Inspection on 12/10/06 for Croft House

This inspection was carried out on 12th October 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Croft House 07/10/08

Croft House 03/10/07

Croft House 21/11/05

Croft House 16/05/05

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

CARE HOMES FOR OLDER PEOPLE Croft House 26 Kirkham Road Freckleton Preston Lancashire PR4 1HT Lead Inspector Phil McConnell Unannounced Inspection 12th October 2006 10:30 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 Croft House DS0000063015.V308105.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. Croft House DS0000063015.V308105.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Croft House Address 26 Kirkham Road Freckleton Preston Lancashire PR4 1HT 01772 633981 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) Ammram Limited Mrs Janet Margaret Finn Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places Croft House DS0000063015.V308105.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home is registered for a maximum of 22 service users: Up to 22 service users in the category of OP (Older People) The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 21st November 2005 Date of last inspection Brief Description of the Service: Croft House Care home provides residential care for up to 22 older people. It is situated in the village of Freckleton, which is close to the city of Preston. Leisure amenities are close by as well as local shops and a public transport system. The home is on two floors and there is a chair lift in place. There are a number of aids and adaptations in place throughout the care home suitable for the age range and needs of residents living there. There are twenty single rooms and one double room at present only one bedroom has en suite facilities. The present rate of charging is between £320 and £379.50 Croft House DS0000063015.V308105.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Information was obtained and used to assess the key standards that are identified in the National Minimum Standards in Care Homes for Older People, including: The pre inspection questionnaire (completed by registered manager) and an unannounced inspection visit to the service. Unfortunately only a couple of comment cards were returned to the commission for social care and inspection (CSCI) from health centres, with no questionnaires from service uses or comment cards from relatives being received. During the visit to the home three service users’ files were examined, including the most recent person to go and live at Croft House and discussions took place with some of the service users throughout the day. The inspection visit lasted approximately 6.5 hrs and there was the opportunity to observe the care provided to the service users and the interaction between them and the staff. At the present time 15 people are resident at Croft House. The registered manager was available throughout the visit and there was the opportunity to have conversations with other staff members and visiting relatives. Discussions also occurred with a district nursing sister and a student nurse, who were visiting Croft House to attend to a service user who had recently been discharged from hospital. The homes policies, procedures and all other documentation including health and safety files and certificates were readily available for inspection and a full tour of the home was carried out. Overall there was a pleasant and welcoming atmosphere within the home and the service users appeared to be happy and content. What the service does well: The home has a welcoming and pleasant atmosphere. The staff team have generally remained consistent, giving stability, continuity and familiarity to the service users. The staff team are committed to providing the best possible care that they can. The home maintains good relationships with service users’ relatives. Croft House DS0000063015.V308105.R01.S.doc Version 5.2 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. Croft House DS0000063015.V308105.R01.S.doc Version 5.2 Page 7 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 Croft House DS0000063015.V308105.R01.S.doc Version 5.2 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 “Quality in this outcome area is ‘Good’. This judgement has been made using available evidence including a visit to this service”. A detailed pre-admission process is in place with sufficient information and guidance available, to enable a prospective service user to make an informed choice. EVIDENCE: Three service users’ files were examined including the last person to be admitted to the home and all of their files contained full and relevant assessment documentation. Information observed included admission assessments, care plans, detailed social services assessments, up to date daily record sheets, and a letter referring to people being allowed to bring their own furniture and belongings into the home, in order to make their move more personal. There were individuals’ property lists in their files, which confirmed that people are encouraged and allowed to bring in personal items, which helps to maintain familiarity and a sense of belonging. Croft House DS0000063015.V308105.R01.S.doc Version 5.2 Page 9 Letters are sent to service users before being admitted to the home with the name of who their key worker will be. This helps to give the service user confidence and some assurance that there is a named carer, who has specific responsibility for them. A prospective service user usually visits Croft House before