Inspection on 27/08/08 for Croft House

This inspection was carried out on 27th August 2008.

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

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 04/01/06

Croft House 07/12/04

Croft House 26/07/04

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Croft House North Croft Williton Somerset TA4 4RR Lead Inspector Kathy McCluskey Unannounced Inspection 27th August 2008 10:00 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 DS0000016030.V366759.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 DS0000016030.V366759.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Croft House Address North Croft Williton Somerset TA4 4RR 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) 01984 632536 01984 633983 michelle.tickner@somersetcare.co.uk Somerset Care Limited Mrs Diane Allen Care Home 41 Category(ies) of Dementia - over 65 years of age (14), Old age, registration, with number not falling within any other category (41) of places Croft House DS0000016030.V366759.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. May accommodate older persons (category OP) and older persons with dementia (category DE(E)). May accommodate up to 41 persons of either sex. Date of last inspection 4th January 2006 Brief Description of the Service: Croft House is registered with the Commission for Social Care Inspection to provide care for up to 41 people over the age of 65. The home is divided into two units, the main part of the home is able to accommodate 27 older people and the Seaton unit is home to 14 people who have a dementia. All rooms in the Seaton unit have been block purchased by Somerset Social Services in accordance with the Specialised Residential Care scheme (SRC). The home is not registered to provide nursing care. The home was purpose built some years ago and is located in a residential area of Williton. All service user accommodation is set on the ground floor, all bedrooms in the home are used for single occupancy and there is a variety of communal space. The home is owned by Somerset Care Ltd, the registered manager is Diane Allen and the responsible individual is Brenda Clare. We were informed that the home’s current fee levels are between £392 & £480 per week. Fees do not include personal items, toiletries, newspapers, hairdressing. Croft House DS0000016030.V366759.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 3 star. This means the people who use this service experience Excellent quality outcomes. The focus of this inspection visit was to inspect relevant key standards under the Commission’s ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for service users and measures the quality of the service for each outcome group under four general headings. These are; - excellent, good, adequate and poor. This unannounced key inspection was conducted over one day (7hrs) by CSCI Regulation Inspector Kathy McCluskey. The registered manager was available throughout this inspection. We were informed that at the time of this inspection 35 people were living at the home. 22 in the main unit and 13 in the specialist dementia care unit. During the inspection we were able to meet with the majority of the people living there, 1 person who was visiting for day care and we spoke to four members of staff. We were given unrestricted access to all parts of the home and records requested for this inspection were made available to us. As part of this key inspection the Commission sent comment cards to a number of people living at the home, staff and healthcare professionals. We received completed comment cards from 7 people living at the home, 5 staff and 5 healthcare professionals. Comments have been included throughout the report. The home returned its’ completed Annual Quality Assurance Assessment (AQAA) to the Commission within the required timescale. The AQAA is a selfassessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. Extracts from the AQAA have been included in the report as appropriate. We would like to thank all involved, for their time and cooperation with the inspection process. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. Croft House DS0000016030.V366759.R01.S.doc Version 5.2 Page 6 What the service does well: This was a positive inspection. Requirements raised at the last inspection had been addressed and no requirements or recommendations have been raised as a result of this inspection. Croft House provides a comfortable, homely and welcoming environment. Anybody thinking about moving to Croft House is fully assessed by the registered manager or deputy manager and assessments are obtained from other healthcare professionals where appropriate. This is to ensure that the home is able to meet the assessed needs and aspirations of individuals. The home also offers a day care and respite service. Croft House has the provision of a specialist unit which provides care to people with dementia. Staff have been appropriately trained and some of the senior management team have completed training in ‘dementia mapping’ with Bradford University. The home has established very good links with visiting healthcare professionals. Each person living at the home has a plan of care which is developed from appropriate assessments. We examined a selection of care plans and found them to be very detailed and up to date. We spoke to people living at the home about the care they received and responses were very positive. People