We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards.

Transcription

1 Inspection Report We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards. Crest Lodge Churt Road, Hindhead, GU26 6PS Tel: Date of Inspection: 02 July 2014 Date of Publication: September 2014 We inspected the following standards as part of a routine inspection. This is what we found: Consent to care and treatment Care and welfare of people who use services Safeguarding people who use services from abuse Management of medicines Staffing Supporting workers Assessing and monitoring the quality of service provision Inspection Report Crest Lodge September

2 Details about this location Registered Provider Registered Manager Overview of the service Type of service Regulated activities Mr. Liakatali Hasham Mrs Janice Hilda Daly Crest Lodge is privately run and provides accommodation for adults who require residential or nursing care, many of whom experience mental disorder. Care home service with nursing Accommodation for persons who require nursing or personal care Accommodation for persons who require treatment for substance misuse Diagnostic and screening procedures Treatment of disease, disorder or injury Inspection Report Crest Lodge September

3 Contents When you read this report, you may find it useful to read the sections towards the back called 'About CQC inspections' and 'How we define our judgements'. Summary of this inspection: Page Why we carried out this inspection 4 How we carried out this inspection 4 What people told us and what we found 4 More information about the provider 6 Our judgements for each standard inspected: Consent to care and treatment 7 Care and welfare of people who use services 9 Safeguarding people who use services from abuse 12 Management of medicines 13 Staffing 15 Supporting workers 17 Assessing and monitoring the quality of service provision 18 About CQC Inspections 20 How we define our judgements 21 Glossary of terms we use in this report 23 Contact us 25 Inspection Report Crest Lodge September

4 Summary of this inspection Why we carried out this inspection This was a routine inspection to check that essential standards of quality and safety referred to on the front page were being met. We sometimes describe this as a scheduled inspection. This was an unannounced inspection. How we carried out this inspection We looked at the personal care or treatment records of people who use the service, carried out a visit on 2 July 2014, observed how people were being cared for and checked how people were cared for at each stage of their treatment and care. We talked with people who use the service, talked with staff and reviewed information sent to us by other authorities. Pharmacist visited on 7 July What people told us and what we found The summary is based on our observations during the inspection, speaking with people who used the service, the staff who supported them and from looking at records. If you wish to see the detailed evidence supporting our summary please read our full report. We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led? Is the service safe? People were protected from the risk of inappropriate or unsafe care. This was because the provider had effective systems in place to assess, plan, deliver and review the care that was provided. Staff knew people and their needs well and delivered appropriate care. There were procedures to identify, assess and manage risks to the health, safety and welfare of people and care workers in relation to activities had been used effectively. One person said, "They care for me well and I like the staff." Another person said, "They help me with what I need." people told us they enjoyed the food and that they could choose how they spent their time. Inspection Report Crest Lodge September

5 Not everyone we spoke with had a positive view about the care or the staff. Two people expressed negative views. The staff were aware of these people's needs due to their mental health conditions and this had been recorded. We observed that despite these people expressing negative views the staff took time to listen and reassure them. Staff understood how to manage emergency situations and they had the training and equipment to do so safely. Staff were supported, supervised and trained to carry out their roles to the expected standards. Is the service effective? People's care needs had been assessed effectively. The staff were aware of people's assessed needs and this meant that appropriate care and support was delivered. The staff were aware of people's health needs including changes to those needs and appropriate medical or specialist health advice and treatment had been provided. Is the service caring? People were supported by kind staff who knew them well. We observed kind and caring interactions between staff and people who used the service. The staff offered people choices and respected people's wishes. They provided time for people to express themselves and spent time sitting and chatting to people. There were systems in place to ensure people and relatives could provide feedback to the provider about the quality of the service provided. There was also a system through which staff were enabled to share their experiences and views about the service. Is the service responsive? The service was responsive to people's needs because there were enough staff with the appropriate skills, experience and qualifications to meet people's needs at all times. Arrangements were in place to provide staff when there was a shortfall due to sick leave or holidays. Is the service well-led? The registered manager and the provider's had an effective system for assessing and monitoring the quality and safety of the service. This meant they had identified shortfalls and taken appropriate action to ensure people received a safe, effective, caring, responsive and well led service. You can see our judgements on the front page of this report. Inspection Report Crest Lodge September