moving into the home and the person would also know which room they are being allocated prior to admission. Again this helps individuals to be a little more familiar with the home and staff and also enables the person to be more at ease and relaxed. There was the opportunity to speak with a couple of service users who were staying at the home on a respite basis and one said, “I came in on an emergency admission after having a fall at home and my confidence is now much better I am considering whether to stay on a permanent basis”. This person’s assessment was completed on admission. Another person said, “All I can say is that I am very well looked after”. A relative confirmed that a pre-admission assessment took place prior to her relative being offered accommodation, “My mum was able to make her own decision about coming to live here and I was also involved in the assessment process” and went on to say, “I am more than happy with the care and support my mum receives, it’s not like a rest home, it’s more like an ordinary home”. Croft House DS0000063015.V308105.R01.S.doc Version 5.2 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. “Quality in this outcome area is ‘Good’. This judgement has been made using available evidence including a visit to this service”. The home works in partnership with other agencies to ensure that service users’ health needs are fully assessed and addressed. Equality, dignity and respect is actively and positively demonstrated in the way that care is provided. EVIDENCE: Three service users’ care plans were examined and they were found to be of a good standard, containing relevant information with clear guidance on how to provide individual personal care and how to meet a person’s health care needs. There were individual risk assessments in individuals’ files, which formed part of the persons care plan, which are reviewed on a monthly basis by the registered manager or a senior carer. This helped to demonstrate that Croft House DS0000063015.V308105.R01.S.doc Version 5.2 Page 11 individuals’ needs are regularly monitored and assessed, in order to ensure that their changing needs are adequately met. There was documented evidence regarding service users’ specific health needs with hospital appointments, GP’s appointments and other treatments and consultations with other health professionals being carried out and clearly recorded. This demonstrated that individuals’ health needs are monitored and treated correctly when necessary. There was the opportunity to speak with a visiting District Nurse Sister, who commented, “This is one of the better homes that I visit” and “the staff are always helpful”. A service users relative said, “my mum has been in bed for over 4 weeks now and the staff have been marvellous in caring for her” and “they ring up if anything is wrong or they are concerned”. All of the service users’ medication records were up to date and correct containing individual photographs, helping to avoid any confusion when administering medication and the medication was stored safely and securely. The homes owner is a pharmacist and he carries out a regular audit of the medication and GP’s hold regular medication reviews for individual service users. At the time of the inspection visit none of the resident service users were selfmedicating, however there were contracts/agreements readily available for anyone who wanted to self-administer their own medication. In discussion with service users they were complimentary about the staff, one person said, “I think it’s very good here with a really nice atmosphere” and “There are several good things about living here, but probably the most important thing is that everyone wants to help”. In observation throughout the visit it was apparent that service users were being treated respectfully and with dignity. Croft House DS0000063015.V308105.R01.S.doc Version 5.2 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is ‘Good’. This judgement has been made using available evidence including a visit to this service”. More regular varied activities need to be available, in order to provide further stimulation and motivation to service users. Visitors are openly welcomed to the home, demonstrating that relationships with family and friends are maintained and encouraged. The quality of the meals provided is consistently good; with the food menus providing a balanced and wholesome diet, helping to promote a healthy eating plan for service users. EVIDENCE: The homes notice board displayed daily / weekly activities that take place within the home. However on the day of the inspection visit the arranged activity had been postponed because of holidays and in discussion with a visitor it was commented, “The home is generally ok, my only criticism would be that people lack interests and motivation”. Croft House DS0000063015.V308105.R01.S.doc Version 5.2 Page 13 It would be good practice to keep an activities book or a record of activities and events that have actually taken place, this would give a much clearer indication of what recreational and leisure activities are available and attended for and by service users. Regarding any day trips or outings, the registered manager said, “most people go out with their relatives or friends, but we have a visit planned to go to Lowther Pavilion and a date is to be arranged to visit Blackpool illuminations”. There were books, magazines and newspapers available in the home. A hairdresser visits regularly and one visitor said, “my mum has her hair done regularly and she