Inspection on 17/01/06 for Croft House Nursing and Residential Home

This inspection was carried out on 17th January 2006.

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

Other inspections for this house

Croft House Nursing and... 23/05/07

Croft House Nursing and... 13/07/05

Croft House Nursing and... 16/03/05

Croft House Nursing and... 20/07/04

Croft House Nursing and... 03/03/04

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Claremont House

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Sun Court Nursing Home

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Bramley Avenue (73)

Bilney Hall

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Mabbs Hall Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Croft House Nursing and Residential Home Braintree Road Great Dunmow Essex CM6 1HR Lead Inspector Diane Roberts Unannounced Inspection 17th January 2006 09:00 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 Nursing and Residential Home DS0000015400.V280952.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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 Nursing and Residential Home DS0000015400.V280952.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Croft House Nursing and Residential Home Address Braintree Road Great Dunmow Essex CM6 1HR 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) 01371 872135 01371 874727 BUPA Care Homes (BNH) Limited Care Home 38 Category(ies) of Old age, not falling within any other category registration, with number (7), Physical disability (2), Physical disability of places over 65 years of age (31) Croft House Nursing and Residential Home DS0000015400.V280952.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. A person of either sex, aged 55 years and over, who requires nursing care by reason of a physical disability (not to exceed 1 person) Persons of either sex, aged 65 years and over, who require nursing care by reason of a physical disability (not to exceed 31 persons) Persons of either sex, aged 65 years and over, only falling within the category of old age (not to exceed 7 persons) No more than 2 persons may attend the home on a daily basis in addition to those 38 accommodated The total number of service users accommodated must not exceed 38 persons One service user over the age of 54 years, who requires nursing care due to a physical illness/disability, whose name is known to the Commission. 13th July 2005 Date of last inspection Brief Description of the Service: Croft House Nursing and Residential Home is registered to provide nursing and personal care for up to a total of 38 residents over the age of 65 years, and up to 2 residents over the age of 55 years. The home can also provide day care for up to 2 people. Croft House is in a purpose built two-storey building. The home has 32 single and three double rooms. All rooms have en-suite facilities. The home is on two floors and a passenger lift is available. There is a sitting room on each floor and a large dining room on the ground floor. The home has attractive gardens and a paved area with seating. The home is located five minutes from Dunmow town centre and there is a bus stop outside the home. Croft House Nursing and Residential Home DS0000015400.V280952.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over five hours and was carried out as part of the annual inspection programme for this home. The registered manager was not present at the inspection with the Deputy Manager being in charge of the home. The Inspection focused upon outstanding standards not previously covered this year and the homes response to the last agenda for action. A partial tour of the premises was undertaken. Four residents and two staff were spoken to during the inspection. Unfortunately no comment cards were received from residents or relatives. What the service does well: What has improved since the last inspection? What they could do better: Further development is needed with the care planning system and the home are already aware of this. Further work is needed on risk assessments for fire safety and working practices with the home. Croft House Nursing and Residential Home DS0000015400.V280952.R01.S.doc Version 5.1 Page 6 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 Nursing and Residential Home DS0000015400.V280952.R01.S.doc Version 5.1 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 Nursing and Residential Home DS0000015400.V280952.R01.S.doc Version 5.1 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): Standards not assessed at this inspection. EVIDENCE: Croft House Nursing and Residential Home DS0000015400.V280952.R01.S.doc Version 5.1 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 the following standard(s): 7, 8 9 and 10. Individual plans of care are in place, which are generally of an acceptable standard. The health care needs of residents are met by the home. The home has good systems in place for the safe administration of medicines. Residents are treated with respect and their privacy is upheld. EVIDENCE: Each resident has a care plan in place and this is based upon a comprehensive assessment, including risk assessments for falls, pressure sores, nutrition etc. The deputy manager/care manager has been working to improve