also told us that the staff were very kind and that their privacy and dignity were respected by staff. We observed staff interacting with people in a warm and professional manner. We were able to see evidence that the home follows safe procedures for the management and administration of peoples’ medication. The home is very much part of the local community and people living at the home told us that there was a range of activities on offer if they wanted to join in. Many were keen to tell us about the recent trip to Ilfracombe followed by tea in a local village hall. The home ensures that people living in the specialised unit have opportunities for appropriate social stimulation. The home’s completed AQAA told us that they focus on people’s abilities not their disabilities. People told us that they were able to make choices about their lives. One person said that they felt ‘as free as a bird’. Meals are freshly prepared at the home. The home employ catering staff who cover a seven day period. This year the home was awarded a five star ‘excellent’ rating from the Environmental Health department for their food hygiene standards. People living at the home told us that the food was very good and that there Croft House DS0000016030.V366759.R01.S.doc Version 5.2 Page 7 was plenty to eat. People told us that they would feel confident in raising concerns if they had any. The home has effective systems in place to enable people to raise concerns. Policies and procedures are in place to reduce the risk of harm or abuse to the people living there and all staff have received training in recognising and reporting abuse. Somerset Care ltd is committed to staff training and development and this means that people living at the home benefit from a very well trained team of staff. Staff told us that they had received the training needed to care for the people living at Croft House. In completed comment cards, healthcare professionals were also positive about the training that staff received. Management systems within the home are excellent. The home has an experienced and appropriately qualified registered manager who is supported by a deputy manager and senior staff. Somerset Care Ltd provides very good management support to the home. Effective procedures are followed to ensure that staff, people using the service and other stakeholders can help to influence changes within the home. Under the heading ‘What does the service do well?’ staff made the following comments in completed comment cards; ‘provides a high quality of care for the elderly and the specialised residential unit’ ‘Provides a safe and secure environment for all of our residents including residents with dementia’ ‘Provides excellent care and support to both residents and staff’ ‘Looks after the well being of all residents’ ‘All the staff are very welcoming to relatives and customers’ In response to the same question, healthcare professionals made the following comments; ‘There is always appropriate music and activities within the home’ ‘The staff are very respectful to residents and appear supportive’ Staff are always welcoming of people when they visit either announced or unannounced’ ‘The staff like and respect the residents’ ‘They strive to give residents a happy, homely environment’ The home liaise well with myself’ They treat residents as individuals and with humour, kindness and respect’ ‘Communicate well with families and professionals’ ‘The home is part of the wider community’ Croft House DS0000016030.V366759.R01.S.doc Version 5.2 Page 8 They keep staff and have low staff turnover’ 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. The summary of this inspection report can be made available in other formats on request. Croft House DS0000016030.V366759.R01.S.doc Version 5.2 Page 9 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 DS0000016030.V366759.R01.S.doc Version 5.2 Page 10 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): 1, 2, 3, 4 & 5. Standard 6 is not applicable as the home is not registered to provide intermediate care. Quality in this outcome area is Good This judgement has been made using available evidence including a visit to this service. People are provided with the information they need to enable them to make an informed decision about moving to the home. The home ensures that people are appropriately assessed before a placement is offered. People are given the opportunity to ‘test drive’ the home. EVIDENCE: The home has produced a Statement of Purpose which provides information about the home and services offered. On moving to the home, people are provided with a ‘Welcome pack’, which provides further information about the home. Croft House DS0000016030.V366759.R01.S.doc Version 5.2 Page 11 There have not been any changes to these documents since the last inspection. Seven people using the service completed comment cards for the Commission and all responded ‘Yes’ to the question; ‘Did you receive enough information about this home before you moved in so you could decide if it was the right place for you? They also made the following comments; ‘I was given very helpful information’, ‘I was able to visit before hand’. The home also provides a day care and respite service and one person spoken with during the inspection told us that after using the day care service for many years, they had then made the decision to move to the home on a permanent basis. Two people spoken with told us that their relatives