always looks nice”. One of the service users independently attends church on a weekly basis and the home has representatives from local churches visiting fortnightly. The home has an open house policy with visitors to the home being made welcome and service users are encouraged to maintain relationships with their families and friends. During the inspection one visitor said, “The staff always make me feel welcome, it’s a pleasure coming here” and “I am always made very welcome, nothing is too much trouble”. There was a choice of menus available, which were seen to be nutritious, varied and appetising. Some of the comments regarding the meals were, “The food is top class, first rate” “the food is fine” and “the meals are marvellous”. There was the opportunity to have a cooked meal during the visit and it was very good, being well presented and nutritious. A discussion took place with two of the homes cooks and it was apparent that they provide good quality meals, commenting that, “only fresh produce is used, virtually everything is home made”. Two of the present service users have diabetes and the cooks were fully aware of the dietary needs of these people. Although no service users living in the home at the present time have specific cultural or religious dietary needs, the cooks were aware and understanding that future service users may have different dietary requirements and would adjust the menus accordingly. Croft House DS0000063015.V308105.R01.S.doc Version 5.2 Page 14 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. “Quality in this outcome area is ‘Adequate’. This judgement has been made using available evidence including a visit to this service”. Thorough satisfactory and adequate policies and procedures are in place, helping to protect vulnerable people. Staff members are not being adequately or appropriately trained, in order to manage any protection issues. EVIDENCE: The home had a comprehensive complaints policy and procedure in place, regarding the safeguarding and protection of vulnerable adults. No complaints have been received since the last inspection report was published. No relatives’ comment cards had been received by the commission, therefore it was difficult to fully determine if people are aware of how to make a complaint. The service users, who were spoken with, knew whom they could speak to in the home if they had a complaint. They were also aware that the inspector for CSCI (Commission for Social Care Inspection) could be contacted if they chose to do so. There was a policy in place to deal with a suspicion or allegation of abuse. However, in discussion with staff, there was limited understanding of what Croft House DS0000063015.V308105.R01.S.doc Version 5.2 Page 15 action to take in the event of any allegation being made. Staff are made aware of the relevant polices, but suitable training in the protection of vulnerable adults has not been provided for some staff. In discussion with the manager it was said that appropriate training is planned for the near future. Croft House DS0000063015.V308105.R01.S.doc Version 5.2 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. “Quality in this outcome area is ‘Poor’. This judgement has been made using available evidence including a visit to this service”. The overall environmental standard is poor. A proactive refurbishment programme is required, in order to ensure that the home is safe, pleasant, hygienic and well maintained for people living and working in the home. EVIDENCE: A full tour of the home was completed and generally it was found to be clean and comfortable, however there were a number of things identified during the visit, which need some attention. The kitchen is in need of being fully refurbished with the work surfaces are very badly worn, with holes in places, the kitchen units are damaged and unsafe, some of the wall tiles are broken and cracked and the food mixer is in need of being replaced. Croft House DS0000063015.V308105.R01.S.doc Version 5.2 Page 17 The laundry was situated away from the general living area, helping to effectively manage infection control, although the laundry is small, but adequate, it was a little untidy and would benefit from better organisation. The décor in the home is looking old, worn and very tired and is in need of decorating throughout including the service users’ bedrooms. Some of the carpets need steam cleaning, including some of the bedrooms and the lounge carpets, with much of the furniture around the home looking quite worn and in need of being refurbished or replaced. Some of the radiators are still missing covers, notably the 1st floor bathroom. The manager was informed that all radiators need to be covered for health and safety reasons, or their surface temperature controlled. The reinforced glass in a fire escape door on the ground floor was badly cracked. The manager was informed that this needed to be repaired immediately. The top floor of the building, although unused by service users is in need of being cordoned off because of safety issues, there is a very low balustrade at the top of the stairs and a gap between the landing and a low level window. A suggestion was made to the manager to possibly install a safety gate at the foot of the stairs. There was appropriate specialist equipment observed around the home, such as lifting hoists, a stair lift and walking frames, thereby helping to ensure that individual needs are catered for, whilst independence is promoted. Croft House DS0000063015.V308105.R01.S.doc Version 5.2 