Inspection on 09/03/07 for Croft, The

This inspection was carried out on 9th March 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Croft, The 28/03/08

Croft, The 03/11/05

Croft, The 11/05/05

Croft, The 13/10/04

Croft, The 08/06/04

Similar services:

21 High Street

Vale House

Chestnut Walk

Dunwood Manor Nursing Home

The Old Vicarage

Excelsior

Cherwood House Care Centre

Durban House Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Croft, The Hooke Hill Freshwater Isle Of Wight PO40 9BG Lead Inspector Janet Ktomi Unannounced Inspection 9th March 2007 09.30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Croft, The DS0000012480.V327137.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, The DS0000012480.V327137.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Croft, The Address Hooke Hill Freshwater Isle Of Wight PO40 9BG 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) 01983 752422 01983 752422 Mrs Patricia Anne Foster Mrs Caroline Joy Metcalf Care Home 16 Category(ies) of Dementia - over 65 years of age (12), Learning registration, with number disability over 65 years of age (2), Mental of places disorder, excluding learning disability or dementia (2) Croft, The DS0000012480.V327137.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home may accommodate one named person, under the age of 65 years, in the (DE) category 3rd November 2005 Date of last inspection Brief Description of the Service: The Croft is an extended detached house in a residential area of Freshwater, close to all amenities. It is registered as a care home for a total of 16 residents, 14 over 65 years of age and 2 under 65 years. The home specialises in caring for people with dementia and/or mental health problems. The home is on two levels and as there is no passenger lift the residents in the four upstairs bedrooms need to be mobile. With the exception of one twin room all bedrooms are for single occupancy, none of the bedrooms are en-suite. The home is owned by Mrs P Foster and managed by the registered manager Mrs Caroline Metcalf. Weekly fees range from £361.97 to £490.00 dependant on assessed needs. Croft, The DS0000012480.V327137.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was the first ‘Key Inspection’ for the Croft, a ‘Key Inspection’ being part of the new inspection programme, which measures the service against the key National Minimum Standards. The visit to the home, was conducted by one inspector over one day lasting a total of seven hours, where in addition to any paperwork that required reviewing the inspector met with people who live at the home, staff, the manager and undertook a tour of the premises. The inspection process also involved pre fieldwork visit activity, with the inspector gathering information from a variety of professional sources, the Commission’s database, pre-inspection information provided by the service and linking with previous inspectors who have visited the home. Comment cards were received from five relatives, one service user, one district nurse, three care managers, three care staff and one GP. What the service does well: The manager and staff have a good understanding of the needs of each individual resident, and relate to the residents with understanding and affection. Residents stated they are well cared for and that the staff are kind. Comments from care managers included ‘excellent in compassion, consideration and care to people in distress, very very kind’ Care managers, district nurses and the homes GP commented on how well the home liaises with external professionals and keeps them informed about changes in service users needs. Relatives also commented on how well they are kept informed by the home. Meals are well balanced and take the residents preferences into account. Home cooking and fresh fruit and vegetables are used. Special diets are provided and necessary assistance with meals is given. One service user stating ‘they are cooked well and vegetarian for me’. The home has a good training programme for care staff with in excess of sixty percent of care staff having at least an NVQ level 2 in care with additional staff undertaking this qualification. Comment cards from care staff stated that the home is a nice place to work and that staff work as a team. Service users stated they were happy living at the Croft and ‘I feel safe here’. Croft, The DS0000012480.V327137.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The following requirements are made following this key inspection. The manager must review all risk assessments and update these to ensure they are still relevant to the service user. The manager must undertake individual risk assessments on all bedroom radiators and if it is indicated that a risk is present then appropriate measures including guarding must be undertaken. The manager must ensure that correct manual handling procedures and individual guidelines are adhered to at all times. The home must ensure that it has a recent photograph of all service users. The manager must ensure that all medication administered to residents is recorded on the Medication Administration Record sheets and the correct recording procedure employed when medication is not administered. All residents prescribed as required medication must have written guidelines as to when the medication should be given. In general service users are treated with respect and their privacy is maintained, however the inspector observed several incidents when their dignity was not ensured. Service users must be treated with dignity and respect at all times, care practises must ensure this. The manager must undertake an audit of the homes furniture and fittings and ensure that any damaged/old items are repaired or replaced. The home must replace the two toilet seat risers which were shown to the manager as the metal bars which hold these in place have become corroded and on one had fallen off and the other were loose and sharp. The home does not employ a cleaner with care staff undertaking cleaning