CARE HOME ADULTS 18-65
Croftlands 41 Durranhill Road Carlisle Cumbria CA1 2SW Lead Inspector
Liz Kelley Unannounced Inspection 10th February 2006 10:00 Croftlands DS0000022572.V280228.R01.S.doc Version 5.1 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 Croftlands DS0000022572.V280228.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 Adults 18-65. 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. Croftlands DS0000022572.V280228.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Croftlands Address 41 Durranhill Road Carlisle Cumbria CA1 2SW 01228 524296 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) The Croftlands Trust Ms Penny Poxon Care Home 10 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (9), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (1) Croftlands DS0000022572.V280228.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. The service must at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. To accommodate nine people in the category of Mental Disorder (1MD). To accommodate one named person in the category MD(E) (1 MD(E) Date of last inspection 22nd July 2005 Brief Description of the Service: Croftlands accommodates up to 10 people who have difficulties in maintaining aspects of their mental health. The intention of the service is that people can live in the home for up to three years. The goal is to help service users move onto other accommodation where they can live as independently as possible. The premises are a large detached three-storey Victorian style property, which has been modernised and converted for its current usage. The house is situated in a suburb of Carlisle and stands in its own walled gardens with a driveway leading up to the entrance. Each service user has an individual bedroom with wash hand basin, and each floor has a bathroom or shower room. There are two lounges and two kitchens on the ground floor; one of the lounges is designated as a no-smoking area. The home has a zero tolerance on illegal drugs. An office, staff room and staff sleeping in room is also provided. Croftlands is run by The Croftlands Trust; this is a non-profit making organisation, which runs a number of residential and community based services in the County for people with mental heath problems. Croftlands DS0000022572.V280228.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection and took place over 4 hours. Four service users were spoken to. Two staff, the deputy and manager were spoken to. A visiting Community mental health professional was interviewed. Care plans and administration files were sampled. This was the second visit of the inspection year and the majority of areas were covered on the first visit. Feedback cards had been received from visiting professionals earlier in the year. On this visit it was noted that service users being referred to the home had more complex and challenging needs. What the service does well: What has improved since the last inspection? What they could do better:
The organisation should review the homes purpose in light of changing referrals and changes in mental health provision in the area. The home is currently divided between those who consider Croftlands their home and have lived here several years and those who are only likely to stay for several months. This can cause frictions between service users and a conflict in approach for staff. Staff must be more accurate in giving and recording medications as people experiencing difficulty with medications can be a major factor in being referred to the home. And, therefore staff must give this their full attention and gravity it requires. Croftlands DS0000022572.V280228.R01.S.doc Version 5.1 Page 6 The home must be kept cleaner and is in need of a good “spring clean”. Currently all cleaning and domestic duties are carried out by support staff. Due to the complexity of the needs of service users currently being referred to the home it has been difficult for staff to spend valuable time away from service users in cleaning the home. Staff have become demoralised by these tasks and their skills and training need to be put to better use. Therefore, the home must employ a cleaner or look at ways to take this burden off staff and service users. Service users should still be encouraged to carry out domestic tasks but this should be as a result of an assessment and detailed in a care plan. Service users files also require a “spring clean”. Many items require archiving so that only current and necessary information is held on file. 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. Croftlands DS0000022572.V280228.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Croftlands DS0000022572.V280228.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 2,3 and 4 were assessed and met at the last inspection. However, it was noted that service users being referred to the home had increasingly more complex and challenging needs. EVIDENCE: The organisation should review the homes purpose in light of changing referrals and changes in mental health provision in the area. The home is currently divided between those who consider Croftlands their home and have lived here several years and those who are only likely to stay for several months. This can cause frictions between service users and a conflict in approach for staff. Clarity of purpose is needed to give a consistent approach to service users and to be responsive to the changing provision in this field. Croftlands DS0000022572.V280228.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 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 6, 7 and 9 were assessed and met at the last inspection. EVIDENCE: Croftlands DS0000022572.V280228.R01.S.doc Version 5.1 Page 10 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13,15,16,and 17 Staff are committed to helping service users to maintain positive relationships with family and friends; and in promoting appropriate links with the local community. The staff team are also skilled at supporting service user’s personal development and in encouraging informed decision-making. Service users are offered a nutritious and balanced diet and staff are well informed on the links with mental well-being. EVIDENCE: Service users are supported to maintain and develop relationships with the community and were in contact with relevant professionals, such as community psychiatric nurses, and occupational therapist to assist in developing social skills. Family contact is indicated in each persons individual plan and staff were knowlegble about the extent of this contact. Staff were also supportive of the family and relationship dynamics for each person. Example were staff going with service users all over the country to attend weddings, funerals and family
