe way. This will benefit the people who live at the home. However, the manager has not had the opportunity to develop the training matrix, and there did appear to be some gaps in the provision of training. She must give this priority so that people can be assured that staff have up to date training in how to provide care in a safe way. The manager confirmed that a number of staff have completed first aid training. She was not entirely sure whether there was a qualified first aider on duty at all times. She must carry out an assessment to check that there are sufficient staff with this qualification so that people can be assured that there is someone available to carry out first aid treatment if needed. The Crest Residential Home DS0000027960.V350243.R01.S.doc Version 5.2 Page 23 At this site visit, the manager was advised that the kitchen area was not cleaned to a high standard, and required a deep clean. She provided feedback that she intends to address this immediately. The Crest Residential Home DS0000027960.V350243.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 The Crest Residential Home DS0000027960.V350243.R01.S.doc Version 5.2 Page 25 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 OP9 Regulation 13 Requirement Timescale for action 20/12/07 2 OP38 13 3 OP38 13 People who look after their own medication must have a risk assessment completed which must be regularly reviewed so that a check can be kept that it is still safe, and that the person wishes to continue, to do so. Staff mandatory training must be 29/02/08 reviewed to make sure that all staff are up to date. This will help to ensure safe and consistent working practice. A risk assessment must be 31/01/08 completed to check what level of first aid training is required by staff at the home so that people can be assured that they will be given the proper first aid attention in emergencies at any given time. The risk assessment should consider: • • • the needs of service users how likely it is that first aid will be needed what kind of first aid is likely to be needed. Where a risk assessment is not completed, there must be a The Crest Residential Home DS0000027960.V350243.R01.S.doc Version 5.2 Page 26 4 OP38 13 qualified first aider on the premises at all times. So that it is a suitable area for the preparation of food the kitchen area must be kept clean. 20/12/07 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 OP9 Good Practice Recommendations To reduce the risk from any avoidable error: The general practitioner’s advice and agreement should be sought about which medication can be given, and for how long, without prescription and consultation. • Consideration should be given to the provision of further training in the safe handling of medication for applicable staff. • Further thought should be given as to how staff can be protected from distraction when they are administering medication to people. To help make sure that people’s spiritual needs are met, pending arrangements for regular visits from a representative of the Church of England denomination should be actioned as soon as is practicable. Staffing availability should be kept under regular review to reflect changes in people’s needs so that the care that they get remains consistent. Recruitment files should be kept up to date at all times, so that it can be confirmed that all necessary checks have been made as evidence that people are being properly protected from unsuitable workers. A reference should always be obtained from the previous employer, so that assurance can be sought that the prospective employee has not been dismissed by them for any reason of misconduct which may make them unsuitable to work with vulnerable people. People’s views about the service should be collected and analysed as soon as is practicable, so that they can be DS0000027960.V350243.R01.S.doc Version 5.2 Page 27 • 2 OP12 3 4 OP27 OP29 5 OP33 The Crest Residential Home assured that their views are being taken into account when deciding how the home should be run. The Crest Residential Home DS0000027960.V350243.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ 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 Crest Residential Home DS0000027960.V350243.R01.S.doc Version 5.2 Page 29 - 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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