in the morning along with providing care to service users. Overall the home did not appear clean with some parts (notably bathrooms and some bedrooms) in need of a thorough cleaning. The lack of cleaning in some parts of the home Croft, The DS0000012480.V327137.R01.S.doc Version 5.2 Page 7 represents a significant infection control risk to service users, visitors and staff. The manager must ensure that the home and all equipment is kept clean. The manager had not repeated the Criminal Records Bureau (CRB) check for one new employee but had taken a copy of a check undertaken by another care service shortly prior to the person applying to this home. The manager must ensure that new CRB and POVA checks are undertaken on all new staff. CRB checks are not transferable from one provider to another. The manager must ensure that all records are fully maintained. Also as previously identified the homes office is small and although secure storage is available it is recommended that consideration is given as to how the limited space in the office is better utilised. 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, The DS0000012480.V327137.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Croft, The DS0000012480.V327137.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4 and 5. Standard 6 is not applicable, as the service does not provide intermediate care. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. No service user moves into the home without having had his/her needs assessed and being assured that these will be met. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. EVIDENCE: The inspector discussed the homes admission procedure with the manager and viewed recent pre-admission assessments undertaken. At the time of the inspectors unannounced visit the home was fully occupied having admitted a new service user the previous week. The manager stated that should the home have a vacancy she would contact social services and Croft, The DS0000012480.V327137.R01.S.doc Version 5.2 Page 10 inform them. The manager stated that the home frequently receives telephone calls from the relatives of people requiring residential care. The manager stated that it is often not possible for new service users to visit the home however if this is possible people would be invited to visit alternatively the relatives are invited to visit the home and view the available bedroom and meet existing service users and staff. On the day of the inspectors visit the relatives of someone requiring residential care visited the home, they were shown around the home, provided with a brochure and informed that there were currently no vacancies. The manager is aware of the homes registration categories and when referrals outside these are received she is aware of the necessary procedures that must be undertaken. The service applied for, and the commission agreed, a minor variation in July 2006 to allow the home to admit a service user with dementia who was under the age of 65 years. Should the home have a vacancy the manager stated that she would arrange to visit the potential service user and their family. Information would also be sought from care managers and other professionals involved with the care of the referred person. The home has a comprehensive pre-admission assessment tool that the manager completes to identify the health, social and care needs of the potential service user. Two completed pre-admission forms were viewed and had been fully completed. Where possible relatives are asked to provide a life history to help staff understand the service user and the things that may be important to them. Examples were seen in some care plans. Discussions with the manager indicated that she was clear as to the level of care the home could provide and would not admit people whose needs were in excess of those which could be met at the home. One service user has been assessed and provided with additional 1-1 support funded by social services to meet his individual needs for a high level of external activities prior to a place being offered to him. Discussions with care staff and service users during the inspectors visit indicated that care needs were met and staff felt confident to meet service users needs. Comment cards received from relatives stated that they were confident that their relatives care needs were being met at the home. Comment cards from health professionals and care managers confirmed that they felt service users needs were met at the home. There have been no previous concerns in respect of the homes statement of purpose, service users guide or contracts/terms and conditions of residency therefore these non-key standards were not assessed. The home does not provide intermediate care therefore standard 6 was also not assessed. Croft, The DS0000012480.V327137.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users health, personal and social care needs are set out in an individual care plan however risk assessments require updating. Although service users health care needs are recorded and met the manager must ensure that manual handling guidelines are adhered to at all times. The manager must ensure that all medication administered to residents is recorded on the Medication Administration record sheets and the correct recording procedure employed when medication is not administered. All residents prescribed as required medication must have written guidelines as to when the medication should be given. Whilst generally service users are treated with respect and their privacy is maintained the inspector observed several incidents when their dignity was not ensured. Service users must be treated with dignity and respect at all times, care practises must ensure this. Croft, The DS0000012480.V327137.R01.S.doc Version 5.2 Page 12 EVIDENCE: The care plans of four residents were seen during the inspection visit. These clearly showed the assessed needs of the residents and how these should be met. Care plans are reviewed each month by key workers. Included