Inspection on 21/02/08 for Carr Croft Care Home

This inspection was carried out on 21st February 2008.

CSCI found this care home to be providing an Poor service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Carr Croft Care Home 19/08/08

Carr Croft Care Home 12/09/07

Carr Croft Care Home 25/01/07

Carr Croft Care Home 03/08/06

Carr Croft Care Home 17/03/06

Carr Croft Care Home 13/12/05

Similar services:

Abbey The

Snydale Care Home

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Carr Croft Care Home Stainbeck Lane Leeds West Yorkshire LS7 2PS Lead Inspector Catherine Paling Key Unannounced Inspection 21st February 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Carr Croft Care Home DS0000066259.V359748.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Carr Croft Care Home DS0000066259.V359748.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Carr Croft Care Home Address Stainbeck Lane Leeds West Yorkshire LS7 2PS 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) 0113 2782220 F/P 0113 2782220 Carrcroft Care Home Limited Ms Jacqueline Waters Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35) of places Carr Croft Care Home DS0000066259.V359748.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To provide accommodation for one named service user in the category DE(E) 16th January 2008 Date of last inspection Brief Description of the Service: Carr Croft is a large converted Victorian house, providing personal care for up to 35 older people. Nursing care is not provided and the community nursing service gives support for any nursing needs that can be managed at the home. The garden area to the front has had some landscaping following completion of the extension. People have access to this area. Accommodation is provided in single and shared rooms. Some of the shared rooms have en-suite facilities, as do the new bedrooms in the extension. Communal areas are on the ground floor, with a large lounge/dining area; a smokers’ lounge and other seating areas. The home is situated close to the local amenities of Meanwood. Current charges range from £400 up to £560 for private clients. Additional charges are made for chiropody, hairdressing, daily papers, toiletries, some activities and transport. Escorts are charged at £7.50 per hour. Charges are reviewed twice a year in April and October. This information was provided by the home at this inspection of February 2008 Information about the services is provided by the home in the form of a Statement of Purpose and Service User Guide. Carr Croft Care Home DS0000066259.V359748.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This was an unannounced visit by two inspectors who were at the home from 09.30 until 16.20 on 21st February 2008. The purpose of the inspection was to make sure the home was operating and being managed for the benefit and well being of the people who live there and in accordance with requirements. Before the inspection we reviewed accumulated evidence about the home. This included looking at any reported incidents, accidents and complaints. We used this information to plan the inspection visit. At the last key inspection we identified significant shortages of staff; as we have done on five separate occasions since December 2005. Following the inspection visit of September 2007 a warning letter was sent to the provider regarding these issues. We took legal advice and as a result of continued breaches of the Care Homes Regulations a Statutory Enforcement Notice was served on the provider and registered manager of the home in November 2007. Since the September 2007 visit there have been three additional inspections, known as random visits, to check progress in addressing shortfalls. The reports of these visits are available from us on request. We looked at a number of documents during the visit and visited all areas of the home used by the people who live there. We spent a good proportion of time talking with the people at the home and visitors as well as with the manager and the staff. Comments made to us during the day appear in the body of the report. What the service does well: People living at the home and their relatives spoke well of the home and of the staff: Some people said: • ‘Would recommend this place to anyone’ Everyone has their needs assessed before they are admitted to the home. There are large well equipped showers and assisted bathrooms with in the new part of the building which allows staff to provide help to less able people. Carr Croft Care Home DS0000066259.V359748.R01.S.doc Version 5.2 Page 6 Visitors are welcomed into the home throughout the day and often take people out if they are able to go. Since the appointment of the chef the food has improved greatly and people enjoy what is provided. What has improved since the last inspection? What they could do better: There is now an ancillary staff team to support the care staff. However, the care staff said that they were still involved in laundry duties even though there were not enough of them to look after people properly. This means that there continues to be a serious risk of care needs being overlooked or not met. We found evidence that peoples’ personal hygiene needs were not being met. People said that they were bored and the provision of stimulation and activity was poor. There were large parts of the day when people were unoccupied and unsupervised by staff. Some improvement was seen in care records but others needed more detail. . This would give staff more information and make sure care needs were not missed. During the course of the visit there were several examples of a lack of respect of the dignity of people at the home. People looked unkempt and were wearing stained and creased clothing and without their hair done. The continued shortages of care staff are having a significant impact on the care of people at the home and the ability of staff to improve the quality of life for people. Carr Croft Care Home DS0000066259.V359748.R01.S.doc Version 5.2 Page 7 The CSCI is taking further legal advice and may take further enforcement action as a result of continued breaches of the Care Homes Regulations. Additional detail can be found in the body of the report and requirements and recommendations are at the end of the report. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Carr Croft Care Home DS0000066259.V359748.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Carr Croft Care Home DS0000066259.V359748.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (Standard 6 does not apply to this service). People who use the service experience adequate quality outcomes in this area. Overall, people are provided with enough information to enable them to make an informed choice about the home. The admission process includes preadmission assessments to make sure that people’s care needs can be met. We have made this judgement using available evidence including a visit to this service. EVIDENCE: A relative said, “Would recommend this place to anyone, very satisfied” Staff gave good examples of how they help people to settle into the home as part of the admissions procedure. They said they introduce them to staff and other people in the home. They also said it was important to spend time getting to know a person and finding out how they want to be cared for. Carr Croft Care Home DS0000066259.V359748.R01.S.doc Version 5.2 Page 10 The home carries out their own pre-admission assessment. Information about the person was brief and did not always make clear why the person was being admitted to the care home. Pre-admission assessment information is based on what a person can’t do rather than on their strengths and abilities. This is not person centred and does not give a picture of the person as an individual and the lifestyle they wish. This means that some care needs could be overlooked. Some basic needs and risks, such as an increased risk of falling, are highlighted. On admission a further assessment is completed within 24hours of admission. The one we looked at had not been fully completed. There was space for baseline observations to be recorded, such as urinalysis, weight and temperature, but these had not been completed. There was also space for a signature to be recorded, of the person or their representative. None of the sections were signed. A care plan is drawn up to address the ‘settling-in’ period with instructions for staff to introduce the person to others living at the home and to help them find their way around. In the example looked at this care plan was still in place more than 6 months after the person had been admitted to the home. There was no indication that this was because they were having any particular difficulty in settling down and perhaps should have been discontinued, as instructions were no longer relevant. Carr Croft Care Home DS0000066259.V359748.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People who use the service experience poor quality outcomes in this area. Care plans do not consistently contain enough detailed information about individual needs. This means that mean that some care needs are overlooked. Staff practices compromise the dignity of the people at the home. Overall, people at the home are protected by safe medication practices. We have made this judgement using available evidence including a visit to this service. EVIDENCE: The format of the care plans does not have enough space for staff to write a detailed care plan that is person centred and individual. People’s needs are detailed as “problems’”, again, this does not highlight people’s strengths properly or their wishes of how they want to be looked after. There is no evidence of how the person or their family has been involved in drawing up the care plan. Carr Croft Care Home DS0000066259.V359748.R01.S.doc Version 5.2 Page 12 Some care plans have vague information that does not tell staff how to provide the care and support people need. For example, statements such as “suitable footwear” and “maintain dignity” do not give staff specific enough instruction and could lead to important care needs being missed. There was very little information on peoples’ social needs. There was no information on what the person likes to do or is interested in. There was some good information for staff about specific cultural and religious needs. Nutritional care plans did not identify any particular likes and dislikes. The nutritional care plan for one person, who was an insulin controlled diabetic gave no detail of their special dietary needs. In addition, there was no detailed information for staff about the condition other than for ‘staff to be aware and to be observant’ without any idea of what to be aware of or what to observe. Records made in another section of the records for this person showed that they had needed treatment from paramedics one occasion when the condition became unstable. This information should have been transferred to the care plan and staff should have specific detail about any signs or symptoms of instability of diabetes. There was some good detailed information on toileting and mobility. In one case there was some good information for staff on how to support one person who did not always find it easy to socialise at the home. Care plans for personal hygiene needs did not really provide detail of how personal hygiene has been maintained. Information on bath record sheets, at the back of the files, did not match the instruction in the care plans. One person’s, records said that they had ‘a shower 2-3 times a week’. However, over a number of months, they had been having a shower less than