Croftlands DS0000022572.V280228.R01.S.doc Version 5.1 Page 11 get-togethers. Where, appropriate family were encouraged to visit and arrangements are made to allow privacy on these visits. Decision-making has a high profile in the home and staff have a good understanding of service users support needs. Personal development and making informed decisions is a key feature for individuals and the staff team are skilled at enabling service users to make these choices. Risk assessments are in place to support decision-making and to assist in activities to take place rather than preventing them. Emphasis is on what service users can do rather than cannot. Sometimes to reach and achieve goals these have been carefully broken down into achievable steps and progress monitored jointly with staff and service users. Menus are planned with service users on a weekly basis and a communal evening meal is encouraged. Although there is a weekly shop for the house where service users choose to take part, individual shopping is also encouraged to develop independence and daily living skills. Staff are given training on the importance of healthy diets and the role in promoting good mental health for service users. Croftlands DS0000022572.V280228.R01.S.doc Version 5.1 Page 12 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 20 Staff are not accurate when giving and recording medications. EVIDENCE: At a previous inspection the Pharmacy Inspector made requirements and recommendations, which the manager has not yet responded to. The manager must also review how medications are administered and record to reduce the number of errors that were noted. Service users experiencing difficulty with medications can be a major factor in being referred to the home, and this area needs to be improved. The manager is aware of these shortfalls and is looking into measures to tackle this with individual staff concerned. The manager stated that all staff were due to be given additional training in the safe handling of medications. Croftlands DS0000022572.V280228.R01.S.doc Version 5.1 Page 13 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 The home has a satisfactory complaints system with evidence of service users able to express their views on the home, and these being acted upon. The home has good systems in place to protect the rights and well-being of service users. EVIDENCE: Service users were observed freely expressing opinions to staff, and other ways of expressing views more formally via the complainants procedure were seen. The open atmosphere created within the home ensures that service users feel free to express their opinions and are confident that they will be listened to and concerns acted upon. The Home has induction training that covers adult protection issues and the various forms of adult abuse. The home has polices and practices that safe guarded the handling of service users monies. Service users have good and varied links with outside organisations and advocate groups which ensures that they have channels to express views and concerns if necessary. These areas, and training in Adult Protection safeguarded service users from abuse. Croftlands DS0000022572.V280228.R01.S.doc Version 5.1 Page 14 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 The home is not being kept clean and hygenine levels are unacceptable. EVIDENCE: The home was in need of a good spring clean and was dirty in some areas. Currently all cleaning and domestic duties are carried out by support staff. Due to the complexity of the needs of service users currently being referred to the home it has been difficult for staff to spend valuable time away from service users in cleaning the home. Staff have become demoralised by these tasks and their skills and training need to be put to better use. The home must employ a cleaner. Service users should still be encouraged to carry out domestic tasks but this should be as a result of an assessment and detailed in a care plan. In a similar fashion gardens must be kept tidy and the grounds wellmaintained. The home must employ a cleaner to carry out day-to-day domestic chores and ensure the home is hygienic. Croftlands DS0000022572.V280228.R01.S.doc Version 5.1 Page 15 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34 The recruitment practices of the organisation and the home ensure that service users are safeguarded and that staff have the qualities and aptitudes to work in social care. EVIDENCE: The Home followed the recruitment procedure of The Croftlands Trust. Staff files are now held in the home contained all the relevant documentation and were clearly sectioned and well-organised. The selection procedure included obtaining two written references, a formal interview and an informal interview involving service users, wherever possible. All staff had CRB disclosure checks. Upon appointment staff were issued with a handbook, which includes job descriptions and terms and conditions. Appointments are subject to a six-month probationary period. The Croftlands Trust has a code of conduct and all members of staff have a statement of terms and conditions. A new member of staff interviewed confirmed these practices. The organisation has appointed a Human Resources manager who is to look at a Staff Development programme. This will help to improve staff turn over rates and boost staff morale. By providing staff with a more formal career structure. These are all good practices to ensure that service users are supported by a carefully selected and vetted staff team.
Croftlands DS0000022572.V280228.R01.S.doc Version 5.1 Page 16 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 42 Service users benefit from living at a home that is well-run by the manager and by the systems of the organisation. These systems and ethos ensure that service users are central, and their views are valued and acted upon. EVIDENCE: The Home operated to The Croftland Trust’s Quality Assurance standards that included physical aspects of running the Home as well as monitoring the delivery of service. The provider, The Croftland Trust, appoints an operations manager to carry out Quality Assurance checks. These are sent into the Commission for Social Care Inspection on a monthly basis. From these reports areas for improvement are highlighted and the actions were checked at inspection. These were judged to work well in monitoring and improving the service for those living at the Home. The records examined on the day of the inspection were well ordered, relevant, appropriate and up-to-date for the smooth running of the Home and in meeting the needs of the residents. Croftlands DS0000022572.V280228.R01.S.doc Version 5.1 Page 17 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 X 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 X 33 X 34 3 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X X X X X LIFESTYLES Standard No Score 11 X 12 X 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 3 2 X X X X X X 3 X Croftlands DS0000022572.V280228.R01.S.doc Version 5.1 Page 18 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard YA20 YA20 Regulation 13 13 Requirement Safe storage of medicines for self-administration must be provided (Previously 30.04.05) Records of consent to hold and administer medication for service users must be gained (Previously 30.04.05) Gardens must be kept tidy and the grounds well-maintained Medications must be recorded accurately A cleaner/domestic must be employed to keep the home at acceptable levels of cleanliness Timescale for action 31/03/06 31/03/06 3. 4. 5 YA24 YA20 YA30 23 13 23 31/03/06 31/03/06 30/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA20 YA1 Good Practice Recommendations The homes systems of recording and dispensing should be reviewed to eliminate recurring errors The home should review its aims to reflect the needs of the service users group in the home and trends within the Mental Health field.
DS0000022572.V280228.R01.S.doc Version 5.1 Page 19 Croftlands Croftlands DS0000022572.V280228.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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