Inspection on 23/02/06 for 81-83 Crofters Close

This inspection was carried out on 23rd February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

81-83 Crofters Close 20/11/06

81-83 Crofters Close 18/10/05

81-83 Crofters Close 23/02/05

81-83 Crofters Close 14/06/04

81-83 Crofters Close 15/03/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Crofters Close, 81/83 81/83 Crofters Close Droitwich Worcs WR9 9HT Lead Inspector P Wells Unannounced Inspection 23rd February 2006 13:45 Crofters Close, 81/83 DS0000037500.V284876.R01.S.doc Version 5.1 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 Crofters Close, 81/83 DS0000037500.V284876.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Crofters Close, 81/83 DS0000037500.V284876.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Crofters Close, 81/83 Address 81/83 Crofters Close Droitwich Worcs WR9 9HT 01905 773993 01905 773993 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) www.worcestershire.gov.uk Worcestershire County Council Ms Valerie Goode Care Home 6 Category(ies) of Learning disability (6), Physical disability (6) registration, with number of places Crofters Close, 81/83 DS0000037500.V284876.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th October 2005 Brief Description of the Service: The home is situated in a quiet cul-de-sac on a residential estate, approximately one and a half miles from Droitwich town centre. There are shops on the estate and a park nearby. The home is operated by Worcestershire County Council and the responsible individual is Stephen Chandler. Mrs Val Goode is the registered manager. The communal rooms and two single bedrooms are on the ground floor with four single bedrooms on the first floor. The home has a two-person passenger lift. The home provides permanent accommodation and personal care for a maximum of six, highly dependent adults with learning and physical disabilities. At the time of the inspection there were five service users and a vacancy. Some of the service users have lived in the home since they were children. The home had its own unmarked minibus. The aim of the service is to provide a caring and safe home ensuring the privacy, dignity and comfort of each service user. Crofters Close, 81/83 DS0000037500.V284876.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine, unannounced inspection that took place during the afternoon of 23rd February 2006. For this inspection, time was spent preparing, reading the monthly reports from the Service Manager and the pre inspection questionnaire. Four hours were spent at the home. In November 2006 the manger returned to managing just the home, having managed two homes for the County Council. A new service manager, Ms Amanda Nally was appointed in December 2006. This report to be read alongside the previous report. The inspector met with the service users who were all at home, the staff on duty and the manager. The majority of time was spent with the manager discussing the service and reading documentation, as she had not been available at the previous visit. The inspector appreciated the co-operation of the service users, manager and staff. What the service does well: This established service provides a permanent home, care and support to five service users with special needs. The house is kept bright, clean and safe with a welcoming atmosphere. The service users appear content and comfortable. Some of the service users are able to indicate that they liked living here and it was apparent that a new service user had settled well. The service users are supported by experienced staff, the majority of whom have worked at the home for sometime and know the service users well. The arrangements for admitting a service user are most suitable. The manager and staff are able to demonstrate how the service meets the National Minimum Standards. Positive comments had been received from the speech and language team. Crofters Close, 81/83 DS0000037500.V284876.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Crofters Close, 81/83 DS0000037500.V284876.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Crofters Close, 81/83 DS0000037500.V284876.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2,5 The home has suitable information about the service for prospective service users and their families. The assessment process is thorough and unrushed. The agreement/contract has been introduced. EVIDENCE: Standards 1-4 were assessed previously and met. At this inspection the following was noted: The information about the service will be updated to include the changes in senior management. Different formats for the service user guide were being discussed with the communication team. There was thorough preparation taking place for the admission of a prospective service user in consultation with the family, social worker and health care professionals. Service users now had an agreement/contract, which had been agreed on their behalf by relatives. Crofters Close, 81/83 DS0000037500.V284876.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Service users individual needs and choices continue to be known, met and recorded. EVIDENCE: Standards 6-9 were assessed and met at the last inspection. On this occasion the following was noted from observations, discussions and the sample service user plan and risk assessments viewed: The plan and risk assessments had been reviewed and were kept up to date. The plan included assessments from other professionals to ensure that special needs were being suitably met – for example communication, behaviour, eating and drinking. Additional guidance was being sought from heath care professionals to assist staff in supporting a service user with emotional needs. The plan for a service user who was fairly new to the staff had been developed as staff got to know the person, their needs and preferences. It was pleasing to observe on this occasion how well this service user had settled and this was a credit to the staff. Service users were assisted in positive and a relaxed manner by staff with their daily routines. Crofters Close, 81/83 DS0000037500.V284876.R01.S.doc Version 5.1 Page 10 Crofters Close, 81/83 DS0000037500.V284876.R01.S.doc Version 5.1 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14,16,17 The service users with staff support, are able to be involved in activities in and out of the home. The lifestyles and rights of the service users are respected. The service users are provided with three meals a day drinks and snacks. However the activities and menus could be developed. EVIDENCE: The majority of these standards were