6 More information about the provider Please see our website for more information, including our most recent judgements against the essential standards. You can contact us using the telephone number on the back of the report if you have additional questions. There is a glossary at the back of this report which has definitions for words and phrases we use in the report. Inspection Report Crest Lodge September

7 Our judgements for each standard inspected Consent to care and treatment Before people are given any examination, care, treatment or support, they should be asked if they agree to it Our judgement The provider was meeting this standard. Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. Where people did not have the capacity to consent, the provider acted in accordance with legal requirements. Reasons for our judgement Before people received any care or treatment they had been asked for their consent and the provider had acted in accordance with their wishes. Not everyone who lived in the home was able to verbally agree to their care. This was because many of the people who live in Crest Lodge have an enduring mental health diagnosis which meant they may not have been able to verbally communicate their consent or wishes. The provider had ensured that decisions in respect of care and support had been discussed with a multi-disciplinary team, an advocate or people's families. We discussed the Deprivation of liberty safeguards (DoLS) with the registered manager and lead registered nurse. There was currently no DoLS in place but there was one application pending. We were told how they had used the process in the past and action had been taken as appropriate when necessary. The registered manager was able to give us examples of when they had held staff meetings to discuss changes to peoples' mental health, capacity and best interest decisions. Where people did not have the capacity to consent, the provider acted in accordance with legal requirements. We saw that where the person who used the service lacked capacity, best interest meetings had been held with people who knew and understood the person who used the service. This was either an advocate, family member or a social worker. Documents to support best interest meetings were held in the care plan file. We spoke to six members of care staff and they were able to talk knowledgeably about how to support people and offer choices in daily life activities. Staff had knowledge of recognising people's feelings when they offered personal care or support. One staff member said, "We always ask them if they want a wash before we approach them, Inspection Report Crest Lodge September

8 because sometimes they can get agitated or distressed." We saw staff were able to respond to individual's reactions when offering them support in the lounge areas and when eating. For example, during the meal service, we saw that one person had stopped eating and got up from the table, staff let them walk around and then offered support and assistance. This had given the person time to accept staff help to finish their meal. We saw another person being assisted with their meal in a way that was empathetic and supportive. Time was spent in offering encouragement and prompting. Staff could recognise people's mood changes which ensured that staff knew when people did not want to do something or wanted to leave the communal areas or gardens. By direct observation staff approached people in a manner that was open and spoke clearly to them. We saw staff did not force assistance on people. They waited, supervising people discreetly and then offered assistance again. One staff said, "Some people can get really angry and frustrated, but we know that if we just supervise them, we can try and offer support and guidance later." This had enabled them to gain people's agreement to care and support. We saw that the staff had looked at people's life experiences and talked with families if possible to know their preferred method of care and support and this information was recorded and used positively in the delivery of care. The staff had ensured that the risks, benefits and alternative options were discussed and explained in a way that the person who used the service was able to understand. An example was staff explaining to one person the need to take their medication. They told why it was important and the benefits of taking it. It was done in a simple way that was non-threatening and non-confrontational. We also saw that the service had undertaken individual risk assessments on those people that required a nursing profile bed with bedrails. A consent form for the use of bedrails had been completed with evidence of family or representative consultation. We saw that a mental capacity assessment had been undertaken for and with people on admission and then reviewed monthly. Most people in the service at this time had the capacity to make everyday decisions about how they spent their time. We saw that some people had a 'do not attempt resuscitation' DNAR form in their care notes. These had been completed by the individual/or family member and the person's doctor. We were told and we saw that this was reviewed regularly. Inspection Report Crest Lodge September