within care plans were risk assessments and guidelines to meet general and specific risks such as falls and manual handling. The inspector noted that a number of risk assessments had not been reviewed or updated for approximately two years and some were no longer relevant. One service users risk assessment concerned the risk of him using the stairs however he now has a ground floor bedroom and has done so for a while. The manager must review all risk assessments and update these to ensure they are still relevant to the service user. Some care plans contained life histories of the resident which would give staff an insight into the individual and what may be important to them. Daily recordings of care provided are maintained. The care plan of the newest service user did not contain a photograph. The manager confirmed that the home does have the necessary equipment to take photographs and the home must ensure that is has a photograph of all service users. The care plan of the new service user stated that the service user had memory loss and did not understand why she could not go to her own home. Therefore the service user is potentially at high risk of trying to leave the home. Other photographs were noted to have been dated two years prior to the inspectors visit and the home should update photographs should service users physical appearance alter as they age. Care plans contained information about service users health needs and how specific needs should be met including the need for special diets. Comment cards received from the district nurses who visit the home daily stated that the home regularly request advice and that residents are well managed especially their pressure areas, ‘many residents have limited mobility but do not get pressure sores’. Pressure relieving equipment was seen around the home on service users beds and chairs with a number of residents being assisted to return to their beds for a period after lunch for a rest. Service users comment cards and those spoken with during the inspection visit stated that they could see a doctor if required and that the home organise this for them. During the inspectors visit the consultant psychiatrist was visiting the home to review several service users. The manager stated that should she have any concerns the consultant is always available. The homes GP also returned a comment card and was positive about the care provided at the home. As previously stated the home undertakes risk assessments and provided management guidelines in respect of manual handling and hoists are available. Croft, The DS0000012480.V327137.R01.S.doc Version 5.2 Page 13 The inspector witnessed a service user being inappropriately transferred from a wheelchair to a lounge chair. The inspector checked the service users care plan and this clearly stated that the service user was unable to stand and weight bear due to a long term physical condition and a hoist should be used for all transfers. The service user had been transferred using a handling belt by two care staff. This placed the service user at significant risk of injury to both his shoulders and chest. Staff were also at risk of injury. This was discussed with the manager who was unsure why staff had not used one of the hoists, which are positioned around the home. The manager must ensure that manual handling guidelines are adhered to at all times. Medication is administered by senior staff who have completed both externally accredited training and internal training with updates. Medication is stored in the homes office in a locked medications cabinet that is secured to the wall when not in use. With the exception of liquids most medication is predispensed into weekly blister packs by the local pharmacist. The home uses the Medication Administration Record Sheets supplied by the pharmacist that are pre-printed. These were viewed and a number of gaps noted when it was not clear if medication had been administered or not. Some service users have as required medication for pain, anxiety or inappropriate behaviours. The home does not have specific guidelines to inform staff when these should be given. The manager must ensure that all medication administered is recorded on the Medication Administration Record sheets and the correct recording procedure employed when medication is not administered. All service users prescribed as required medication must have written guidelines as to when the medication should be given. Comment cards returned from relatives and a service user stated that service users are treated with respect and dignity. With the exception of one twin room (which was seen to contain a portable screen), all bedrooms are for single occupancy thereby ensuring privacy during personal care tasks. Several bedrooms were noted to have an unpleasant odour. The inspector spent part of the inspection in the homes lounge with staff and service users. During this time the inspector noted several incidents which compromise service users dignity. Staff were noted to approach one service user whilst pulling on disposable rubber gloves, they did not give an explanation to the service user as to why they wanted him to come with them and spoke with other people in the room, when he was reluctant to go with them they each took an arm and escorted him out of the lounge, only at this point did they appear to talk to the resident. Also as previously stated one resident was seen to be inappropriately transferred to a lounge chair. Another resident was in bed, and although looked comfortable and well cared for the divan bed base was stained. These incidents all compromise residents dignity and should not occur. Service users must be treated with dignity and respect at all times, care practises must reflect this. Croft, The DS0000012480.V327137.R01.S.doc Version 5.2 Page 14 Croft, The DS0000012480.V327137.