once per week and some months only once over the month. Another person’s plan said that they were ‘bathed 1-2 times weekly’. Records showed that this was not the case and was more like one bath every four weeks. Many people looked unkempt. A number of people were sat during the morning with wet hair, that had not been blow-dried. Some staff said they always washed hair when people had a bath or shower, others said they would just wet it and comb through. Other people made comments about the lack of hairdressing in the home, One man was unshaven; his hair was dishevelled and not combed. He had stained clothing and very dirty fingernails. What people said: • “I would prefer a man to help me, I think they have set one on this week” Carr Croft Care Home DS0000066259.V359748.R01.S.doc Version 5.2 Page 13 • • • • • • “There’s not enough staff, I could do with a bath sorting out but it’s difficult. I am supposed to have one every two weeks but have gone six weeks sometimes” “The hairdresser has stopped coming, don’t know why, not sure what’s going to happen”. “Don’t always have time to blow dry and style people’s hair” “Should have been toileting ages ago but have had a rush on today” (Staff said this in apology to someone who had been waiting to be taken to the toilet). “Encourage people to have clean clothes on every day, difficult if people refuse to” “Should always document it if people refuse care, don’t know if everybody does though”. One person smelt strongly of urine. Staff said that they should be having 2-3 baths per week but thought that as this person can be aggressive some of the younger staff were avoiding the task as they did not know how to approach them. Inexperienced staff need to have the support and guidance of experienced staff to help them properly care for people. There is a clear risk of care needs being overlooked particularly when there are few staff on duty. The shortfalls in the effectiveness of personal hygiene care may be contributing to the unpleasant smell at the home Staff gave good examples of how they ensure people’s privacy and dignity during personal care. Also how they encourage people to be as independent as possible. Observations during the day were of good rapport between staff and the people living at the home. They showed a good understanding of meeting people’s needs as individuals. This was mainly around physical care needs though and not social needs. One staff said, “It is useful to know about people’s backgrounds and history but more important to know about their medical needs or any allergies”. Staff said they found the care plans useful and staff that complete them are experienced staff who have received training from the manager. Staff could describe the care they give and this in most cases matched up with what was in the care plans and risk assessments. Daily records were kept but did not give a full picture of how someone spent their day or record the care given. For example, “settled day”, “been fine” “no concerns” “been ok”. Care plans were reviewed monthly. Care should be taken to make sure that these reviews are an evaluation of how successful the care plan has been including any changes that have happened over the previous month. Carr Croft Care Home DS0000066259.V359748.R01.S.doc Version 5.2 Page 14 The manager provides medication update for staff and carries out spot checks. On the day of the visit the carer doing the morning medications did not complete the round until 12.30pm. Staff said it can take a lot of time if there new people or new medications to be given. In addition to people waiting a long time for their tablets it also means that just two carers were left to meet the needs of 31 people. Carr Croft Care Home DS0000066259.V359748.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People who use the service experience poor quality outcomes in this area. People said that they do not have enough to occupy them through the day and that they were bored. People are supported in maintaining contact with their family and friends and visitors are welcomed at the home. We have made this judgement using available evidence including a visit to this service. EVIDENCE: Visitors are welcomed at the home at anytime throughout the day and some people go out regularly with their families. However for those without visitors or who are unable to get out there is little or no social interaction, activity or stimulation. The majority of people sat staring into space or sleeping. The television was on but no one was watching. There were large periods of time when people were unsupervised for the morning. There was little interaction with the staff other than to be given medication or a cup of tea. These observations were unchanged from previous visits. People said they never have meetings to discuss activities or what they might be interested in. People were not clear how activity choices are arrived at and some people said that Carr Croft Care Home DS0000066259.V359748.R01.S.doc Version 5.2 Page 16 the manager decides the activity programme on a weekly basis. The activities co-ordinator also works as a carer and has just four hours a week for activities. The focus tends to be quizzes and nail manicures. Staff said that there is not enough equipment or resources to offer more. People had not had their hair done and some looked unkempt. One person said that they would have liked their hair done more frequently and that they last had it done about two weeks ago. What • • • • • • • • • • • people said: “Not a lot going off” “Just sit on bottom all day” “Time drags sometimes” “Would like to do more” “No entertainment” “Never get taken out, only with my daughter” “Haven’t noticed much activity” “Activities could be better, there needs to be more to keep them occupied” “Not really enough activity or entertainment for them” “Trips always cancelled, promises made then hopes dashed” “Not much time to sit and chat with residents” All the staff said they did not think they had enough staff to be able to provide a good level of activity. Observations support this view. There were very positive comments made about the food and chef. People said that there were good choices and lots of variety available and that the food was always served nicely, ‘always fills you up’. ‘Can always have something different if you don’t fancy what you chose’. Carr Croft Care Home DS0000066259.V359748.