Inspection on 16/05/05 for Croft House

This inspection was carried out on 16th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 12/10/06

Croft House 21/11/05

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 PR4 1HT Lead Inspector Lillian McMullen Announced 16 May 2005 th 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 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 F57 F09 S63015 Croft House V217516 160505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Croft House Address 26 Kirkham Road Freckleton Preston Lancashire PR4 1HT 01772 633 981 01772 633 981 Telephone number Fax number Email 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 22 Care Home 22 Category(ies) of Old Age (22) registration, with number of places Croft House F57 F09 S63015 Croft House V217516 160505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 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. 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 public transport system. The home is on two floors and there a chair lift is in place. There are a number of aids and adaptaions 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 ensuite facilities. Croft House F57 F09 S63015 Croft House V217516 160505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was announced and started at 10am and took place over 7 hours. The Inspector spoke to five staff members, ten residents, three relatives, the homeowners and the manager. Part of the inspection was spent on looking at care documentation together with the homes policies and procedures. What the service does well: What has improved since the last inspection? What they could do better: At present Regulation 26 visits are not being undertaken, the new owner was made aware of the need and purpose of these visits and that a record providing evidence that Regulation 26 visits have been conducted on a monthly basis must be supplied to the Commission for Social Care inspection. Croft House F57 F09 S63015 Croft House V217516 160505 Stage 4.doc Version 1.30 Page 6 All documentation including the Statement of Purpose must be amended to include the new owners name and qualifications. The care plans have been revised since the previous inspection however further development is required to ensure they are easy to follow whilst clearly stating the assessed needs of the individual resident. Risk assessments should also be an integral part of the care plan. 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 F57 F09 S63015 Croft House V217516 160505 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Croft House F57 F09 S63015 Croft House V217516 160505 Stage 4.doc Version 1.30 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 standard(s) 3 There is a good assessment procedure in place, which ensures the needs of the residents can be met. EVIDENCE: The records of three residents recently admitted had full assessment information. Also on file was information about the specialist needs required by residents all of which was acquired prior to admission. There was also evidence of social work assessments being carried out to supplement the homes assessment. Staff members confirmed they had access to this information and could describe in detail the care needs of residents. Residents confirmed they had been involved in their assessment and had met the manager prior to coming to live at Croft House. It was also evident that relatives are involved in the admission process during the inspection a relative of a newly admitted resident commented that she had visited the home prior to the admission of her father to discuss the arrangements for his admission. Residents spoken to said they were happy that their needs were being met by the home. Croft House F57 F09 S63015 Croft House V217516 160505 Stage 4.doc Version 1.30 Page 9 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 standard(s) 7,8 and 10 Promotion of health is taken seriously. Resident’s welfare is closely monitored and health needs were met. EVIDENCE: Individual records are kept for each resident with a plan of care setting out the action that needed to be taken by care staff to ensure all aspects of health, personal and social care needs of the residents were met. However the care plans could be developed further to make them simpler to follow whilst keeping all relevant information accessible to staff. There was no evidence that risk assessments currently form an integral part of the care planning process and this is an area that requires addressing. Significant events are recorded and daily entries made on case files, which inform the care, plan and used as the focus for the care plan review. One resident has been cared for in bed for some considerable time, evidence was available to confirm he had been provided with a special mattress that was suitable for the relief of pressure and prevention of pressure sores. Discussion with staff confirmed they were aware of the needs of this residents and the Croft House F57 F09 S63015 Croft House V217516 160505 Stage 4.doc Version 1.30 Page 10 level of care that needed to be provided. The inspector noted evidence of turning and nutritional records. Whilst medication procedures were not assessed at this inspection, the new owner is a qualified pharmacist and is currently researching medication systems that best meet the needs of Croft House. Croft House F57 F09 S63015 Croft House V217516 160505 Stage 4.doc Version 1.30 Page 11 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 standard(s) 12,13,14 and 15 Social activities and meals are both well managed, creative and provide daily variation and interest for people living in the home. EVIDENCE: There was a visitor in the home, who spoke to the inspector and confirmed that she can “visit at anytime” and that she is always made to feel welcome and is always offered refreshments. She also commented that “the cook not only likes to feed the residents up but also their visitors, there are always tea and cakes on offer”. A number of residents were spoken to and all confirmed that they are free to come and go as they please, one resident said that “I go out to the pub every day for a pint and to read my daily paper”. Evidence was seen on another residents care plan of regular contact with family, and trips out of the home with family on a regular basis. An activity programme is in place, which includes a weekly visit from a physiotherapist who engages residents in a light exercise class. Residents confirmed that it was their personal choice weather they participated or not. A dedicated cook makes meals on the premises. The menus were inspected and found to provide a varied and balanced diet. The cook was able to confirm Croft