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users find the lifestyle experienced in the home matches their expectations and preferences and satisfies their cultural, social, religious and recreational interests and needs. Service users are able to maintain contact with family, friends and the local community and are helped to exercise choice and control over their lives. Service users receive a wholesome appealing diet with special diets catered for. EVIDENCE: Comment cards returned from one service user and three relatives confirmed that the home provides activities for service users. The pre-inspection questionnaire completed by the manager listed activities provided which include a visiting musician on a Tuesday. The manager and staff explained that many activities are individual as the service users do not respond well to group activities and the inspector would agree. One service user has 1-1 support Croft, The DS0000012480.V327137.R01.S.doc Version 5.2 Page 16 provided as part of a care package funded by social services and the inspector viewed records of the activities he has undertaken with support staff. This service user also attends a local external day centre two mornings per week. The manager stated that she has recently secured agreement from the court of protection for additional 1-1 funded time for another service user. The inspector spoke with this service user who confirmed that he now had opportunities to go out more and had been out the previous day and expected to go out the next day. He confirmed he was able to choose where he went and what he did when out with his carer. Care plans were seen to contain life histories for some service users that would provide care staff with background information as to previous interests and activities. Care plans also stated activities service users enjoyed and contained records of activities undertaken. The home has a car suitable for people with mobility needs and is used by staff when taking service users out for shopping or to local cafes etc. Care staff stated they have time for activities and are able to take people out when the manager is in the home as this still leaves sufficient staff to meet other peoples needs. Separately funded 1-1 time is identified on the homes duty rotas. Most of the people living in the home previously lived in the West Wight area. Comment cards returned from relatives confirmed that they are able to visit whenever they liked. The home does not have a separate private room available for visitors, however the lounge/dining is divided into several sections so a limited degree of privacy could be provided should people not wish to return to their bedrooms to receive visitors. As stated previously the home is able to provide some external outings in the local community. The inspector was able to talk with several service users, who confirmed that they are able to make choices and decisions and that these are respected. The inspector overheard the cook asking service users whether they would prefer rice or potatoes with their lunchtime meal. Two service users prefer to spend their time in their bedrooms and their rooms (and most others) were personalised. Some service users would be unable to make verbal choices and decisions, care staff stated that they have got to know service users well and understand what most behaviour’s mean for individual people. Life history information contained in care plans will also help care staff to know what service users like and dislike. The comment card returned from one service user stated that he/she is provided with the vegetarian diet they have requested and that staff respect the decisions and choices he/she makes. Sample menus were provided with the pre-inspection questionnaire. These indicted that a range of meals are provided with fresh fruit and vegetables. The cook confirmed that special diets are catered for and that she is aware of individual likes and dislikes of service users. Information about nutritional needs is recorded on the pre-admission assessment and where necessary on care plans. A food record had been commenced on one new service user whose assessment indicated that she may not eat/drink adequately. This had now Croft, The DS0000012480.V327137.R01.S.doc Version 5.2 Page 17 been discontinued as staff had realised that the service user ate and drank very well. The home has a dining area adjacent to the lounge and service users were seen seated to the tables at lunchtime. A number of the people who live at the home require assistance with their meals and therefore two sittings are provided to ensure that staff have the necessary time to provide assistance without rushing. Croft, The DS0000012480.V327137.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 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users and their relatives are confident that their complaints will be listened to, taken seriously and acted upon. Service users are protected from abuse. EVIDENCE: Comment cards from one service user and three relatives stated indicated that they were aware of how to make a complaint and that the manager had explained this to them. Discussions with service users during the inspector’s visit indicated that they had no complaints or concerns and that they would probably say something to a member of care staff. The complaints procedure is included within the service users’ guide. Care staff stated that they would try to sort out a complaint if they could and if not would pass it onto the manager for her to resolve. Comment cards from professionals stated that they had not made any complaints or had any complaints about the service passed to them. Observations of interactions between service users and staff and the manager indicated that service users would feel able to state if they had concerns or complaints. The inspector discussed the home’s adult protection procedure with care staff and the manager. Croft, The DS0000012480.V327137.R01.S.doc Version 5.2 Page 19 In discussion with care staff they stated that they would inform the manager if they had any concerns that might indicate that a service user was being abused. Care staff have