9 Care and welfare of people who use services People should get safe and appropriate care that meets their needs and supports their rights Our judgement The provider was meeting this standard. Care and treatment was assessed, planned and delivered in a way that was intended to ensure people's safety and welfare. Reasons for our judgement People's needs were assessed and delivered in line with their individual care plan. People's needs had been planned effectively using the care planning system. The service used a computer care documentation system. People's care plans were also printed and kept in a lockable filing cupboard for staff to access quickly. The registered manager told us the paper care plans were meant to have been replaced as changes to people's health occurred or following their review. Four of the paper care plans were not up to date and did not reflect the changes recorded on the main computer used daily. The registered manager told us they knew the paper records did not always reflect accurately the up to date information recorded on the computer system. We found this did not affect the care that staff were delivering because the staff knew people's needs well and communicated changes daily to each other. The registered manager told us they had already identified this shortfall and were in the process of ensuring the paper records were consistent with the electronic care plans. We looked at six care plans both the paper record and computer ones. Records demonstrated that people's individual health, welfare and social needs had been assessed prior to admission and again on arrival at the home. The information gained was documented and evidenced that the family and the previous placement, either hospital or care home, had been involved. There was evidence that people's wishes and expectations were considered. We were told that if possible a trial visit would be arranged to ensure that the home could meet people's needs and wishes. We saw that people had received a further in depth needs analysis on admission based on the 'activities of life'. The main care plans were reviewed monthly, but some specific care plans were reviewed more frequently if required. For example, pressure wounds and end of life care. The care plans we saw identified people's health, health related problems, and psychological needs. They included plans for personal care, oral hygiene, appetite traits and nutrition, continence, mobility and tissue viability. The staff we spoke with were knowledgeable about people's needs and they described how they followed the recorded care assessments when they delivered care and support in practice. The staff maintained Inspection Report Crest Lodge September

10 detailed daily records of the care they delivered which demonstrated the guidance had been followed and people had received appropriate care. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. There were risk assessments in place that provided a baseline for monitoring people's health, safety and wellbeing. Not all care plans we looked at provided guidance for staff to follow. We found that for one person their protective dressings on limbs were not in the care plan and therefore not all staff would know why these were in place. Some people had no behavioural de-escalation plans in place for staff to follow consistently. We spoke with staff who were able to tell us how they managed difficult and challenging behaviour and how they cared for the person's dressings. We saw that specific care for some people such as,ensuring that their eye glasses were clean were not in place, but once mentioned to the registered manager this was developed and put into practice before we left the inspection. Staff were delivering care as people wanted and required to meet their needs. Staff spoken with confirmed that they read the care plans and contributed to changes in care plans regularly. One staff member told us, "The care plan is vital to us, as people's condition can change between shifts; we get a verbal handover as well." The paper care file contained the main care plans and health related risk assessments, such as Waterlow for tissue viability. Food and fluid charts were in place for those that required them. The input and output records had been totalled 24 hourly and monitored to ensure that people were not dehydrated. We saw that people's weight and nutritional needs had been recorded on admission and reviewed monthly. If appetite trends had been identified, staff had involved G.P's, speech and language therapists and dieticians in a timely manner. The service used the malnutrition universal screening tool (MUST) and this had been reviewed monthly. We observed the lunch service and saw that people received a nutritious diet presented in an appetising way. By direct observation we saw that people were assisted with their meal in an unhurried and respectful manner. There was specialist cutlery available such as food plate guards, angled forks and spoons. These aids encouraged people's independence and maintained their dignity. The staff monitored people's mobility and skin integrity by careful observation and individual involvement of the people who used the service. Staff used a body map to reflect any skin damage that had occurred so that all staff were kept informed and alert to changes. People had been provided with pressure relieving equipment as required. The pressure relieving equipment was checked daily to ensure they were working. However, there was no record of the setting of the mattress within the documentation. This meant staff would not know the setting required for maximum benefit. No one had developed pressure sores as a result at the time of the inspection. We saw multi-disciplinary notes from doctors, physiotherapists, occupational therapists and clinical psychiatrists and speech and language therapists. This showed that people had access to health care support and staff recognised when to seek specialist advice and treatment. Inspection Report Crest Lodge September

