Inspection on 23/01/06 for Homecroft

This inspection was carried out on 23rd January 2006.

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

Other inspections for this house

Homecroft 09/06/07

Homecroft 30/08/06

Homecroft 12/07/05

Homecroft 15/02/05

Homecroft 18/05/04

Homecroft 22/12/03

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Homecroft 446 Lichfield Road Four Oaks Sutton Coldfield West Midlands B74 4BL Lead Inspector Karen Thompson Unannounced Inspection 23rd January 2006 11:30 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 Homecroft DS0000016760.V280292.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. Homecroft DS0000016760.V280292.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Homecroft Address 446 Lichfield Road Four Oaks Sutton Coldfield West Midlands B74 4BL 0121 308 6367 0121 308 8294 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) Mr Godfrey Murch Mrs Marjorie Joan Murch Mrs Marjorie Joan Murch Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (19) of places Homecroft DS0000016760.V280292.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th July 2005 Brief Description of the Service: Homecroft is a registered care home for 19 elderly people in Sutton Coldfield. It is located on the main Lichfield Road and is on the bus route for Birmingham as well as Lichfield and Burton. It is also within walking distance of Butlers Lane railway station. Homecroft was open in June 2001 on the site of the owners’ former home and offers modern facilities of a high standard. The home has good matching furniture throughout. There are seventeen single bedrooms and one double bedroom. All have ensuite toilets and wash hand basins. Some of the bedrooms also have level access shower facilities. There is a vertical lift enabling access to the first floor bedrooms and the assisted bathroom. An assisted shower room is available on the ground floor. Communal rooms on the ground include a lounge, a library and dining area, and a conservatory. Also located on the ground floor are the kitchen, laundry and an office. At the front of the home there is ramped access to the building and parking for both able and disabled visitors. There is a well-appointed garden at the rear, which includes lawns, shrubs, patio areas with garden furniture and a small water feature. Homecroft DS0000016760.V280292.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and carried out over five and three-quarter hours and incorporated a number of concerns raised about the home. Areas of concern identified were about staff practice and attitude. This has been looked at under standard 7, 8,18 and 31 to which it specifically relates. This is the second of the statutory inspections for this home for 2005/2006. During the inspection a tour of the premises was made during which some bedrooms were inspected three resident files and other care documentation was inspected. The inspector spoke to both the owners and senior management team and a three service users and a visitor. This report should be read in conjunction with the previous inspection report. What the service does well: What has improved since the last inspection? Resident’s money held by the home needs more detailed recordings of transactions along with receipts, so any queries can be easily identified. The quality assurance system at the home is evolving and is actively seeking resident and relative input to ensure that this is tailored to the group of Staff rotas demonstrate that staff are no longer working excessive hours and the potential for tiredness at work has been reduced. This improvement helps ensure residents get an improved delivery of care. Supervision of staff has improved and meets the standard for the majority of staff. Homecroft DS0000016760.V280292.R01.S.doc Version 5.1 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Homecroft DS0000016760.V280292.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 Homecroft DS0000016760.V280292.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): 3 The admission procedure is thorough ensuring that residents are assured that their care needs will be met by the home. EVIDENCE: Three residents files were sampled and there was evidence that the Registered Provider had carried out a pre-admission assessment for each individual. Homecroft DS0000016760.V280292.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 Residents are referred appropriately to external health professionals but health needs of residents are not always comprehensively assessed by staff, leading to potentially poor outcomes for some residents. Medication systems are robust to protect the residents, but staff training is still required for all staff dispensing and depositing of medication to ensure they are competent. EVIDENCE: An element of the concerns raised related to residents weight loss. This particular resident was being weighed regularly and food and fluid intake was being monitored. The resident had been referred to the general practitioner service for help and support, but in this particular instance the home was unable to demonstrate they had explored the root of the poor dietary intake themselves via a nutritional risk assessment. Assessments are needed to generate a comprehensive care plan and give practical guidance on how to meet this resident’s needs. Overall, the home was found to mostly meet regulations and standard and whilst it is possible other medical factors might have contributed to the weight loss the home did not fully explore physical and psychological factors influencing this residents weight loss in this area Homecroft DS0000016760.V280292.R01.S.doc Version 5.1 Page 10 The care plan daily records clearly indicated that cognitive changes had occurred, which were impacting on how the resident expressed their needs. No mental health assessment had been carried out by the home, (referrals to external professional had taken place) and emotional outbursts were clearly signs of unexplored and unmet needs. The impact of the noise from the new extension to the home on someone suffering from cognitive/sensory impairment had not been acknowledged or strategies put in place to minimize the impact. The home needs also to consider implementing social/background profiles for residents so that staff know the values, preferences and lifestyle of the resident they are looking after, as each individual has unique and complex needs based on these past experiences. A further aspect of the concerns, raised was about sores on a resident’s body. The home carry’s out skin integrity risk assessments. The resident was