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. “Quality in this outcome area is ‘Adequate’. This judgement has been made using available evidence including a visit to this service”. The staffing levels are satisfactory and the staff team have sufficient skills and experience to provide an adequate standard of care to vulnerable people. The home has a rigorous recruitment process, which gives the confidence that service users are protected and safeguarded as much as possible. The training programme does not meet the necessary training needs of the staff employed, to ensure that a good quality service is provided to vulnerable people. EVIDENCE: The staffing levels were examined and found to be adequate and satisfactory, with the staff files containing information with regards to the experience, skills and training that staff have received. On examination of the training programme and in discussion with some of the staff, it appears that the training available is sometimes limited. The company who usually provide the training including the NVQ (national vocational qualification) have disbanded and the manager said that they are looking for another training organisation. Croft House DS0000063015.V308105.R01.S.doc Version 5.2 Page 19 The manager was informed that it is essential that alternative training providers be found to help ensure that service users are supported and cared for by adequately and appropriately trained staff. Medication training has been provided to the staff that are responsible for administering medication. During the inspection visit the staff were observed demonstrating a caring, sensitive, dignified and respectful approach, with service users responding positively and it was evident that good relationships existed between service users and the care staff. There is a thorough recruitment in place, with staff files containing evidence that Criminal Record Bureau (CRB) checks had been carried out and staff are only employed on the satisfactory completion of these checks with two independent satisfactory references being obtained. This helped to show to ensure that service users are protected and safeguarded by having a robust recruitment and selection process. Croft House DS0000063015.V308105.R01.S.doc Version 5.2 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. “Quality in this outcome area is ‘Good’. This judgement has been made using available evidence including a visit to this service”. The home is well managed and organised, ensuring as much as possible that service users receive a good quality service. The health and safety certificates were up to date, helping to ensure that people are protected and safeguarded. EVIDENCE: The manager has many years of experience in the care profession and is adequately qualified, having obtained the national vocation qualification in level 3 (NVQ) and is in the process of completing the Registered Managers Award. She has been the manager at Croft House for 3.5 years and was Croft House DS0000063015.V308105.R01.S.doc Version 5.2 Page 21 previously the manager of another residential home for approximately 10 years. In discussion with other staff members, there was a general opinion that the manager is fair and approachable, one comment was, “The manager is very good and always approachable”. The home’s policies and procedures were examined and found to be up to date and satisfactory, helping to ensure that policies are kept up to date and relevant for the care and protection of vulnerable adults. As previously mentioned there is limited evidence that all of the necessary training needed to ensure that people are adequately cared for and protected is being provided. All inspection certificates were in place and up to date and correct, including: gas safety certificates, electric check certificates, fire extinguisher checks, lifting hoists and emergency lighting certificates. Inspection records were available with regard to the testing of Legionella and water temperatures are being regularly recorded. Croft House DS0000063015.V308105.R01.S.doc Version 5.2 Page 22 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 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 1 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Croft House DS0000063015.V308105.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? NONE 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 2 Standard OP18 OP19 Regulation 18 (1) (i) 23 (2) (b) (c) and (d). Requirement Staff to be suitably trained in ‘The protection of vulnerable adults’ *The premises to be in a good state of repair internally and externally. (Kitchen) *The kitchen equipment to be in good working order. *All parts of the home to be reasonably decorated. Timescale for action 31/12/06 28/02/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP19 OP28 OP28 Good Practice Recommendations A refurbishment programme should be implemented. (See requirement and standard.) 50 of the staff should be qualified to at least NVQ level 2 (Need to re-establish training) A training matrix should be implemented. Croft House DS0000063015.V308105.R01.S.doc Version 5.2 Page 24 4 OP19 All radiators accessible to service users need to covered. Croft House DS0000063015.V308105.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ 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. Extracts may not be used or reproduced without the express permission of CSCI Croft House DS0000063015.V308105.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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