11 We observed positive interaction between people who used the service and the staff of all denominations. One visitor told us, "The staff are fantastic here, I could not be happier with the care they give." Another person said, "The staff are great we have a laugh and they care for me, they listen to what I need." We spoke with six other people who expressed similarly positive views about the staff and the care and treatment they received at the home. There were two people we spoke with who disagreed with the generally positive view about the care expressed by others. The staff were aware of their views and it was recorded that this was due to their mental health condition. We spoke with an occupational therapist who had been visiting the home three times a week for about 14 years to provide activity and therapy, They said, "The staff are wonderful they work with people who can be challenging and they really care for them." There were arrangements in place to deal with foreseeable emergencies. There was comprehensive contingency plan in place including contact numbers for staff to use. The staff knew where the plan was kept in the event they required guidance. We looked at the fire evacuation procedures and the training records for fire drills. These evidenced that they were undertaken regularly and within the guidelines for each test. The emergency plans for the evacuation of the building were in place and accessible to staff and visitors. The staff had received training in emergency first aid and resuscitation techniques and appropriate equipment was available. People who use services were only deprived of their liberty when this had been authorised by the Court of Protection, or by a Supervisory Body under the Deprivation of Liberty Safeguards. The Deprivation of Liberty Safeguards (DoLS) were only used when it was considered to be in the person's best interest. The registered manager described one situation where a DoLS application had been submitted to the local authority for consideration. This showed the staff knew how to appropriately follow the procedures for protecting people from unlawful restrictions. Staff told us that they had received training in assessing mental capacity and in the DoLS guidelines. Inspection Report Crest Lodge September

12 Safeguarding people who use services from abuse People should be protected from abuse and staff should respect their human rights Our judgement The provider was meeting this standard. People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Reasons for our judgement People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. We spoke with five people who all said they felt safe at this home and they could speak to the staff if they were worried about anything. Three staff we spoke with said they had completed training in safeguarding people from harm and abuse in the last two months. The records we saw confirmed this and that all other staff had carried out this training within the last twelve months. The staff we spoke with described how they would have reported and recorded any concerns about allegations of abuse. The provider responded appropriately to any allegation of abuse. One recent incident had not been reported in a timely manner because staff had failed to recognise the possibility of abuse. Since this incident staff had been retrained to respond appropriately. When further incidents had occurred the senior staff followed the procedures that were in place for reporting allegations of harm or abuse to the local authority and they had taken steps to protect people from abuse. People who use the service were protected against the risk of unlawful or excessive control or restraint because the provider had made suitable arrangements. The registered manager and lead clinical nurse told us that staff never used restraint to control people. The staff we spoke with understood how to deescalate incidents without the need for physical restraint. No one was prevented from leaving the service and we saw people moving freely around the home and grounds and going into the village when they chose. Inspection Report Crest Lodge September

13 Management of medicines People should be given the medicines they need when they need them, and in a safe way Our judgement The provider was meeting this standard. People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. Reasons for our judgement The pharmacist inspector from CQC visited the service to check compliance with safe medicine management. Appropriate arrangements were in place in relation to obtaining medicine. This meant that medicines would be available for continuity of prescribed treatment. Medicines were handled appropriately and kept safely. All medicines were stored in locked cupboards and trolleys within locked rooms. Controlled drugs were stored in a cupboard which had extra security and records were maintained of the use of controlled drugs. This meant people were protected from any risk associated with unsafe storage of medicines. Medicines were prescribed and given to people appropriately. We saw evidence that the local pharmacist had visited recently and had audited all the prescribed treatment. There was good support from the doctors. The general practitioner visited each week to review peoples' healthcare and treatment and the psychiatrist visited once a month. This meant that there were clear processes in place to ensure a person's medicines prescription was up to date and reviewed as their needs or conditions change in relation to their medicine. Appropriate arrangements were in place in relation to the recording of medicines. We saw records of medicine received, disposed and administered. We saw evidence of audits and checks that were done to check that staff had maintained accurate records. This meant that evidence of medicines prescribed and a complete and accurate history of the medicines administered was available for future reference. We watched medicines being given to people. We saw that the nurse used a good manner whilst giving medicines. We saw that one medicine which is meant to be given an hour before food for maximum effect was given after lunch. We informed the clinical lead nurse who told us that this will be addressed. Additional guidance information on when to give medicines prescribed to be administered only when needed were available for consistency and a person centred approach. Any medicines to be given covertly were managed under a best interest policy and consultation Inspection Report Crest Lodge September