asleep during the inspection so the inspector was unable to chat to the individual about health issues. Daily records demonstrated creams were occasional applied by staff and staff confirmed that soreness had been an issue, but no cream had been prescribed or the condition acknowledged in the care plan. This element of the concerns did not meet standards and regulations due to poor documentation and monitoring. Concerns had been raised was about staff not changing a residents clothes over a number of days. Records demonstrated that personal care was given but did not state whether clothing had been changed. The practice of changing and laundering clothes will be looked at more fully next inspection. Care plans were being reviewed monthly but resident/relative involvement was not evident. The home should consider how it reviews the care plans what evidence it will use to trigger and contribute to a review. All of the medication audits undertaken were correct. Not all staff dispensing medication have completed an accredited medication-training course. All medication not used needs to be returned to the pharmacist, at present not all is disposed of in this manner. All bedrooms have an appropriate fitted lock to the bedroom doors and a lockable facility within the room. The care plans were unable to demonstrate that residents had been offered a key to their room and those residents chatted to could not remember whether they had been offered a key. The home must ensure that its care documentation reflects whether residents have been offered a key. Homecroft DS0000016760.V280292.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): 12, 13, 15 Residents are helped within the home to exercise choice and control around their daily lives. The homes regimes and structures are not always flexible enough to ensure these areas of need are fully met. EVIDENCE: The inspector chatted to residents about their craft sessions. Residents sell what they make and the profits go towards a charity they have nominated. The residents also have access to a ‘shop’ run by them to where they can purchase personal items and profits from this also go to their nominated charities. Residents were observed wandering freely around the home, chatting in small groups. Visitors were observed to be around the home during the course of the inspection. Meal timing does allow for flexibility and whilst residents are always offered a cup of tea on waking, breakfast is not offered until 8.30am. If a resident has been awake for several hours this seems an excessive amount of time to wait for toast or cereals. Residents spoken to said the quality of the food was good. One resident stated “food very good just like living at home.” Homecroft DS0000016760.V280292.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): 16, 18 The procedural arrangements including complaints fail in some areas to ensure residents are informed and fully protected. EVIDENCE: The complaints procedure, which is on display in the reception area, had been amended and meets the standard. The Care Manager needs to ensure that the service users guide contains the same complaints procedure as the one displayed in the reception area. In relation to adult protection, the home has obtained a copy of the Multi agency guidelines for Birmingham. The Adult protection policy and procedure need to be amended to reflect these guidelines. The majority of staff had received training in relation to adult protection since the previous inspection. Concerns had been raised about the appropriateness of language used towards residents by staff. Whilst the inspector witnessed good interaction between staff and residents it must be acknowledged that recent research has shown that 75 of aggressive outbursts by residents are due to poor staff interaction. Language used in some of care documents could sometimes be described as controlling. Staff need to be aware of what triggers challenging behaviour but also how their responses can effect outcomes. Staff training is required in dealing with challenging behaviour. The home was found to need to make improvements in this area under the NMS and regulations. Homecroft DS0000016760.V280292.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, 21, 23, 26 The standard of the environment within the home was good providing residents with a safe, attractive and homely place to live. EVIDENCE: An extension to the home had been in the process of being built which will enhance the facilities already available. The home had a good standard of furnishings and fittings in communal areas. All bedrooms have ensuite facilities of a toilet and washbasin and some ensuites also have a level access shower. The home has a communal assisted bath upstairs and a communal assisted shower downstairs. All bedrooms seen were personalised and had a good standard of décor and furnishings. The home was clean and the standard of thoroughness with regards to cleaning was of an exceptional standard. Homecroft DS0000016760.V280292.R01.S.doc Version 5.1 Page 14 The health protection unit in relation to systems and process to protect residents and staff from cross infection recently carried out an external audit, the results of this audit were very good. Homecroft DS0000016760.V280292.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): 27, 30 Staff training has lapsed in a number of key areas of good care, placing residents and staff potential risk to their health and well being. EVIDENCE: The inspector took away 3 weeks of rotas. Staff at the home had multi role that included caring, domestic and laundry tasks. The home has a separate staff for catering. During daylight hour’s three members of staff are available to meet residents needs. The night staff consists of one waking and one sleeping care assistant that can be called upon if needed with senior staff offering on call assistance. The home has a commitment to training and developing staff. Mandatory training has lapsed however in a number of areas such as manual handling and fire safety training. Homecroft DS0000016760.V280292.