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People who use the service experience adequate quality outcomes in this area. A complaints procedure is available and, overall, people feel that any concerns will be taken seriously. People feel safe at the home. We have made this judgement using available evidence including a visit to this service. EVIDENCE: There is a complaints procedure displayed in the home. Records are kept of any complaints received and details of any investigation carried out by the manager. People who live at the home were aware of how to complain if not happy about something. They all felt confident to “speak up”. One person said, “I feel safe but also like to keep an eye on others to make sure they don’t fall, sometimes we all have to shout nurse”. This reflects on the number of care staff at the home and the long periods of time when people living at the home are unsupervised in the main lounge/dining area. On the day of the visit we saw people calling out for staff as they were anxious that another person, who was trying to get out of a chair, would fall. Relatives also knew how to complain and said anything they had brought to the attention of the manager had been dealt with well. Carr Croft Care Home DS0000066259.V359748.R01.S.doc Version 5.2 Page 18 All staff said they had received or were booked on a safeguarding adults course. All gave examples of the different types of abuse, including signs and symptoms of. Staff were aware of their responsibilities to report any type of abuse or allegations made to them. Carr Croft Care Home DS0000066259.V359748.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. People who use the service experience adequate quality outcomes in this area. Overall people live in a comfortable and safe environment. Some practices and lack of equipment put people at potential risk of cross infection. We have made this judgement using available evidence including a visit to this service. EVIDENCE: The home provides a comfortable and homely environment for people. There is easy access to the gardens at the front of the home, which provide an attractive outlook. There continues to be is a security issue with the front door being unlocked and people free to wander into the home without challenge as seen again on the day of the visit. There was a stale and unpleasant smell in the entrance area of the home, the lounge/dining room and in some of the bedrooms. Carr Croft Care Home DS0000066259.V359748.R01.S.doc Version 5.2 Page 20 One relative said it used to bother her that the home had a funny smell, but she felt it had now improved. We have made several visits to the home since last September and had not noticed the smell on previous visits. This could be a training issue for the new domestic staff employed; or for care staff with regard to continence management; or a reflection of the low number of care staff, meaning that people cannot be bathed as often as they want. There was an outbreak of a respiratory illness at the beginning of the year and a number of people were affected. The home acted promptly and appropriately containing the spread of the infection. The manager received a letter from the Infection Control Specialist acknowledging the “conscientious and effective way” the outbreak was managed, “ timely recognition and reporting the problem allowed control measure to be implemented and reduced the potential spread to other care settings”. However, as identified at previous visits there were some issues around poor practice regarding infection control. Staff confirmed they had received infection control training. But they all raised a number of concerns. They said: • “We don’t wear aprons when dealing with any incontinence, there aren’t enough” • “I have had to buy my own gloves” • “There’s never enough gloves” • “Sometimes there are paper towels to dry your hands on, but never enough. We have to wave them in the air to dry them and then you are tempted to dry them on your uniform” • “We don’t have red bags for soiled linen, we have to take it to the laundry in a white bag and then get it out to put in the washer” The laundry room has 2 washers and a dryer. There is a sluice cycle on the washers. There were no paper towels for hand drying and no gloves or aprons available. Staff said they were not provided with aprons when doing the laundry. There was also a sluice sink in the laundry that is clearly used for hand sluicing soiled garments. This is also poor practice and puts people at risk of cross infection. Carr Croft Care Home DS0000066259.V359748.