had visited the home on their behalf. During this inspection we observed staff showing somebody around the home who was thinking of visiting for day care. The home’s completed AQAA stated that ‘A prospective resident is always invited to visit, spend some time at Croft House and to have a meal with us’. The home ensures that people moving to the home are provided with a statement of their terms and conditions of occupancy. People who are funding their care privately are provided with Somerset Care contracts and those who receive support from the local authority receive a Social Services Financial Agreement. We examined a selection of care plans and these contained evidence that people had been appropriately assessed before a placement at the home had been offered. Pre-admission assessments are carried out by the registered manager or the deputy manager and, as recommended at the last inspection, completed assessments are maintained within the plan of care. We were also able to see that the home had obtained detailed assessments from other healthcare professionals as appropriate. Croft House DS0000016030.V366759.R01.S.doc Version 5.2 Page 12 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 & 10 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home’s care planning systems are good and these promote a person centred approach to care. The home follows safe and appropriate procedures for the management and administration of peoples’ medication. The home ensures that people are treated with respect and their right to privacy is upheld. EVIDENCE: The home has recently started using Somerset Care’s computerised care planning programme. Hard copies of care plans are also maintained to enable people to easily view their plan of care. The computerised system is password protected. Croft House DS0000016030.V366759.R01.S.doc Version 5.2 Page 13 Three care plans were examined at this inspection and these were found to contain appropriate and up to date information. Care plans had been developed from a range of assessments and instructions for staff contained clear information about how the individuals care needs should be met. It was positive to note that people’s preferences had been clearly documented thus enabling staff to ensure a person centred approach to care. Care plans examined related to people who had more complex needs and these contained appropriate information about how their needs relating to diabetes, pressure area care and emotional needs should be met. Four people spoken with during the inspection told us that they felt very well cared for and that ‘staff know what I like’, ‘They are always there for you day and night’, ‘They will do anything for you’, ‘I feel very well cared for here’. Seven people living at the home completed comment cards for the Commission and all confirmed that they received the care and support they needed. Five healthcare professionals completed comment cards and all confirmed that the home met peoples’ healthcare needs; ‘Croft House always highlight when they do not feel that they can meet an individuals needs and seek advice and guidance’. We were able to see evidence that people have access to a range of appropriate healthcare professionals. The home records details of each individual’s contact with a healthcare professional in their plan of care. The home’s completed AQAA stated; ‘The senior team maintain extremely good working relationships with a wide range of professionals to ensure We are able to promote and maintain service users health and access to relevant health care services’ In completed comment cards, all five healthcare professionals responded ‘Always’ to the question; ‘Does the care service seek advice and act upon it to manage and improve individuals’ health care needs’. All seven people living at the home who completed comment cards responded ‘Always’ to the question; ‘Do you receive the medical support you need?’ The following comments were also received; ‘Medical support given is more than when living in my own home’, ‘Each time medical support is needed it has always been forth coming’ We examined the home’s procedures for the management and administration of peoples’ medication. The home uses the monitored dosage system (MDS) with pre-printed medication administration records (MAR). All medicines were found to be securely stored and no excess stocks were apparent. We sampled all available MAR charts and found these to be appropriately completed. As required at the last inspection, the amount administered for variable doses had been recorded. Clear information was available for staff as to the use of ‘as required’ medication. We found controlled drugs to be appropriately stored and managed. Croft House DS0000016030.V366759.R01.S.doc Version 5.2 Page 14 Medicines are only administered by senior staff all of whom have received appropriate training. During this inspection we spoke with a number of people living at the home and we were also able to observe staff interacting with people. People living at the home told us that they were treated with respect and kindness; ‘They are so thoughtful when they help me to have a bath’, ‘My key worker is male and they offered me a choice of a female carer to help me if I wanted’, ‘The staff are so kind and considerate, I can’t fault them’. We observed staff knocking on peoples’ bedroom doors before entering. Staff were heard communicating with people in a very kind and respectful manner and people were addressed using their preferred form of address. The home’s completed AQAA stated; ‘We ensure service users privacy and dignity is up held by staff at all times, there is a focus on this from the start of employment through induction, on going training with senior staff walking the job and supporting and supervising staff’ Croft House DS0000016030.V366759.