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Inspection on 21/01/10 for Crouch House and Crouch Cottage

Also see our care home review for Crouch House and Crouch Cottage for more information

This is the latest available inspection report for this service, carried out on 21st January 2010.

CQC found this care home to be providing an Excellent service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

There is a thorough and supportive assessment process. The home offers a structured therapeutic programme which people who have experienced it say is highly recommended and successful. The service sets clear goals for people and monitors these closely with support from other professionals. There is a low staff turnover and the staff team work closely together to offer a consistent approach. The facilities provided support the therapeutic work by giving the opportunity to regain health and fitness in a safe and supportive environment. The home offers an aftercare service which includes therapy sessions and support.

What has improved since the last inspection?

The home have started to record their Regulation 26 monitoring visits. They have acquired a copy of the West Sussex County Council guidelines for Safeguarding Adults.

What the care home could do better:

We have made a requirement for the home to keep the Commission informed of all events described under Regulation 37.

Key inspection report Care homes for adults (18-65 years) Name: Address: Crouch House and Crouch Cottage Forest Mere Health Farm Liphook Hampshire GU30 7QJ     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Liz Palmer     Date: 2 1 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 23 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 23 Information about the care home Name of care home: Address: Crouch House and Crouch Cottage Forest Mere Health Farm Liphook Hampshire GU30 7QJ 08702200714 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: The Sporting Chance Clinic care home 4 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 past or present alcohol dependence past or present drug dependence Additional conditions: The maximum number of service users to be accommodated is 4 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender; Either whose primary care needs on admission to the home are within the following category: Past or present dependence on alcohol (A) Past or present dependence on drugs (D) Date of last inspection Brief description of the care home Crouch House and Crouch Cottage are registered to provide personal care (PC) for up to four service users in the categories A Past or Present Alcohol Dependency and D Past or Present Drug Dependency. They provide a structured 26 day programme for amateur and professional sportsmen and women who experience addictions. The accomodation is located in the grounds of Forest Mere Health Farm. There is one shared bedroom and two singles. The Registered Manager is Mr James West. The Responsible Individual on behalf of the company is Mr Peter Kay. Care Homes for Adults (18-65 years) Page 4 of 23 2 4 0 2 2 0 0 9 4 4 Over 65 0 0 Brief description of the care home The service is a charitable organisation and fees range from an unspecified donation to £12,000 for the 26 day programme. Fees and donations are based on the individuals ability to pay. People unable to pay are not excluded from the programme. Care Homes for Adults (18-65 years) Page 5 of 23 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was a key inspection where we assess compliance with all the key standards. We gave a short notice of 24 hours to the home for this inspection as there were no residents in situ. The inspection started at 9.45am and ended at 2pm. The judgements in this report are based on several different sources of evidence. These include; the Annual Quality Assurance Assessment (AQAA) completed by the home. Staff records, a sample of care records, a sample of policies and we spoke to the registered manager and the responsible individual (RI) who both assisted with the inspection process. Care Homes for Adults (18-65 years) Page 6 of 23 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 23 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 23 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this 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 that use the service can feel assured that their needs will be assessed and that the service has an understanding of their needs using the assessment process. Evidence: During this inspection there were no residents at the home. The assessments of the last four people to be admitted were looked at. The assessment process includes gathering information by interviewing the potential residents. Details covered in the assessment include a medical history, reason for admission, next of kin and other significant relationships and any medication needs. Care Homes for Adults (18-65 years) Page 9 of 23 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this 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 who use the service are fully involved and have agreed to the daily routines of the home, although this occurs within the boundaries of the homes daily structure. Individual goals and aspirations are striven for within the therapeutic framework of the home. Evidence: Four care plans from the previous admissions were looked. These were detailed and reviewed at the three stages of the planned programme. Daily records of therapy sessions and details of peoples emotional well-being were seen to be recorded and handed over to staff members. They are individual and person centred in their approach. Risk assessments are undertaken and people are supported to take risks within the secure and therapeutic framework. In their AQAA the home tells us that they have a high rate of recovery which is Care Homes for Adults (18-65 years) Page 10 of 23 Evidence: supported by their outreach and ongoing recovery programme. The feedback forms we looked at stated that people using the service felt safe and well cared for. Care Homes for Adults (18-65 years) Page 11 of 23 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are supported within the structured therapeutic framework with the provision of recreational and occupational activities to aid them in their recovery. A nutritious and healthy diet is provided and is key to the recovery programme at this home. Evidence: Residents are able to use the facilities at the Champneys health farm as part of the recovery programme. Regaining their fitness is a vital part of the process and the high specification facilities available to them is particularly important as all residents are amateur or professional sports people. They are also expected to take part in a structured programme of activities and therapies including equine therapy, shiatsu, football, as well as group and one to one therapy sessions. Residents are also expected to participate in the daily running of the home with regard to cleaning and Care Homes for Adults (18-65 years) Page 12 of 23 Evidence: laundry. Due to the nature of the therapeutic programme communication with family members is restricted and risk assessed on an individual basis. Risk assessments for individuals were seen and showed that the care is person centred and individualised. All meals are taken at the restaurant at Forest Mere health farm where a range of healthy and nutritious food is provided. Residents commented on the food in their feedback forms. Of the twenty forms looked at 19 were very positive about the food. One person described the food as outstanding. There is a small kitchen in the home providing facilities for making hot and cold drinks and snacks can be made. Each person also receives a nutritional assessment and guidance from a qualified nutritionist at the start of their programme. Care Homes for Adults (18-65 years) Page 13 of 23 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have access to services that support their health and personal support needs. The policies and procedures for the administration of medication suitably protect people who use the service. Evidence: We looked at the records for the four previous admissions to the home. The care plans