House F57 F09 S63015 Croft House V217516 160505 Stage 4.doc Version 1.30 Page 12 she had information about residents with special diets and personal preferences. Meal times are set although flexible enough to accommodate preferences. The inspector ate a light lunch, during the inspection, which was appetizing and enjoyable. One resident stated, “ the staff know what I like”, and this was further evidenced when speaking to staff members, who commented on what residents like and don’t like at mealtimes. Croft House F57 F09 S63015 Croft House V217516 160505 Stage 4.doc Version 1.30 Page 13 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 standard(s) EVIDENCE: None of the above standards were assessed at this inspection. Croft House F57 F09 S63015 Croft House V217516 160505 Stage 4.doc Version 1.30 Page 14 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 standard(s) 19 and 26 The home is adequately decorated and furnished but would residents lives would be further enhanced by a refurbishment being implemented. EVIDENCE: Whilst the home is furnished and decorated to a comfortable standard some areas are tired and worn, apart from day to day maintenance there has been little work done to the physical environment. The new owner has plans to increase the number of en suite facilities and is also considering installing a passenger lift. A maintenance man is employed and plans are being made to upgrade the furnishings and decoration on a priority basis. Since the last inspection radiator guards have been fitted in residents bedrooms in the basement of the home ensuring the health and safety of any service users who may be accommodated there. Croft House F57 F09 S63015 Croft House V217516 160505 Stage 4.doc Version 1.30 Page 15 Hot water temperatures were regulated but the home was not recording water temperatures. This can place residents at risk and these should be monitored on a regular basis. At the time of the inspection the home was clean and no offensive odours were noted. Croft House F57 F09 S63015 Croft House V217516 160505 Stage 4.doc Version 1.30 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30 The policies and procedures for the recruitment of staff are robust and provide safeguards for the protection of residents. EVIDENCE: There has been only one new staff member recruited to work at the home since the last inspection. The manager said the homes recruitment procedures had been reviewed and any future staff members would not commence employment without the necessary recruitment checks being undertaken to ensure the protection of residents living at the home. These would include references and a Criminal Records Bureau check being received before the staff member could commence working at the home. Staffing levels were sufficient for the number of residents living at the home. Residents said they were happy with the care they receive from the home and were well treated by the staff. One visitor said they were very happy with the care provided for their relative. The visitor commented “the staff are so kind and nothing seems to be too much trouble for them”. The visitor also said in their opinion the home always had sufficient staff on duty. Staff spoken to said they were clear about their role and work well as a team to ensure the individual and collective needs of residents are met. Croft House F57 F09 S63015 Croft House V217516 160505 Stage 4.doc Version 1.30 Page 17 A number of staff are undergoing NVQ training. In addition short courses are arranged to ensure staff have the necessary knowledge and skills to meet the needs of the residents living at Croft House. A through induction programme is in place which is appropriately documented. Croft House F57 F09 S63015 Croft House V217516 160505 Stage 4.doc Version 1.30 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 and 38 The home is well managed and run in the best interests of residents. EVIDENCE: Residents, visitors and staff members were very positive in their comments about the homes manager and her style of management. Residents and visitors spoken to said they found the manager to be approachable, supportive and helpful. Staff members said they found the manager was supportive and provided a clear sense leadership. The quality of the service provided is closely monitored and this is evidenced as the home has achieved the ISO 9002 Quality benchmark for two consecutive years. Croft House F57 F09 S63015 Croft House V217516 160505 Stage 4.doc Version 1.30 Page 19 An issue from previous inspections was the lack of formal supervision being provided for the staff team. The inspector was pleased to note that bi monthly supervision sessions have commenced and records are being maintained. Staff spoken to said they welcomed the instigation of supervision and felt that it provided the forum to discuss any concerns and ideas with the manager. The home has very good environmental risk assessments, which are well laid out and informative however these require reviewing. Information provided on the Pre Inspection Questionnaire confirmed that all safety certificates were up to date and that all equipment is regularly serviced. To date the new owner has not conducted Regulation 26 visits, following explanation as to the requirement and purpose of these visits the new owner gave his assurance that he would commence these visits and submit copies of his findings to The Commission of Social Care Inspection. Croft House F57 F09 S63015 Croft House V217516 160505 Stage 4.doc Version 1.30 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x 3 x x x x 3 Croft House F57 F09 S63015 Croft House V217516 160505 Stage 4.doc Version 1.30 Page 21 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. 2. 3. Standard 33 7 1 Regulation 26 15 4 Requirement Regulation 26 visits must be conducted. Risk Assessments must form an intergral part of the care planning process All documentation should be ammended to include the name and qualifications of the new owner. Timescale for action 31/5/05 31/5/05 31/5/05 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. 4. Refer to Standard 7 19 28 Good Practice Recommendations Care plans could be developed further to make them simpler to follow. A refurbishment programme should be implemented. 50 of the staff should be qualified to at least NVQ level 2 Croft House F57 F09 S63015 Croft House V217516 160505 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection Unit 1, Tustin Court Portway 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 F57 F09 S63015 Croft House V217516 160505 Stage 4.doc Version 1.30 Page 23 - 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. 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