assessed and met at the last inspection. On this occasion the following was observed: The service users continue to have day placements for some weekdays. Other days the service users are at home. At this visit service users were all in and activities including watching television, an activities box, pottering about and staff conversing with staff. The birthday of a service user was being celebrated with cards, presents and a birthday cake. Two service users were enjoying specific television programmes such as the winter Olympics. A sensory room would be beneficial. Holidays during 2006 for service users who like going away were being considered and outings for those who like to remain at home. This should be a Crofters Close, 81/83 DS0000037500.V284876.R01.S.doc Version 5.1 Page 12 priority, as the service users did not go on holiday last summer due to staff shortages. An advocate for a service user without family contacts was still being sought. Service users need staff assistance with managing their daily routines, opening doors and their mail. Hence none of the service users have bedroom or front door keys, although these are available. The service users have free access around the home and can choose whether they wish to be alone or have company. They are accompanied out. Consideration could be given to using pictures and photographs to assist service users in choosing what they would like to do – for example for activities, outings, food and which staff are looking after them. The mini bus will soon need replacing and this was being discussed, as it is essential that the service have transport for the service users. The manager had introduced a newsletter about the service in January 2006 to circulate to families and friends. The menus and dietary needs were discussed with the manager and it was apparent that these matters were being considered. It is acknowledged that additional staff time is now taken up with transporting service users to and from their day centres. However the menus should be reviewed to include more homemade dishes, fresh produce and variety, taking into consideration the individual dietary needs of the service users. For example the two-week menu viewed there were was no alternative dish, snacks or suppers indicated and some foods repeated – sausages, baked beans, fish fingers and salmon sandwiches. Following the review, a nutritionist could check the menus. The recommendations of the environmental health officer were being implemented regarding testing of cooked/heated foods. Mealtimes are unrushed with service users being provided with adapted crockery and cutlery or assistance. Crofters Close, 81/83 DS0000037500.V284876.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20 There is a suitable medication system in place. An aspect of the administration of medicines should be reviewed. EVIDENCE: Standards 18 & 19 were assessed and met at the last inspection. On this occasion the following was observed which were indicators that these standards were still being met: The personal and health care needs of the service users were clearly recorded in the service user plans. When the health care need of an individual changed the service ensured discussions took place with health care professionals and that any new guidance/protocol was obtained. Assistance with personal care was given in private and discreetly. Service users routines were known and respected. Regular weighing had been introduced and the record should include a place for comments/follow up. This was welcomed for service users where there is a known problem. The scales should be checked for accuracy and calibrated if needed. The home has an established monitored dosage system for the administration of the service users’ medications. A medicine round was observed and it was apparent that there were safe systems in place for the administration of Crofters Close, 81/83 DS0000037500.V284876.R01.S.doc Version 5.1 Page 14 medicines and the staff were competent and trained. Two staff administer the medication. The deputy carries out a monthly audit. The use of a medication, on occasions, for a service user’s behaviour was being reviewed by his specialist doctor and a revised protocol agreed. It was observed that medication is given to the service users with fromage frais. Staff explained that four of the service users will only take medication if administered with food, hence this arrangement. The GP had recorded his approval. It was recommended that this practice be checked against the UKCC guidance on the covert administration of medicines. The service were still awaiting an updated medicines policy from the County Council. Crofters Close, 81/83 DS0000037500.V284876.R01.S.doc Version 5.1 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 The home has suitable policies and procedures in place for the protection of vulnerable adults. The staff ensure that service users are listened to and any problems that arise are addressed quickly. The method for managing service users’ personal monies could be developed. EVIDENCE: The home has a complaints procedure. There had been no complaints about the service since the last inspection. The home had procedures in place for the protection of vulnerable adults. Some staff have received training in protecting vulnerable adults and all staff have recently attended three courses in supporting service users who may have challenging behaviour. However physical intervention is not used or needed. The home has a complex system for recording the service users’ monies, which is detailed and has been audited in the last year. The manager has been making enquiries as to how the service users could be supported in managing their own monies. They now have their own bank accounts but service users’ monies are still going through a joint residents’ account. The manager is aiming at the service users’ monies being separate and this is welcomed. Consideration could also be given to the service users retaining their monies in their bedrooms. Crofters Close, 81/83 DS0000037500.V284876.