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 & 15 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People have the opportunity to participate in a range of activities and the home takes into account peoples’ abilities and preferences. The home ensures that people are able to live a flexible lifestyle and it enables people to make choices and decisions about their lives. The home ensures that people are offered a wholesome diet and that people’s preferences are respected. EVIDENCE: The home employs an activities co-ordinator who provides 4 hours support over a 5-day period. A weekly plan of activities is displayed in the reception area of the main home. Activities planned for this week included; ‘rest and relax’, ‘newspaper discussion’, ‘if I were a millionaire’ discussion’, ‘nail care’ and ‘music and movement’. People spoken with in the main unit told us that ‘there is always something going on if you want to join in’. Croft House DS0000016030.V366759.R01.S.doc Version 5.2 Page 16 People also told us that there are regular trips out and people were keen to tell us about a recent trip to Ilfracombe’. When we arrived on the specialised dementia care unit, we heard music and laughter. The majority of people were in the lounge enjoying a ‘sing along’ to old time music with staff. One person, who told us that they ‘like to keep busy’, was helping staff to fold sheets. The atmosphere was warm and inclusive and every person living in the unit was engaged in some form of activity. People appeared happy and contented and staff interactions were very positive. The home obtains a life/social history from people when they move to the home and this enables staff to ensure that peoples’ preferences are respected. We did not meet with any relatives at this inspection but some people, who had regular visitors, told us that their visitors were always made to feel welcome and were always offered refreshments. The home’s completed AQAA told us that ‘visitors are welcome at any reasonable time’. The home enables people to exercise choice and control over their lives. People living at the home made the following comments; ‘I am as free as a bird here and can do what I like when I like’, ‘I can go to bed when I like and get up when I like’, ‘It is so relaxed here’. We received the following comment from a healthcare professional; ‘The home try and find out as much as they can about an individual in an attempt to support people to live their chosen life style’. The home ensures that people who are living on the specialist dementia unit are also supported to make choices and decisions. Positive interactions were observed during this inspection. In their completed AQAA, the home state that they promote an ‘approach to care that focuses on service users ability not disability’ Meals are freshly prepared at the home. The home employ catering staff who cover a seven day period. This year the home was awarded a five star ‘excellent’ rating from the Environmental Health department for their food hygiene standards. During this inspection we asked people living at the home about the meal provision. Responses were very positive; ‘The food is excellent’, ‘There is always plenty to eat and they know what I like and what I don’t like’, ‘there are always choices and the food is very good’, ‘I enjoy the food and have benefited from being at Croft as my appetite was very poor at home’ People living at the home also told us that snacks and drinks were made available throughout the day and that they were always offered a hot drink if they woke during the night. The home has systems in place to seek the views of people about the food provision and people are given the opportunity to offer menu suggestions. Croft House DS0000016030.V366759.R01.S.doc Version 5.2 Page 17 We were able to see evidence that special diets are catered for. Details of any special requirements or preferences were found to be recorded in the care plans examined. Nutritional assessments are also completed and care plans are raised where there is an assessed need. People told us that they could choose where to have their meal. Each unit has its’ own dining room. We noted that dining tables had been attractively laid with table cloths, napkins, flowers and condiments. Croft House DS0000016030.V366759.R01.S.doc Version 5.2 Page 18 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 & 18 Quality in this outcome area is Good This judgement has been made using available evidence including a visit to this service. The home has effective procedures in place which allow people to raise concerns. Complaints are appropriately responded to. The home has procedures in place to reduce the risk of harm or abuse to the people living there. EVIDENCE: The home has systems in place to enable people to raise concerns. A complaints procedure is clearly displayed within the home. A suggestions box is also available in the reception area of the home. We spoke to a number of people living at the home during this inspection and all stated that they would not hesitate in raising concerns if they had