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): 31, 33, 35, 36, 38 Whilst there are signs of good management there are areas that require further development to ensure that residents and relatives receive the service that they are happy with. Systems are in place to protect the health, safety and welfare of residents but further work is required to ensure that this is comprehensive. EVIDENCE: There have been changes to the management structure, which has resulted in the promotion of one of the deputy manager to care manager. The Commission will need to have an application for a new registered Manager of Homecroft. Concerns had been raised was in regards to customer care from the senior management team. Whilst the complainant acknowledges their response may not have been appropriate in all instance they feel aggrieved at the senior teams response. Homecroft DS0000016760.V280292.R01.S.doc Version 5.1 Page 17 Examination of care records highlighted that this had not been the first time the relationship had broken down. Staff are required to work positively with residents, relatives and or their representatives this element of the concern was found not to meet standards and regulations. The home quality assurance system is evolving. The home is gathering residents and relative opinions in the form of a questionnaire along with regard meeting and internal audits are taking place and these are informing the quality assurance audit. The Manager receives no personal allowance for residents but does hold money deposited with her for safekeeping. Residents’ money is held along with records and receipts. Relatives depositing money appear not always to be given a receipt even though this is recorded on the residents’ transaction sheet. It is also recommended that the home have two receipt books one for money in relation to residents’ personal spending money and another in relation to fees paid into the home by relatives. Formal staff supervision was taking place within the home and records’ were being kept. These need to be taking place six times a year and in the majority of cases this was occurring. The deficit appears to be with senior members of staff and this needs to be rectified to ensure they are properly supported to carry out their role especially in light of changes in management structure. The home must audit staff records to ensure all members of staff have received fire safety training and that this is taking place for each member of staff at least twice a year. The Commission had not received notice via Regulation 37 of incidents such as fall that had occurred in the home. The Registered Providers need to carry out unannounced visits and produce regulation 26 reports in relation to this and ensure the Care Manager and the Commission receive a copy. Homecroft DS0000016760.V280292.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 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X 3 X 3 X X 3 STAFFING Standard No Score 27 3 28 X 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 2 X 2 Homecroft DS0000016760.V280292.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 15(1) Requirement Timescale for action 30/04/06 2. OP7 12 3. OP7 13(4)(b,c) 4. OP7 15(2)(b,c) The Registered Person must ensure that all residents care plans are based on a comprehensive assessment and cover all aspects in relation to health, personal and social care. The Registered Person must 30/04/06 ensure that all residents have social/background profile completed so staff are aware of the values and preferences of residents allowing for these to be incorporated into the care planning and service delivery The Registered Person must 30/04/06 ensure that nutritional, mental health, manual handling and falls assessment take place for all residents and that these are linked into the care planning process. The Registered Person must 30/03/06 ensure that care plans are reviewed and updated frequently to reflect changing needs and current objectives for health and personal care. This process must involve consultation with residents and or representatives. DS0000016760.V280292.R01.S.doc Version 5.1 Homecroft Page 20 5. OP9 13(2) 6. OP8 15(1) 7. OP9 13(2) 8. OP16 22 9. OP18 18(1)(a) 10. OP18 13(6) 11. OP18 13(6) The Registered Person must ensure that all unused medication is returned to the pharmacist. The Registered Person must ensure that multidisciplinary input is recorded in the service users care plan. Outstanding requirement 30 September 2005 The Registered Person must ensure that all staff administering medication have received accredited training. Outstanding requirement 30 September 2005 The Registered Person must ensure that the complaints procedure in the service users guide is simple and clear and acknowledges that residents can complain at any point in the process to the Commission. The Registered Person must ensure that all staff receives training in regards to challenging behaviour. The Registered Person must ensure that all staff are trained in relation to audit protection and they clearly understand their role. Outstanding requirement 30 September 2005 The Registered Person must ensure that they have a copy of the Birmingham Multiagency guidelines and that this is incorporated into their adult protection policy and procedure and staff are familiarised with it. Outstanding requirement 30 September 2005. The Registered Person must ensure that staff files evidence training and that all staff receive the required training within the DS0000016760.V280292.R01.S.doc 28/02/06 30/03/06 30/03/06 30/03/06 30/05/06 30/03/06 30/03/06 12. OP38OP30 19 Sch 2(4) 30/04/06 Homecroft Version 5.1 Page 21 target time limits. Outstanding requirement from 15 February 2005. The Registered Person must audit staff training and ensure that all staff have received a yearly update for manual handling and fire safety training and care planning documentation. The Registered Person must audit staff training with regards to customer care and ensure that this training is carried out. The Registered Person must ensure that Regulation 26 visits are carried out and a report of this visit left in the home and a copy forwarded to the Commission. The Registered Person must ensure that all staff receives formal supervision 6 times a year. The Registered Person must ensure that the Commission is notified without delay of any event or occurrence within the home as detailed in the regulations. Outstanding requirement 30 August 2005 13. OP31 12(5) 30/05/06 14. OP31 26 30/03/06 15. OP36 24 30/03/06 16. OP38 37 30/03/06 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. Refer to Standard OP35 Good Practice Recommendations It is recommended that the home develop strategies to manage when service users appear not to be in receipt of any personal allowance. DS0000016760.V280292.R01.S.doc Version 5.1 Page 22 Homecroft Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Homecroft DS0000016760.V280292.R01.S.doc Version 5.1 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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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