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,29,30 The house is homely, comfortable, clean, safe and well maintained for the service users. The rooms and facilities were suitable for the service users. EVIDENCE: The premises have previously been assessed and met these standards – see previous reports for details of the accommodation. The home was warm, safe, clean and well maintained for the service users. Since the last visit an extension to the office and dining room has been completed and furnished. This upgrade had been approved by the relevant agencies. The additional space is welcomed and it is hoped the new communal area will be fitted out as a sensory room. A bathroom had been refurbished and this included a specialist bath. The advice of an occupational therapist had been sought with regard equipment and specialist bed for a prospective service user. Transfer arrangements between the bedroom and bathroom had also been considered. As the new bed has wooden rails, a risk assessment will need to be carried out to ascertain whether bumpers should be installed. Crofters Close, 81/83 DS0000037500.V284876.R01.S.doc Version 5.1 Page 17 Some of the fire doors still needed automatic door closures so that these doors can remain open during the day. At this visit the arrangements for hygiene and control of infection were assessed. The home has appropriate procedures in place and protective clothing for staff assisting with the personal care of service users. The laundry is suitably equipped. The home has separate staff bathing, toilet and hand washing facilities. In all the communal bathroom and toilets there were soap and paper towel dispensers. Staff were undertaking training in infection control. Consideration should be given to identifying one member of care staff on each shift to be responsible for the preparation meals and for protective clothing to be identified for staff working in the kitchen. There is a dishwasher. Crofters Close, 81/83 DS0000037500.V284876.R01.S.doc Version 5.1 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 Service users are supported by experienced, trained and competent staff whom know the service users well. There is a suitable recruitment process for vetting new staff. EVIDENCE: Standards 32, 33 & 35 were assessed and met at the last inspection. At this visit it was apparent that the service continues to have a settled staff group. They are experienced, trained and skilled to meet the individual needs of the service users whom they know well. The vacancy of gardener/maintenance person was about to be filled. The service would still benefit from administrative support. There is an on going training programme for staff to attend courses in safe working practices and caring for service users with special needs. Six of the ten staff had an NVQ in care, which was above the recommended average of 50 of staff having an NVQ in care. Other staff were undertaking an NVQ in care and new staff undertaking the Learning Disability Award Framework (LDAF) induction training. Staffing levels were being reviewed for the admission of a sixth service user. Crofters Close, 81/83 DS0000037500.V284876.R01.S.doc Version 5.1 Page 19 The manager was following the County Council’s recruitment process and staff records indicated that the recruitment process was thorough and appropriate records kept. Crofters Close, 81/83 DS0000037500.V284876.R01.S.doc Version 5.1 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39,42 The quality assurance system needs to be developed. The home has suitable systems in place to ensure the service users’ health and safety are protected. Staff are familiar with safe working practices. EVIDENCE: A quality assurance programme had been introduced and questionnaires sent out to families and stakeholders. As yet these questionnaires had not been analysised by the County Council and findings published. There were checks in place for health and safety matters. Also the new service manager had introduced monthly audits of the service and the initial results positive. The standard of safe working practices was assessed and it was apparent that there were systems in place to ensure the health and safety of the service users and staff. Equipment, gas and electrical services were being checked regularly. Risk assessments for safe working practices and accident book were in place. Crofters Close, 81/83 DS0000037500.V284876.R01.S.doc Version 5.1 Page 21 Water temperatures were regularly being checked and the manager confirmed that a legionella assessment had been carried out but the certificate could not be located. The manager agreed to follow up on this. Staff had received training in safe working practices. The majority of the staff had undertaken first aid training and five were first aiders. Four other staff needed to renew their training. The home should aim at a member of staff trained in first aid being on duty at all times, preferably a first aider, as many of the service users who stay do have special needs (learning and physical disabilities); or a risk assessment carried out. The fire precautions were being regularly checked and a fire risk assessment was in place. The manager had followed up on the recommendations in the assessment and was waiting to hear from the County Council when this remedial work would be carried out. Four staff had undertaken the fire warden’s course. Staff had received some fire awareness training in-house but the record needed to be clearer to easily identify that all staff have received quarterly fire awareness training. Crofters Close, 81/83 DS0000037500.V284876.R01.S.doc Version 5.1 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 2 15 2 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X 2 X X X 2 X X 3 X Crofters Close, 81/83 DS0000037500.V284876.R01.S.doc Version 5.1 Page 23 Are there any outstanding requirements from the last inspection? 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 YA24 Regulation 23 Requirement Fire doors that need to be kept open must be fitted with automatic door release mechanisms. (timescale of 31/01/06 not met) The quality assurance programme must be implemented in line with the standard and regulation. Timescale for action 31/05/06 2 YA39 24 31/07/06 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. 2. Refer to Standard YA14 YA15 Good Practice Recommendations The activities, including holidays, for the service users should be developed. For service users without families, consideration should be given to arranging for an advocate or friend to have regular contact. The menus should be reviewed to give more choice, taking into consideration the dietary needs of some of the service users and then viewed by a nutritionist. DS0000037500.V284876.R01.S.doc Version 5.1 Page 24 3. YA17 Crofters Close, 81/83 4. YA33 Consideration should be given to the provision of administrative support. Crofters Close, 81/83 DS0000037500.V284876.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW National Enquiry Line: 0845 015 0120 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. 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