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People who use the service experience poor quality outcomes in this area. There are not enough staff to make sure that the needs of the people at the home are met effectively and consistently. We have made this judgement using available evidence including a visit to this service. EVIDENCE: As seen at the last additional visit in January there have been improvements in the number of ancillary staff employed at the home providing support to the care staff. The kitchen is fully staffed with a chef, assistant cook and two kitchen assistants. This means that the kitchen is staffed from 07.45 until 18.30 and that there is little or no need for staff staffed to be involved in kitchen duties. There are three domestic/laundry staff, one working full time and two part time providing cover over seven days. This is also a significant improvement although at this visit the care staff said that they continued to be involved in doing laundry throughout the day. This is not acceptable particularly as care staff numbers have not increased. The care staffing figures did not show the same level of improvement. On the day of the visit there were three carers on shift with the manager. The Carr Croft Care Home DS0000066259.V359748.R01.S.doc Version 5.2 Page 22 manager was busy in the office, one carer was doing the medication round which left just two carers to care for and supervise people. We saw these staffing levels at the January visit and said then that there was not enough staff for the 28 people who were living at the home at that time. At this visit there were 31 people living at the home with no increase to the care staff numbers for the morning, afternoon or night shift. It does not seem that the provider or the registered manager has taken into account the number or dependency levels of people living at the home. The rota showed that staff sickness was not always covered by bank or agency staff meaning that on some days there were not enough staff to meet the needs of the people at the home. Duty rotas also show that new staff are being included in the numbers and do not have a period of induction when they work in a supernumerary capacity. What staff said: • “Sometimes its really hectic, we are really rushed. I think we need four staff on each shift” • “Some people need two staff to give them care, one person needs three at times due to his mobility” • “There’s not enough staff in the mornings especially. One of us has to get everyone up while two are serving breakfast, we have the laundry to do too” • “I have done nights and there is a lot to do for two people, a lot of dependant people” • “We have a bit of time to have a chat with people, not much though” Staff also said they were confused about the on call system. It is unclear on the rota who is on call. This causes anxiety for staff, as they don’t know who to ring in an emergency. This was fed back to the manager who agreed to look at ways of making sure that staff were clear about whom to call if they needed advice. Comments made by people living at the home and received from relatives were supportive of the staff but felt they worked under pressure and that there were not enough care staff on day or night duty. What people said about staff: • “Staff are very nice, helpful, polite” • “They are very good but busy, they don’t have time to sit and chat with us” • “Sometimes sparse but mostly enough” • “Not always enough staff, not always someone around” • “Not always enough staff, people have to wait longer than they should” • “Not enough staff in the evening” Carr Croft Care Home DS0000066259.V359748.R01.S.doc Version 5.2 Page 23 • • • • “Mostly enough but not at night. My mum says she has to wait for her buzzer to be answered” “Staff are exemplary, professional and have good people skills” “They nursed my mother like she was their own” “Staff are wonderful, little angels” Most staff said they were satisfied with the training and updates given. Staff talked about recent training in cultural awareness and how this had been useful for them and given them a better understanding of people’s different needs. Staff on induction said they were enjoying this and got good support from the manager. From records seen there does seem to have been an increase in the training opportunities made available to staff. The manager is working at developing individual training files but will continue to develop a central overview, so that she has easy access to what training people have had. This will help her make sure that people have had their mandatory training. Just over 50 of the care staff have achieved a national Vocational Qualification (NVQ) at level 2, in care. The manager is looking at available funding for some carers to go on NVQ level 3 in care. There were mixed views on whether staff felt well supervised. Some said they had regular meetings with the manager, others said they didn’t. Most staff said they felt they were told if they were not doing their job properly but rarely received positive feedback if they were doing a good job. Some said this could be disheartening. Recruitment practices were looked at for some recently employed staff. The required checks were completed but there were no interview notes or letters of appointment seen. Carr Croft Care Home DS0000066259.V359748.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. People who use the service experience poor quality outcomes in this area. The management of the home is not well organised and this results in some practices that do not promote and safeguard the health, safety and well being of people living at the home. We have made this judgement using available evidence including a visit to this service. EVIDENCE: The registered manager is a qualified nurse and maintains her registration with the Nursing and Midwifery Council (NMC) through regular update. However, as the home does not provide nursing care, regulation requires her to consult with the community nursing service where people at the home have nursing needs. She has yet to complete the registered managers’ award (RMA) but hopes to have done so by July this year. Carr Croft Care Home DS0000066259.V359748.R01.S.doc Version 5.2 Page 25 There is a system of basic in-house audits that the manager uses to help her monitor the service and facilities at the home. These include audits of care planning documentation, the laundry, medication and accidents occurring at the