any. People said that ‘staff are very approachable and will always listen’. Seven people completed comment cards for the Commission and all confirmed that they knew who to speak to if they were not happy; ‘I can speak to a member of staff or the manager’, ‘I would speak to the manager’. Five healthcare professionals completed comment cards and they confirmed that the home had acted appropriately to any concerns raised; ‘these are Croft House DS0000016030.V366759.R01.S.doc Version 5.2 Page 19 followed up and acted upon’, ‘The staff always respond appropriately and take seriously any concerns’. Five staff completed comment cards for the Commission and all confirmed that they knew what action to be taken should a person using the service or their representative raise concerns. The home have received one complaint since the last inspection and we were able to see that this had been fully investigated and found to be unsubstantiated. The Commission have not received any complaints about the home. The home has a range of policies and procedures available to staff which reduce the risk of harm or abuse to the people living there. These include recognising and reporting abuse, whistle blowing and the acceptance of gifts. We were also able to see that staff had received training recently in recognising and reporting abuse. All staff spoken with during the inspection confirmed that they knew action to be taken. The home follows robust procedures for the recruitment of staff and prior to employment, all staff are checked against the criminal records bureau (CRB) and protection of vulnerable adults register (POVA). Croft House DS0000016030.V366759.R01.S.doc Version 5.2 Page 20 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, 20 & 26 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Croft House provides a safe and well maintained environment and people have access to pleasant and well maintained gardens. The standard of cleanliness is good and appropriate procedures are in place to reduce the risk of the spread of infection. EVIDENCE: Croft House is an older purpose built home where all accommodation is situated at ground floor level. Somerset Care Ltd has agreed plans for a new purpose built home which is very positive. Plans are on display in the reception area of the home. Croft House DS0000016030.V366759.R01.S.doc Version 5.2 Page 21 The home has a programme of routine maintenance to ensure that the home is appropriately maintained. Somerset Care Ltd and staff at the home have been committed to ensuring that people have access to well maintained and interesting gardens. Raised beds have been introduced and exercise towers have been installed in garden. Gardens are easily accessible to people using the home and people living in the specialist unit have free access to secure gardens. Many of the people living in the unit have been involved in growing and tending to vegetables. At the time of this inspection the standard of cleanliness in the home was very good and there were no malodours. Seven people living at the home completed comment cards for the Commission and in response to the question; ‘Is the home fresh and clean?’ 5 responded ‘Always’ and 2 ‘usually’. People also made the following comments; ‘The home is always clean and fresh, the home is so out of date I think the staff do an excellent job under poor conditions to keep it clean’ ‘The staff keep everything clean and my laundry is done for me – I am very happy here’, ‘Very clean’. The home has appropriate measures in place to reduce the risk of the spread of infection. Staff hand washing facilities and sanitising gel are appropriately sited throughout the home. Staff have access to appropriate protective clothing. Training records made available to us indicated that all staff have received training in health and hygiene. Croft House DS0000016030.V366759.R01.S.doc Version 5.2 Page 22 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 &30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels have been increased and levels are appropriate to the numbers and needs of the people currently living at the home. People benefit from a very well trained workforce. The home’s robust recruitment procedures ensure that people are not placed at risk of harm or abuse. The home ensures that all newly appointed staff follow an appropriate induction programme. EVIDENCE: We were informed that, since the last inspection staffing levels during the morning and at night have been increased. We were informed that, at the time of this inspection a total of 35 people living in the home which includes 13 people living in the specialist dementia unit. We were told that staffing levels were currently as follows; Morning – 1 x supervisor, 1 x shift leader, 2 care staff (main unit) and 2 care staff (specialist unit), 2 x care support workers. Afternoon – As above but without care support. Croft House DS0000016030.V366759.R01.S.doc Version 5.2 Page 23 Night – 1 x supervisor and 2 x care staff. In addition to care hours, the home employs catering, administrative, maintenance and activity staff. Care support staff on duty are responsible for overseeing the laundry. An additional carer is on duty to meet the needs of people visiting the home for day care. When we asked people living at the home and staff about staffing levels, no concerns were raised. People told us that their needs were met and that ‘staff always have time for you’. Staff told us that they were able to meet peoples’ needs. Seven people living at the home completed comment cards for the Commission and all responded ‘Always’ to the question; ‘Are the staff available when you need them?’ Five members of staff completed comment cards, one responded ‘Always’ and four ‘usually’ to the question; ‘Are there enough staff to meet the individual needs of all the people who use the service?’ Somerset Care Ltd actively promotes and supports staff to achieve National Vocational Qualifications (NVQ) appropriate to their role. The AQAA provided us with information which identified of the 34 permanent care staff employed, 29 have achieved a minimum of an NVQ level 2 in care. This equates to 85 which exceeds the recommended 50 of the National Minimum Standards. The AQAA also indicated that two further staff are currently working towards an NVQ in care. Training opportunities for staff within the home and company are very good. All of the five staff who completed comment cards for the Commission confirmed that they had received the training needed to meet the needs of the people they were caring for; ‘I attend all update training including training for dementia’, ‘I work in the SRC unit and I am sent on regular training in and out of house to keep me informed about how to meet the needs of people that I care for’, ‘We have regular training to enable us to deal with customers in any situation, we also have regular staff meetings to update us on changes and improving the way we work’. We spoke to four staff during this inspection and all were very positive about the training opportunities they were given. Healthcare professionals made positive comments in completed comment cards; ‘As far as I am aware staff have enough skills and experience and training is available for them to keep updated’ ‘Staff appear to be trained in the right skills and experience’ The home’s completed AQAA stated; ‘We have our own training centre, Acacia training, they provide training for all areas including induction and specified training to meet the needs of the service users’ Croft House DS0000016030.V366759.R01.S.doc Version 5.2 Page 24 ‘We have a comprehensive training programme to cover all statutory training and other specific topics, updates are maintained during the year to maintain high standards’ ‘Each staff member has an individual training record’ ‘Identified staff training development needs are highlighted during staff reviews and appraisals’ Detailed staff training records were made available to us and apart from mandatory training, staff had completed training in topics such as dementia care, person centred communication, creating meaningful occupation for people with dementia, asthma, medication, end of life and palliative care and abuse. District nurses have also provided training in the management of diabetes. The home follows robust procedures for the recruitment of staff. Three staff recruitment files were examined at this inspection and these contained all required information including enhanced criminal record checks (CRB) and protection of vulnerable adults checks (POVA). We were able to see evidence that newly appointed staff follow a detailed induction programme which meets with the Skills for Care Common Induction Standards. Croft House DS0000016030.V366759.R01.S.doc Version 5.2 Page 25 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, 32, 33, 35, 36 & 38 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. The home is effectively managed and people benefit from an open and inclusive style of management. Procedures are in place to ensure that peoples’ financial interests are safeguarded. People benefit from a staff team who are appropriately supported and supervised. Appropriate procedures are in place and followed to ensure the health and safety of persons at the home. Croft House DS0000016030.V366759.R01.S.doc Version 5.2 Page 26 EVIDENCE: The registered manager is Diane Allen. Mrs Allen has over six years experience as a senior manager and has been a registered manager within the company for the last five and a half years. She has achieved an NVQ level 4 in care and has also completed the registered managers award. In the completed AQAA, Mrs Allen stated that; ‘I attend frequent management development days and also have an NVQ 2 in dementia care’, ‘I am a dementia care mapper with Bradford university’ ‘I have a clear and progressive vision for the future of Croft house, I always involve staff, service users, their families / representatives in the day to day running of the home, I am always open to new ideas and trends’ People living at the home and staff members spoken with were positive about the registered manager and of the support they received. Somerset Care Ltd has very effective management systems in place to support the home and registered manager. There are effective systems in place which enable people using the service, their representatives and staff to affect the way in which the service is delivered and regular management meetings are held. People living at the home recently influence a change in the menu and all spoken with appeared well informed of all planned changes within the home. Regular meetings are held for all staff and minutes are maintained. Questionnaires are sent out to people living at the home and their representatives twice yearly. We were able to view an analysis of a recent survey and responses to questions were very positive. The home has a suggestion