14 with a multidisciplinary team and the next of kin. Inspection Report Crest Lodge September

15 Staffing There should be enough members of staff to keep people safe and meet their health and welfare needs Our judgement The provider was meeting this standard. There were enough qualified, skilled and experienced staff to meet people's needs. Reasons for our judgement There were enough qualified, skilled and experienced staff to meet people's needs. Staff told us that under normal circumstances there were enough staff on duty to meet everyone's needs. they said the exception to this would be when staff went on sick leave with short notice. The registered manager had a system in place to manage these situations and had a bank of staff or agency staff they used to cover shortfalls in staff numbers. There were 42 people who used the service and the registered manager had carried out an audit of people's needs and from that determined how many staff with appropriate skills were required to provide care and treatment. They told us that although they had not used a recognised tool to determine staff levels the audit had allowed them to evaluate the staff level and if there were sufficient staff. The staff we spoke with said there were enough staff to meet people's needs and we observed staff responding to people's needs without undue delays. We saw staff supporting people to eat their meals, to carry out their chosen activity and to sit and chat with people. The staff did not appear rushed. The registered manager told us they had changed the way the staff were deployed and increased the number of staff available in the previous six to twelve months. They said as a result the number of incidents of violence towards staff and people had decreased. This was confirmed when we saw the list of incidents within the same time. The staff had been trained in areas relevant to their roles including, de-escalation techniques, specialist dietary requirements and diabetes and mental capacity and the deprivation of liberty safeguards. Staff told us they could request training which was provided and when they started employment at this home they worked alongside experienced staff to gain knowledge and skill. People told us there were enough staff to help them when they required care or treatment. One person said, "They help me and I like it because they chat." Another person said, "The staff here are good and they have time to help me have a bath and shower and take me out." Two people we spoke with did not agree and made negative comments about the staff. The staff were aware of this and their views were documented and had been Inspection Report Crest Lodge September

16 determined to be due to their enduring mental health conditions. Inspection Report Crest Lodge September

17 Supporting workers Staff should be properly trained and supervised, and have the chance to develop and improve their skills Our judgement The provider was meeting this standard. People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. Reasons for our judgement We spoke with people but there responses were not directly related to this outcome. Staff received appropriate professional development. The qualified nurses employed to provide treatment had completed courses relevant to their roles including specialist feeding techniques and medicines management. This meant the nurses were clinically able to demonstrate their continued fitness to practice and to remain registered with their professional body. The nursing staff told us that they had opportunities to discuss clinical practice and receive clinical support and supervision. The care staff told us they had supervision meetings where they discussed their work performance and training needs. The records showed that staff had been supervised and supported in their roles and they were able to seek advice and guidance. Staff meetings had been held and the minutes showed that discussions had taken place about the expected standards of care and expectations for staff to provide quality care that met people's needs. Inspection Report Crest Lodge September

18 Assessing and monitoring the quality of service provision The service should have quality checking systems to manage risks and assure the health, welfare and safety of people who receive care Our judgement The provider was meeting this standard. The provider had an effective system to regularly assess and monitor the quality of service that people received. Reasons for our judgement People who used the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. The staff sought people's views about the quality of their care in a number of ways. These included resident's meetings where people had discussed the menus, activities and the home environment. People had commented that they would appreciate more opportunities to go out and as a result two mini buses had been ordered and trips were being discussed with people. We observed staff asking people for their views and opinions and acting on these. For example some people were sitting outside and staff asked them if they would prefer to eat lunch there or in the dining room. People choose different opinions and these were respected. The registered manager told us that although they sent surveys out to families and professionals few were returned. This meant it was difficult to determine overall views of the service. However, relatives and professionals were asked when they attended review meetings. The registered manager and provider had a system for assessing and monitoring the quality of the service and making improvements. This included regular audits of care, staff levels, the home environment including repairs needed and medicine management. These audits had resulted in action plans and we saw that the improvements were either completed or being worked towards. This meant that people who used the service could be assured that shortfalls in the service were being identified and plans were in place to rectify these. Decisions about care and treatment were made by the appropriate staff at the appropriate level. The care record included treatment decisions made by health care professionals and these had been followed by the staff. Changes to people's care or treatment were made at an appropriate level. For instance when someone required a change to their medicines a Inspection Report Crest Lodge September