the care planning and recording in the home. Care plans were seen to have been reviewed monthly and this includes the risk assessments. Assessments have been updated, when residents were re-admitted following a spell in hospital. The home needs to ensure that all the care needs have a care plan although this was not seen as a chronic issue with the care plans. Care plans inspected show sufficient detail and an individual approach. Croft House Nursing and Residential Home DS0000015400.V280952.R01.S.doc Version 5.1 Page 10 Daily note recording could improve to reflect the care provided and the resident themselves. Where risk assessments identify a risk, the outcome or action should be identified. There is evidence that residents or their representatives have had input to the care plan and this was also confirmed by residents spoken to on the day. Care plans evidence that the healthcare needs of residents are being met. Records could improve with regard to the weighing of residents and the chiropody service. Residents spoken to report that their healthcare needs are met and confirmed that they see the doctor promptly when needed, the chiropodist and optician etc. Again, risk assessments where risks are identified, as with pressure sores, need some evidence/rational as to the action taken or not, depending on the risk. The home has a satisfactory supply of pressure relieving equipment for use with residents. Records show that where required the home seeks advice or a visit from a specialist nurse or healthcare professional. Wound assessments were seen to be completed and care plans, of a satisfactory standard, were in place. Since the new deputy manager has been in post she has undertaken a significant amount of work on the administration of medication in the home. Records show that she has good links with the dispensing pharmacists for advice and they undertake a regular audit for her. A new stock control sheet has been introduced for every resident, which helps to ensure that items needed are ordered and other items are not over ordered. Records were seen to be very well maintained, clear and informative. Evidence of regular medication reviews were seen and 3 residents were self-medicating with good risk assessments in place. The home has up to date policies and procedures in place. Local guidance was seen to be out of date (2001) and it is recommended that more up to date advice be sort. Residents spoken to on the day of the inspection were very happy living in the home and with the standards of care and services provided. The residents felt that they were treated with great respect and that the nursing and care staff were very caring, flexible and helpful and that nothing was too much trouble. Residents felt that the care provided was never rushed and that they were made to feel special and individual. Croft House Nursing and Residential Home DS0000015400.V280952.R01.S.doc Version 5.1 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 the following standard(s): 15 The meal provision service in the home is good. EVIDENCE: Residents spoken to on the day of the inspection were very happy with the food provided in the home. They felt that the quality of the food was very good and that there was a reasonable choice. Residents confirmed that a late supper was available should they so wish. Mealtimes were seen to be appropriate and the menu offered looked varied, appealing and nutritionally balanced. Specialist diets are catered for and presented in an acceptable and appealing way, including soft/pureed diets. The home has a large attractive dining room with the tables fully set at each mealtime. Residents are encouraged to eat in the dining room but may choose to eat in their room should they so wish. The kitchen was seen to be clean and well maintained. The kitchen staff still need to improve upon the labelling and dating of opened foods stored in refrigerators. Croft House Nursing and Residential Home DS0000015400.V280952.R01.S.doc Version 5.1 Page 12 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): 18 The home has systems in place, which help to ensure that residents are safeguarded from abuse. EVIDENCE: The home has up to date polices and procedures in place for the protection of vulnerable adults and whistle blowing. Local information is given to staff when they commence employment at the home. Staff files checked at random show that the home undertakes CRB and POVA list checks prior to new staff starting at the home. Records show that all staff, including ancillary staff, are up to date with training in the Protection of Vulnerable Adults. Croft House Nursing and Residential Home DS0000015400.V280952.R01.S.doc Version 5.1 Page 13 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 The home is well maintained, accessible and safe. EVIDENCE: A partial tour of the premises was undertaken with the deputy manager. Areas seen, were in good decorative order and homely. An ongoing decoration programme was evident and recently work on painting the corridors has started. The home has bedrooms decorated as they become vacant. Furniture in the home was seen to be in good order and a new carpet has been laid in the downstairs lounge, which also has new wallpaper and curtains. Maintenance