box in the reception area of the home for people to use. The responsible individual conducts monthly visits to the home in accordance with the required Care Homes Regulations and reports are maintained at the home. Regular in-house audits are carried out to ensure that policies and procedures remain effective and that people benefit from good standards of care. The home meets with the local authority on a regular basis to review the provision of the block contracted beds. In the home’s completed AQAA, it states; ‘We received excellent feedback from the Social Services and the Psychiatric team at our last contracts review in June 2008’ The home has procedures in place for people who wish the home to manage small amounts of money on their behalf. Money is securely stored and only senior staff have access to this. We were informed that as there is a senior member of staff on at all times, people can access their money as and when they choose. Appropriate records are maintained for all transactions and Croft House DS0000016030.V366759.R01.S.doc Version 5.2 Page 27 receipts are obtained for any purchase. Regular in-house checks are made on all balances and transactions and records are audited by an independent body on an annual basis. We were informed that the home does not act as financial appointee for any person using the service. We were able to see evidence that the home follow effective procedures to ensure that the staff team are appropriately supervised and supported. All staff spoken with confirmed that they met regularly with senior staff and that they were encouraged to express any training needs or preferences. Documented evidence of this was seen in the three staff recruitment files examined. Five staff completed questionnaires for the Commission and all confirmed that they met regularly with senior staff/manager. Staff also made the following comments; ‘my manager or supervisor will often ask me at the end of every shift is everything is ok’ ‘we also have regular staff reviews and our appraisal’ ‘My manager regularly meets with me and discusses how I am working and supports me in my role’ ‘I have regular reviews and appraisals and can also meet my manager at any time if I need to discuss anything’ The home has policies and procedures in place to ensure the health and safety of persons at the home. During this inspection, we examined the following; FIRE SAFETY – Records examined demonstrated that weekly in- house checks are made on the home’s fire detection and alarm systems. Monthly checks are carried out on the emergency lighting. Annual servicing of all systems and fire fighting equipment is conducted by an external contractor on an annual basis. Training records indicated that all staff had received up to date training in fire safety. We did not examine the home’s fire risk assessment. GAS SAFETY – The home has an up to date annual Landlords Gas Safety Certificate dated 17/06/08. ELECTRICAL SAFETY – The home has an up to date electrical hardwiring certificate dated 23/05/07. Annual testing on all portable appliances was last carried out in December 2007. HOT WATER – Outlets are fitted with thermostatic controls to ensure that they remain within safe limits. Monthly checks are carried out on all outlets to ensure temperatures do not exceed safe upper limits. Croft House DS0000016030.V366759.R01.S.doc Version 5.2 Page 28 ACCIDENTS – appropriate records are maintained for all accidents. Results are analysed monthly so that any traits can be identified. The home also records all falls and there was evidence that action had been taken to reduce reoccurrence as appropriate. EQUIPMENT SERVICING – We saw documented evidence to confirm that all hoists had received up to date six monthly servicing. As required in the Care Homes Regulations, the registered manager informs the Commission of any death or significant event at the home. The home has a range of health and safety policies and procedures available to staff. There was evidence that staff are encouraged to read these. The staff training matrix identified that staff had completed formal training in Health & Safety. The home’s completed AQAA states; ‘A rigorous health and safety training programme in place with regular updates to ensure knowledge and skills are maintained’, ‘All senior staff are trained to first aid appointed persons level, the manager, deputy manager and training co-ordinator all have a ISOH certificate’ ‘Contracts are in place to maintain / service electrics, gas, boilers, plumbing, fire systems, equipment, etc’ ‘A handyman is employed to ensure outside, ie paths, steps, etc are safe and secure’ ‘Health and safety policies are in place and is reviewed regularly’ ‘COSHH, risk and fire assessments are in place and are regularly reviewed’ ‘The manager ensures that all policies, procedures and legislation is complied with’ Croft House DS0000016030.V366759.R01.S.doc Version 5.2 Page 29 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 3 3 3 3 3 N/A 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 x x x x x 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 3 x 3 3 x 3 Croft House DS0000016030.V366759.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? NO 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Croft House DS0000016030.V366759.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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. 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