and daily records looked at showed us that people get emotional and therapeutic support and this is recorded daily. There is a person centred approach to care offered by a small and long standing team of staff. Any needs relating to culture, race or religion are highlighted at the assessment stage. Care plans are person led and flexible, within the boundaries of the therapeutic programme. Records showed that staff respond to any indication that the persons health or well being is effected. We saw records of handover notes to pass on relevant information to staff so that a consistent approach is given. The twelve step programme is followed on an individual basis. Care Homes for Adults (18-65 years) Page 14 of 23 Evidence: The home has good links with other professionals who can offer advice and support. The manager stated that the home has a close working relationship with a local General Practitioner (GP). This GP visits on day one of the programme and gives each person a general health check as well as looking at any specific health issues relating to their past behaviour. These health checks are recorded along with an individual healthcare plan if needed. A full nutritional assessment is also undertaken and a specific diet to improve health and fitness is implemented for each individual. We also saw records relating to a person taken ill and needing urgent hospital treatment. This was handled swiftly and professionally by the home ensuring the person received the medical attention they needed. We looked at the arrangements for storing and administering medication. The recording sheets for past residents were seen on their files. No errors or omissions were seen and the records looked in order. No medication is currently stored as there are no residents. The storage was looked at and seen to be suitable for the sorts of medicines likely to be stored. No storage facility for controlled drugs is available. The manager stated no controlled drugs would ever be used due to the nature of the programme. Care Homes for Adults (18-65 years) Page 15 of 23 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are able to complain and expect to have their views listened to and addressed. The home has satisfactory systems in place to protect the residents from abuse, neglect and self-harm. Evidence: The manager and RI continue to be aware of their responsibilities with regard to safeguarding adults and stated that their staff were too. Guidance for staff on reporting risk of or disclosure of abuse was seen on individual staff files, at the last inspection. At the last inspection the home did not have an up to date copy of the West Sussex County Council Policy on safeguarding. The policy is now available in the home and was seen by us. In their AQAA they state that due to the small staff team and small number of residents it would be difficult for issues to get lost. One to one therapy sessions are part of the programme and records seen showed that residents are able to talk openly and air their views honestly with staff. No complaints have been made to the home and none have been made to the Commission. Care Homes for Adults (18-65 years) Page 16 of 23 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this 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 accommodation is set in tranquil and secluded grounds with high standard facilities and equipment available to residents. Inside, the environment is clean, well maintained, furnished to a high standard and suitable for the purpose recovery and regaining health and fitness. Evidence: The feedback forms completed by residents at the end of their treatment are all very positive about the facilities. The home looked clean and well maintained with suitable communal accomodation. It is maintained through a contract with the Forest Mere health farm. The RI said this continues to work well and repairs are done promptly. Examples of repairs being made swiftly during the recent cold weather were given. Evidence of residents requesting facilities which were then provided were seen. This shows the home listens to and responds to people who use the service. Care Homes for Adults (18-65 years) Page 17 of 23 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff that are suitably recruited, trained, supported and sufficient in numbers to meet the needs of people who use the service. Evidence: No new staff have been employed since the last inspection although the AQAA states plans to recruit three more. The home has a robust recruitment procedure which was discussed with the manager and RI during the inspection. The two weekend staff are both trained to National Vocational Qualification (NVQ) level two and have certificates in Emergency First Aid. There is also a qualified psycotherapist employed. All have worked here for at least six years. A psychiatrist is available to the home and iscalled upon as needed following assessment. Handover notes were seen to show that staff are sharing information to ensure consistent and smooth running of the home. Evidence of regular supervision was seen this is sometimes done over the telephone and always recorded. Care Homes for Adults (18-65 years) Page 18 of 23 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this 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 run with the people who use the service at the forefront of the planning and decision making. Evidence: The RI and the manager are qualified psychotherapists and the manager has also completed the NVQ level four in Management and Social Care. Residents continue to be encouraged to influence the running of the home through group meetings, one to one sessions and anonymous feedback sheets completed at the end of each programme. At the last inspection we asked the home to complete monthly monitoring visits and make a record of these. We call these Regulation 26 visits. The home informed us shortly after our inspection that this was now in place and recorded evidence seen on the day shows the visits take place. The records show that the RI records any issues with staffing, residents, maintenance and that he is acquainting himself with the Commissions new registration standards in preparation for their application. We Care Homes for Adults (18-65 years) Page 19 of 23 Evidence: discussed how the visits could be more unannounced as they are undertaken by the RI who works in the home and is there most days. Out of twenty feedback forms looked at by us only one negative comment was made and this related to the food. Typical comments made on the forms included the counselling and therapy are top class, best therapy I have ever had and gave me my life back. We saw that fire safety checks are undertaken by the Forest Mere maintenance contract along with testing of portable electrical equipment. Regular fire drills and evacuation takes place, more than the statutory requirement as it is done with each new group of four residents. The AQAA was brief in parts but gave us an indication of future plans for improvement. Along with the feedback forms, Regulation 26 visits and the quarterly reports to the board of trustees the home has suitable quality assurance systems in place. During the inspection we noted that a resident had been admitted to hospital as an emergency and the Commission had not been informed of this as required under Regulation 37. This was discussed with the manager and RI who accepted that they should have informed us and agreed to do so in future. There was evidence in a monitoring report that the RI was pleased with how swiftly and competently a staff member had noticed the resident being unwell and getting them the appropriate treatment. Care Homes for Adults (18-65 years) Page 20 of 23 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 21 of 23 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 42 37 The registered person must ensure the Commission is notified of any deaths, illness or other significant events as listed under Regulation 37. The protect and promote the well being of people using the service 11/03/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 22 of 23 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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