received adult protection and some challenging behaviour training. All staff have either attended Dementia awareness training or are booked to undertake this training. Some staff have attended mental health training at the college. The manager is aware of the local procedures for adult protection. Comment cards returned by care mangers stated that the home is good at managing people with potentially challenging or idiosyncratic behaviours. Similar comments were received from relatives comment cards. Care staff stated that one of them is always located in the lounge area of the home and is able to observe and prevent incidents between service users. Overall the homes recruitment practises should prevent unsuitable people working in the home however the home must undertake its own CRB check on one newly recruited staff member for whom the manager accepted a recent check undertaken by another care provider and had not undertaken a check herself. The arrangements in respect of service users personal finances were viewed and found to be appropriate. This will be discussed in greater detail in the management section of this report. Croft, The DS0000012480.V327137.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, 21, 22, 23, 24, 25 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Communal and private rooms are appropriate to meet the service users needs however the manager must ensure that they are kept adequately clean and that damaged/old furniture/fixtures must be repaired or replaced. EVIDENCE: The Croft is an extended older property located in a residential area close to the shops and other facilities in Freshwater. The Croft is domestic in style and provides comfortable and homely accommodation. There is off road parking to the front of the home and a large rear garden laid mainly to lawn with a patio area to the side of the home. The home has one office that is small and clearly storage space is at a premium. The office also houses the homes boiler, medications trolley and Croft, The DS0000012480.V327137.R01.S.doc Version 5.2 Page 21 safe. It is recommended that the proprietor and manager consider how the office could be better organised with perhaps more storage space in cupboards provided as the storage of folders overhead may be a risk which should be risk assessed. The office is the only private room in which the manager would be able to speak with staff or relatives and currently not suited to this task. The only natural light comes from an overhead sky light which is damaged and requires external cleaning. The communal facilities are limited, however the service users seemed content to sit as a group in the lounge. Part of the lounge is a conservatory extension with suitable blinds that would reflect some of the heat in the summer. The manager confirmed that in the heat of the summer this area can become too hot and service users are encouraged to sit elsewhere or return to their rooms for a rest in the afternoon. The dining area is adjacent to the lounge and although not private provides an additional sitting area. During the inspectors visit one service user was enjoying an individual activity in this area. The home does not have a private meeting room or an area where service users who smoke may do so. Service users who smoke currently do so in the dining area (not at meal times), with the window open. The manager is aware that this arrangement is not ideal and will have to change when the laws in respect of smoking change later in the year. The inspector noted that the fabric on the back of many of the dining room chairs was damaged and that chairs require a through cleaning. Lounge furniture appeared appropriate to service users needs with a range of sofas, chairs and recliner chairs. None of the homes bedrooms are en-suite, however bathrooms and WC’s are located around the home and convenient to communal areas and bedrooms. The home must replace the two toilet seat risers which were shown to the manager as the metal bars which hold these in place have become corroded and on one had fallen off and the other were loose and sharp. The home has two baths with hoists and the third a medic bath. All bathrooms and both bath hoists were dirty and in need of a thorough cleaning. These represented a significant infection risk to service users. The home does not have a sluicing facility. The home has two portable hoists seen during the inspection, these are stored on the ground and first floor, however as previously identified staff did not use the hoist when transferring one service user. The home does not have a lift but has purchased a stairmatic aid. The manager was clear that people would only be admitted to the first floor bedrooms if they were able to manage the stairs and the starimatic would only be used in emergencies. As previously stated the home has two bathrooms with hoists. Grab rails were seen located by WC’s. Pressure reliving equipment was noted on some beds and special cushions for some service users. The home has several profiling beds which may be adjusted to position service user in bed. Croft, The DS0000012480.V327137.R01.S.doc Version 5.2 Page 22 With the exception of one twin room all bedrooms are for single occupancy. The bedrooms on the ground floor extension are small with little space to rearrange furniture or accommodate many personal items. However the residents who occupy these rooms choose to spend the majority of their time in the lounge and only retire to their rooms for bed or a rest after lunch. The bedrooms upstairs are much larger and have space for all the belongings and equipment the residents choose. The residents spoken with were happy with their rooms, although some occupying the smaller rooms were unable to give an opinion. The inspector viewed all the bedrooms with the manager and identified a number of broken items of furniture, which must be replaced/repaired. One divan bed base was badly stained and must be replaced. The surrounds on some vanity units had also become damaged and