19 doctor had reviewed the prescription and made a clinical decision. When a member of staff noticed someone had developed a difficulty eating they had reported this to senior staff and a joint decision had been made to change the person's diet and monitor any improvements. The member of staff involved told us that the decision to change this person's diet had led to an improvement in them eating more at each meal. There was evidence that learning from incidents / investigations took place and appropriate changes were implemented. We saw a list of incidents and the number of incidents between people who used the service had reduced. This was because the registered manager had analysed when incidents occurred and what the triggers had been. The registered manager told us that as a result they had changed the way care was provided to people in different areas of the home and monitored the results. This shows that staff had learnt form incidents and taken action to prevent reoccurrence. The provider took account of complaints and comments to improve the service. People had access to the homes complaints procedure and this was displayed in the hallway. The staff we spoke with described how they supported people to make their complaints and how these were responded to. People did make negative comments to us about aspects of the home including the attitude of the staff and the food. The staff were aware that some people made these comments frequently and this was recorded in their care records. The staff understood this was due to their enduring mental health conditions. We witnessed the staff listening to these people and responding positively and reassuring them. Inspection Report Crest Lodge September

20 About CQC inspections We are the regulator of health and social care in England. All providers of regulated health and social care services have a legal responsibility to make sure they are meeting essential standards of quality and safety. These are the standards everyone should be able to expect when they receive care. The essential standards are described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations We regulate against these standards, which we sometimes describe as "government standards". We carry out unannounced inspections of all care homes, acute hospitals and domiciliary care services in England at least once a year to judge whether or not the essential standards are being met. We carry out inspections of other services less often. All of our inspections are unannounced unless there is a good reason to let the provider know we are coming. There are 16 essential standards that relate most directly to the quality and safety of care and these are grouped into five key areas. When we inspect we could check all or part of any of the 16 standards at any time depending on the individual circumstances of the service. Because of this we often check different standards at different times. When we inspect, we always visit and we do things like observe how people are cared for, and we talk to people who use the service, to their carers and to staff. We also review information we have gathered about the provider, check the service's records and check whether the right systems and processes are in place. We focus on whether or not the provider is meeting the standards and we are guided by whether people are experiencing the outcomes they should be able to expect when the standards are being met. By outcomes we mean the impact care has on the health, safety and welfare of people who use the service, and the experience they have whilst receiving it. Our inspectors judge if any action is required by the provider of the service to improve the standard of care being provided. Where providers are non-compliant with the regulations, we take enforcement action against them. If we require a service to take action, or if we take enforcement action, we re-inspect it before its next routine inspection was due. This could mean we re-inspect a service several times in one year. We also might decide to reinspect a service if new concerns emerge about it before the next routine inspection. In between inspections we continually monitor information we have about providers. The information comes from the public, the provider, other organisations, and from care workers. You can tell us about your experience of this provider on our website. Inspection Report Crest Lodge September