home. Staff are provided with written information of where shortfalls have occurred in their recording. For example, in the case of accident reporting the manager reviews all the forms and gives feedback on any omission or where more detail is needed. There is also a basic audit of the frequency and times that accidents occur which can be used to help identify any trends or times of day when accidents are most likely to occur and action can be taken to reduce accidents. The manager was currently investigating an accident where information from staff and from the person differed. Satisfaction surveys are also carried out and include relatives, people living at the home and staff. The manager also records positive feedback given verbally by relatives and other healthcare professionals who visit the home. The home does not act as appointee and only very small amount of people’s money is kept to pay for hairdressing, magazines, newspapers and other small items such as toiletries. Records were kept and were clear. Managing these small amounts of cash is time consuming for the manager who does not have any regular administrative support at the home and takes her away from her managerial duties. This practice should be reviewed. Regular meetings are held with people at the home and notes are kept. The manager said that it is her intention to hold meetings with the people living at the home every 5 to 6 weeks. What people said: • “I find the manager alright, she sorted me out when I had to complain about a member of staff”. • “She sees to things, she’s very good”. What relatives said: • “She can’t do enough for you”. • “It’s a well run home, she has high standards, she is a good manager” The manager also has regular meetings with small staff groups. For example she has met with the senior staff, carers, and the kitchen staff. She feels that smaller meetings encourage staff to speak out and are more productive. However, some staff felt that the manager did not listen to suggestions they make or to information they give on the dependency needs of people who live at the home. Some staff felt that as the manager did not directly support people with personal care she is unaware of their full needs and the time staff need to give people the proper care. The provider visits the home on a regular basis and records these visits as required under Regulation 26 of the Care Home Regulations 2001. These Carr Croft Care Home DS0000066259.V359748.R01.S.doc Version 5.2 Page 26 reports are available at the home and are sent to us to be used as part of our ongoing monitoring of the service. The manager has a commitment to safeguarding the best interests of the people at the home. However, the continued lack of care staff means that the ability to develop the services and facilities at the home is limited. It also means that the manager is not working in a supernumerary capacity and is not therefore free to give priority to her managerial responsibilities. In order to sustain and continue any improvements at the home the manager should not be included in the carer numbers so that she can work with her staff at improving the quality of life for people living at the home. Carr Croft Care Home DS0000066259.V359748.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 3 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 1 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 X X 3 Carr Croft Care Home DS0000066259.V359748.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes 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 OP10OP8 Regulation 12(4)(a)& (b) Requirement The dignity of people living at the home must be respected by: • Further reviewing the current hairdressing provision to make sure that people have their hair cared for properly. Timescale for action 16/04/08 Timescales of 15/10/07 and 25/02/08 not met. Making sure that the personal hygiene needs of people are met and that they receive the personal care they want. The provider must provide more opportunities for people to be occupied. This must include developing links with the local community and the opportunity for outings where appropriate. This will make sure people at the home will not be bored and will have more stimulation and occupation. Carr Croft Care Home DS0000066259.V359748.R01.S.doc Version 5.2 Page 29 • 2 OP12 OP13 16(m)(n) 06/05/08 3 OP26 13(3) Timescale of 03/09/07; 14/01/08; and 25/02/08 not met. The registered manager must review the arrangements for the control of cross infection. This must include the provision of enough equipment for staff so that they can follow the correct procedures at all times. This is to make sure that people are not put at risk from cross infection. The number of care staff must be reviewed to make sure that there is sufficient staff with the skills and experience, employed to meet the needs of people living at the home throughout the day and night. This is to make sure that that there is proper provision for the health and welfare of people living at the home. Timescale of 25/02/08 not met. 16/04/08 4 OP27 18(1)(a) 16/04/08 Carr Croft Care Home DS0000066259.V359748.R01.S.doc Version 5.2 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations The manager should continue to work with staff to ensure consistency and level of detail in the records. Information in daily records and the evaluation of care plans should be developed to make sure that they reflect the care given. This is to make sure that staff have the information they need to look after people properly. The provider should review the suitability of the shared rooms for occupancy by two residents. 2 OP23 Carr Croft Care Home DS0000066259.V359748.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Carr Croft Care Home DS0000066259.V359748.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!