worn through use and water infiltration. The manager must undertake an audit of the homes furniture and fittings and ensure that any damaged/old items are repaired or replaced. There was an unpleasant odour in some bedrooms. The inspector noted a number of radiators in service users bedrooms that had not been covered or guarded to prevent the risk of service users being burnt should they fall against them and not be able to move away. The manager must undertake individual risk assessments on all bedroom radiators and if it is indicated that a risk is present then appropriate measures including guarding must be undertaken. The home does not employ a cleaner with care staff undertaking cleaning in the morning along with providing care to service users. Overall the home did not appear clean with some parts (notably bathrooms and some bedrooms) in need of a through cleaning. The lack of cleaning in some parts of the home represents an infection risk to service users, visitors and staff. The manager must ensure that the home and all equipment is kept clean. The home has suitable laundry facilities however disposable gloves should be available in the laundry. Care staff have undertaken infection control training, however the inspector was concerned that staff were still wearing disposable gloves when they were returning a service user to the lounge after providing personal attention. Following the provision of care gloves should be removed, hands washed or wiped with antibacterial gel. Croft, The DS0000012480.V327137.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users needs are met by the numbers and skill mix of staff however the manager must determine how domestic/cleaning tasks are met. The home has a good training programme with in excess of sixty percent of care staff having at least an NVQ level 2 in care with further staff undertaking this qualification. Overall the home has appropriate recruitment procedures however the manager must undertake her own CRB checks and not accept those from other care providers. EVIDENCE: The manager stated that the home was fully staffed at the time of the inspectors visit. Duty rotas were supplied with the pre-inspection questionnaire and corresponded to those on duty at the time of the inspectors visit. The home has three staff on duty throughout the day with additional 1-1 worker for one service user. The manager is extra to these numbers. The home employs a cook for breakfast and lunch with care staff finishing the preparation of the evening meal. As previously stated the home does not have separate cleaning staff. Care staff stated that they felt they had enough time to meet service Croft, The DS0000012480.V327137.R01.S.doc Version 5.2 Page 24 users needs. At night one awake and one sleepin staff with the manager on call are provided. Staffing numbers would appear appropriate to meet the service users needs however the manager must identify how she will ensure that the home is kept clean. The home does not use agency staff with existing staff covering if required for holiday and sick leave. Information provided by the manager prior to the inspectors visit stated that sixty per cent of the homes care staff have at least and NVQ level 2 in care. The manager informed the inspector that a further three staff are now undertaking NVQ’s. The manager is fully aware of funding routes for NVQ’s. Pre-inspection information provided by the manager indicated that the home has a consistent staff team. The inspector viewed the recruitment records for three staff recruited over the past few months. The home has a thorough recruitment process. With the exception of one staff member all the required pre-employment checks had been undertaken. The manager had not repeated the CRB check for one new employee but had taken a copy of a check undertaken by another care service shortly prior to the person applying to the home. The manager must ensure that new CRB and POVA checks are undertaken on all new staff. CRB checks are not transferable from one provider to another. The home has appropriate induction procedures that correspond to the General Social Care Council common induction standards. Information about the homes training programme was included with the preinspection information supplied by the manager. The inspector saw the homes training plan during her visit to the service. This indicated that staff have received the necessary mandatory and service user specific training. Care staff confirmed in comment cards and to the inspector that they have lots of training opportunities. Comment cards from visiting professionals stated that staff have the necessary skills to meet service users needs. However despite all the training undertaken the inspector witnessed some examples of poor care practises and the manager must monitor staff and ensure that training is put into practise. Croft, The DS0000012480.V327137.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, 33, 35, 36, 37 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users live in a home that is run and managed by a person who is fit to be in charge, experienced and qualified. The manager is to consider how quality assurance work may be evidenced. Service users financial interests are safeguarded. The manager must ensure that all records are fully maintained. The inspector identified a number of concerns in respect of health and safety. Croft, The DS0000012480.V327137.R01.S.doc Version 5.2 Page 26 EVIDENCE: Previous reports listed the manager’s qualifications that include, the Registered Managers Award, NVQ level 4 in care and level 3 in mental health as well as a certificate in counselling. The manager stated that she undertakes updates in mandatory courses and is to attend some adult protection training for managers provided by the Island social services. Care staff and service users were clear that they are able to discuss any concerns with the manager. The manager confirmed that she has access to the necessary budgets and is able to make decisions