records seen show that there is a comprehensive maintenance plan in place for the home. Bathrooms were seen to be clean and tidy although the bathroom floors seen, appeared stained, despite efforts by staff to address this. This affects the overall look of the bathrooms. The grounds were seen to be in good order for the time of year and accessible to residents should they so wish. Croft House Nursing and Residential Home DS0000015400.V280952.R01.S.doc Version 5.1 Page 14 The Fire Safety Officer visited the home on the 14.11.05. No recommendations were made. At the current time records for fire safety training for staff show good levels of compliance and regular testing of equipment is evident on records. The home needs to address cover for the person who tests the alarms etc. when they are on leave. The home needs to complete a full fire safety risk assessment. Croft House Nursing and Residential Home DS0000015400.V280952.R01.S.doc Version 5.1 Page 15 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): 29 The home has sound recruitment systems in place. EVIDENCE: The home has up to date polices and procedures in place with regard to the recruitment of staff. Staff files were inspected at random. Records show that the home adheres to its policies and procedures and undertakes all the required checks on potential staff. Good records are maintained and updated where required and a checklist system is used. Croft House Nursing and Residential Home DS0000015400.V280952.R01.S.doc Version 5.1 Page 16 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): 35, 36 and 38. The home has good systems in place, which protect resident’s financial interests. Staff in the home are appropriately supervised. The home has systems in place, which protect the health and safety of residents. Some of these could be developed further. EVIDENCE: The home has policies and procedures in place, which guide staff on handling resident’s personal monies. Residents are encouraged to be independent with their finances as far as possible and where required the home will provide support. Records and monies were inspected at random and found to be kept in good order with clear accountable records maintained. The home does not Croft House Nursing and Residential Home DS0000015400.V280952.R01.S.doc Version 5.1 Page 17 act as an appointee for any residents and internal audits are undertaken on a regular basis. The deputy manager has introduced a supervision system for staff as per company policy and procedure. Records inspected showed that the system is working well and nearly all staff have received at least two supervision sessions. The content of the supervision is appropriate and includes training needs, new company polices etc. The home has a comprehensive health and safety policy in place. Safety and maintenance certification was inspected for the fittings and equipment in the home. These were found to be in order with all checks etc. up to date. Some safe working practice risk assessments have been completed but further work is required in some areas, i.e. fire, laundry, maintenance and the kitchen. Records show that hot water temperatures are checked regularly in the home and adjusted where necessary. Statutory training has been provided to both care and ancillary staff and compliance levels are high with clear training records maintained. Staff have attended training in food hygiene, fire safety, health and safety, manual handling, COSHH and infection control. Croft House Nursing and Residential Home DS0000015400.V280952.R01.S.doc Version 5.1 Page 18 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 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 3 X X X X X X X STAFFING Standard No Score 27 X 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 3 X 2 Croft House Nursing and Residential Home DS0000015400.V280952.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 12(3) Requirement The registered person must ensure that the daily progress records provide details of residents physical and psychological health, and how they have spent their day. Informed at the time of inspection. The registered person must ensure that all identified/assessed care needs have a care plan in place. The registered person must ensure that risks identified on assessment are followed up and that records are made of action taken. Timescale for action 30/04/06 2 OP7 15 30/04/06 3. OP8 14(1) 30/04/06 4. OP15 16(2)(j) 5 OP38 23 (4) and 13 The registered person must 17/01/06 ensure that there is a clear system for ensuring that all parts of the kitchen are cleaned, and that fridge and freezer foods are dated. Informed at the time of inspection. The registered person must 30/04/06 undertake a fire safety risk assessment and complete safe working practice risk DS0000015400.V280952.R01.S.doc Version 5.1 Page 20 Croft House Nursing and Residential Home assessments as appropriate. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP9 Good Practice Recommendations The registered person should ensure that all local guidance with regard to medication is maintained up to date. Croft House Nursing and Residential Home DS0000015400.V280952.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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