21 How we define our judgements The following pages show our findings and regulatory judgement for each essential standard or part of the standard that we inspected. Our judgements are based on the ongoing review and analysis of the information gathered by CQC about this provider and the evidence collected during this inspection. We reach one of the following judgements for each essential standard inspected. This means that the standard was being met in that the provider was compliant with the regulation. If we find that standards were met, we take no regulatory action but we may make comments that may be useful to the provider and to the public about minor improvements that could be made. Action needed This means that the standard was not being met in that the provider was non-compliant with the regulation. We may have set a compliance action requiring the provider to produce a report setting out how and by when changes will be made to make sure they comply with the standard. We monitor the implementation of action plans in these reports and, if necessary, take further action. We may have identified a breach of a regulation which is more serious, and we will make sure action is taken. We will report on this when it is complete. Enforcement action taken If the breach of the regulation was more serious, or there have been several or continual breaches, we have a range of actions we take using the criminal and/or civil procedures in the Health and Social Care Act 2008 and relevant regulations. These enforcement powers include issuing a warning notice; restricting or suspending the services a provider can offer, or the number of people it can care for; issuing fines and formal cautions; in extreme cases, cancelling a provider or managers registration or prosecuting a manager or provider. These enforcement powers are set out in law and mean that we can take swift, targeted action where services are failing people. Inspection Report Crest Lodge September

22 How we define our judgements (continued) Where we find non-compliance with a regulation (or part of a regulation), we state which part of the regulation has been breached. Only where there is non compliance with one or more of Regulations 9-24 of the Regulated Activity Regulations, will our report include a judgement about the level of impact on people who use the service (and others, if appropriate to the regulation). This could be a minor, moderate or major impact. Minor impact - people who use the service experienced poor care that had an impact on their health, safety or welfare or there was a risk of this happening. The impact was not significant and the matter could be managed or resolved quickly. Moderate impact - people who use the service experienced poor care that had a significant effect on their health, safety or welfare or there was a risk of this happening. The matter may need to be resolved quickly. Major impact - people who use the service experienced poor care that had a serious current or long term impact on their health, safety and welfare, or there was a risk of this happening. The matter needs to be resolved quickly We decide the most appropriate action to take to ensure that the necessary changes are made. We always follow up to check whether action has been taken to meet the standards. Inspection Report Crest Lodge September

23 Glossary of terms we use in this report Essential standard The essential standards of quality and safety are described in our Guidance about compliance: Essential standards of quality and safety. They consist of a significant number of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations These regulations describe the essential standards of quality and safety that people who use health and adult social care services have a right to expect. A full list of the standards can be found within the Guidance about compliance. The 16 essential standards are: Respecting and involving people who use services - Outcome 1 (Regulation 17) Consent to care and treatment - Outcome 2 (Regulation 18) Care and welfare of people who use services - Outcome 4 (Regulation 9) Meeting Nutritional Needs - Outcome 5 (Regulation 14) Cooperating with other providers - Outcome 6 (Regulation 24) Safeguarding people who use services from abuse - Outcome 7 (Regulation 11) Cleanliness and infection control - Outcome 8 (Regulation 12) Management of medicines - Outcome 9 (Regulation 13) Safety and suitability of premises - Outcome 10 (Regulation 15) Safety, availability and suitability of equipment - Outcome 11 (Regulation 16) Requirements relating to workers - Outcome 12 (Regulation 21) Staffing - Outcome 13 (Regulation 22) Supporting Staff - Outcome 14 (Regulation 23) Assessing and monitoring the quality of service provision - Outcome 16 (Regulation 10) Complaints - Outcome 17 (Regulation 19) Records - Outcome 21 (Regulation 20) Regulated activity These are prescribed activities related to care and treatment that require registration with CQC. These are set out in legislation, and reflect the services provided. Inspection Report Crest Lodge September

24 Glossary of terms we use in this report (continued) (Registered) Provider There are several legal terms relating to the providers of services. These include registered person, service provider and registered manager. The term 'provider' means anyone with a legal responsibility for ensuring that the requirements of the law are carried out. On our website we often refer to providers as a 'service'. Regulations We regulate against the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations Responsive inspection This is carried out at any time in relation to identified concerns. Routine inspection This is planned and could occur at any time. We sometimes describe this as a scheduled inspection. Themed inspection This is targeted to look at specific standards, sectors or types of care. Inspection Report Crest Lodge September

25 Contact us Phone: Write to us at: Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 4PA Website: Copyright Copyright (2011) 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. Inspection Report Crest Lodge September