about spending in the home. The proprietor lives near to the home and undertakes visits to the home providing monthly reports for the manager. These were seen during the inspectors visit. Due to the needs of the people who live at the home resident meetings are not undertaken. The inspector discussed with the manager how quality assurance monitoring can be undertaken and demonstrated in the home. Considering some of the requirements which will be made following this inspection the manager stated that she will start undertaking some formal quality assurance work recording room/equipment audits and individual discussions with service users or their relatives on a regular basis. A requirement is not made in respect of this however this will be reviewed on the next visit to the home by the inspector. The home is not the appointee for any service users however it does manage some personal money for two people. The arrangements and records for these were viewed and found to be appropriate. Should additional services be required by people living at the home these are detailed on invoices sent to the service users relative or person responsible for their finances. Care staff confirmed that a full inventory is made of service users personal items when they are admitted to the home. Care staff confirmed in comment cards that they receive regular supervision both 1-1 and supervision of work and that there are regular team meetings. Throughout the inspector’s visit a number of records were viewed, generally these were appropriately maintained. As previously identified the home must ensure that it has a photograph of all service users, risk assessments must be updated and relevant to service users, medication administration records must be fully maintained and guidelines in place for as required medication, CRB checks must be undertaken by the home. The inspector also noted that the record of baths in the office had not been fully completed and care staff confirmed that more service users than listed had received baths. The manager must ensure that all records are fully maintained. Also as previously identified the homes office is small and although secure storage is available it is recommended that consideration is given as to how the limited space in the Croft, The DS0000012480.V327137.R01.S.doc Version 5.2 Page 27 office is better utilised. The inspector viewed the book that records the checks undertaken on the homes fire detection equipment. These had not been undertaken weekly. Within this report issues in respect of health and safety have been identified in relation to the environment, risk assessments, recording and care practises. The main areas of concern being the dangerous manual handling practises observed by the inspector which placed a service user at significant risk of injury and the concerns about infection control, the lack of cleaning and staff not removing gloves once personal care tasks had been completed. Also of concern in respect of health and safety were that risk assessments had not been updated, radiators in bedrooms not covered or individually risk assessed, damaged and broken furniture and equipment, no guidelines for as required medication and incomplete medication administration records. Croft, The DS0000012480.V327137.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 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 2 2 2 3 3 2 2 1 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 2 1 Croft, The DS0000012480.V327137.R01.S.doc Version 5.2 Page 29 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. 1. Standard OP7 OP38 Regulation 13 (4)(c) Timescale for action The manager must review all risk 01/05/07 assessments and update these to ensure they are still relevant to the service user. The home must have a recent 01/04/07 photograph of all service users. Manual handling guidelines must be adhered to at all times. 01/04/07 Requirement 2. 3. 4. OP7 OP8 OP38 OP9 17 (1)(a) Schedule 3 13 (5) 13 (2) 5. OP10 12 (4) 6. OP19 OP38 23 (2)(c) The manager must ensure that 01/04/07 all medication administered to residents is recorded on the Medication Administration Record sheets and the correct recording procedure employed when medication is not administered. All residents prescribed as required medication must have written guidelines as to when the medication should be given. Service users must be treated 01/04/07 with dignity and respect at all times, care practises must ensure this. All furniture and equipment in 01/04/07 the home must be well maintained. Broken items must be replaced/replaced (toilet seat raisers, repairs to dining room DS0000012480.V327137.R01.S.doc Version 5.2 Page 30 Croft, The 7. OP25 OP38 13 (4) 8. OP26 OP38 13 (3) 9. OP29 19 (1)(b) chairs, bedroom furniture, divan base and vanity units as identified to the manager). The manager must undertake 01/05/07 individual risk assessments on all bedroom radiators and if it is indicated that a risk is present then appropriate measures including guarding must be undertaken. The manager must ensure that 01/04/07 the home and all equipment is kept clean. The manager must ensure staff maintain correct infection control procedures. The manager must ensure that 01/05/07 new CRB and POVA checks are undertaken on all new staff. CRB checks are not transferable from one provider to another. 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 OP19 Good Practice Recommendations It is recommended that the proprietor and manager consider how the office could be better organised with perhaps more storage in cupboards provided as the storage of folders overhead is considered a risk which should be assessed. The office is the only private room in which the manager would be able to speak with staff or relatives and currently not suited to this task. Croft, The DS0000012480.V327137.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Croft, The DS0000012480.V327137.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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