Inspection on 30/08/06 for Homecroft

This inspection was carried out on 30th August 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 23/01/06

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 30th August 2006 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Homecroft DS0000016760.V305324.R02.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. Homecroft DS0000016760.V305324.R02.S.doc Version 5.2 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 Susan Elizabeth Meakin Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (19) of places Homecroft DS0000016760.V305324.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd January 2006 Brief Description of the Service: Homecroft is a registered care home for 23 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 furniture and matching throughout. There are twenty three single bedrooms 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, 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.V305324.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The findings of this report are based on an unannounced fieldwork visit. The inspection was conducted over one day. Information for the report was gathered from a number of sources: tour of the building, examination of records and documents, talking to residents and staff members, direct and indirect observation. What the service does well: What has improved since the last inspection? What they could do better: Homecroft DS0000016760.V305324.R02.S.doc Version 5.2 Page 6 The staff rota demonstrated that on some occasions staff were working excessive hours and there was a potential for tiredness at work. The home must review how it rotas staff to ensure resident are fully supported. Minor amendments are needed to the contract to ensure that no misunderstanding occur in relation to terms and condition. Care planning documentation and recordings need to improve so that the home can demonstrate what care was provided. Prescribed cream medication management needs to improve to ensure that residents receive cream that is within date. The home also needs to draw up a homely remedies policy and procedure to ensure that any over the counter medications given to residents do not conflict with those that have been prescribed. Whilst the home has a number of mechanism and systems in place to monitor quality assurance it must actively gather opinion from people using the service to ensure that it is and can meet residents needs. 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.V305324.R02.S.doc Version 5.2 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.V305324.R02.S.doc Version 5.2 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): 2.3.4 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to this service. The admission procedure is thorough, so residents are assured that their care needs will be met by the home. EVIDENCE: Two residents’ files were sampled and the pre-admission assessments viewed meet the standard. The residents’ files sampled contained a contract. Minor amendments are required of the contract to ensure no misunderstanding could occur. The inspector was informed that the providers are in the process of reviewing the contract. Staff have received training in dementia care and challenging behaviour since the previous inspection. The possibility of further staff training in dementia care was discussed with the care manager during the inspection. The home has a number of residents with cognitive impairment, and their registration Homecroft DS0000016760.V305324.R02.S.doc Version 5.2 Page 9 category has recently been amended to reflect this, following an increase in the number of bedrooms the home provides. Mental health assessments were not found on residents files sampled despite this being an important baseline measurement for monitoring changes. Homecroft DS0000016760.V305324.R02.S.doc Version 5.2 Page 10 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): 7.8.9.10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care needs are not always set out in a comprehensive plan of care, which could potentially lead to poor outcomes for residents. There was evidence of good multidisciplinary working taking place on a regular basis to meet identified health care needs. Medication systems are on the whole good ensuring residents are protected but further work is needed in relation to the home remedies policies and procedures to ensure that the system is fully protecting residents. EVIDENCE: Two residents’ care plans were sampled during the inspection. It was apparent that the staff have worked hard at improving care plan recording. They have implemented a social/background profile for residents so that staff are aware of the values, preferences and lifestyles of each individual they are caring for. The care plans however did not encompass this information into how care would be delivered or provided, such as what time a resident preferred to go to bed or get up. Homecroft DS0000016760.V305324.R02.S.doc Version 5.2 Page 11 Care plans were being reviewed regularly and updated to reflect changes but risk assessments are not always being linked into the care planning process. For example, a resident who had fallen recently had no falls risk assessment in place but had strategies acknowledged in their care planning needs. Care plans were not being signed or dated by the person drawing up the plan, however it was evident that residents were involved in the care planning process. Care plans demonstrated that keys were being offered but relatives could be making decisions for those suffering from cognitive impairment. The staff need to review this and base their decisions not to give a resident a key on a risk assessment and demonstrate that they have involved residents in decisions. Residents’ files demonstrated that a variety of multi-disciplinary team members were visiting the home and referrals were being made to meet resident’s needs. Documentation in relation to these visits was not always comprehensive. Residents do not have a continence assessment carried out by the homes staff. Medication was safely stored. All staff dispensing medication have completed an accredited medication course. Medication management on the whole was good. Prescribed creams were not being dated on opening. This needs to be taking place so that residents receive cream at its optimum condition. Home remedies are administered by staff in the home and these are recorded on the resident’s Medication Administration Record (MAR). However, the home needs to draw up policies and procedure for such medication. Since the previous inspection, the management team have reviewed the laundry system, which enables them to monitor more effectively the receipt and return of clean clothes. One resident commented that “washing’s always nicely laundered”. Homecroft DS0000016760.V305324.R02.S.doc Version 5.2 Page 12 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): 12.13.14.15 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to this service. Choice and control was not well recorded but residents and relatives stated this was taking place and they were happy with the service. Residents maintain contact with family, friends, representatives and the local community as they wish. Residents are offered a choice of meals to meet their nutritional needs. 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 speakers come to visit the home who talk on a variety of topics. Residents also sponsor a donkey, which has visited the home on a number of occasions. The residents also have access to a ‘shop’ run by them where they can purchase personal items and the profits from this go to charities they have nominated as a residents’ group. 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. A hairdresser visits the home weekly. Homecroft DS0000016760.V305324.R02.S.doc Version 5.2 Page 13 Meals are at set periods during the day. Night staff give residents a drink if they want one at around 7am. The inspector was informed by a relative and resident that during the hot weather, ice-lollies and cold drinks were available to residents. Residents are offered a choice of two options at meal times. Homecroft DS0000016760.V305324.R02.S.doc Version 5.2 Page 14 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Procedural arrangements are in place to deal with complaints and protection concerns to ensure that residents are fully protected. EVIDENCE: Arrangements for protecting residents within the home were in place. The complaints procedure meets the standard. The home has received no complaints since the last inspection, Homecroft DS0000016760.V305324.R02.S.doc Version 5.2 Page 15 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): 19.20.21.22.23.24.25.26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The standard of the environment within the home was good providing residents’ with a safe, attractive and homely place to live. EVIDENCE: Since the previous inspection the home has been extended and altered to accommodate four extra bedrooms and to convert the previous double bedroom into two single rooms. This extension also incorporates a small conservatory for residents to sit in. The home had a good standard of furnishings and fittings in all communal areas. All bedrooms have ensuite facilities of a toilet and washbasin with some ensuites also having a level access shower. The home has a communal assisted bath upstairs and a communal assisted shower downstairs. Homecroft DS0000016760.V305324.R02.S.doc Version 5.2 Page 16 All bedrooms seen were personalised with residents’ own possessions and had a good standard of décor and furnishings. One relative commented that the “home is clean, and no smells”. Staff were observed to be wearing the correct protective clothing for the tasks they were performing. Homecroft DS0000016760.V305324.R02.S.doc Version 5.2 Page 17 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): Quality in this outcome area is adequate. The judgement has been made using available evidence including a visit to this service. Whilst the home’s selection procedure ensures they have a committed and caring workforce, they must ensure that training does not elapse in key areas so they can maintain good standards of practice. Planned rotas must be reexamined to ensure that staff are not working excessive hours and become too tired to deliver optimum care. EVIDENCE: The inspector took away 3 weeks of rotas. Staff at the home had many roles that included caring, domestic and laundry tasks. The home has separate staff for catering. During daylight hours there are a minimum of three members of staff available to meet residents’ needs. The night staff consist of one waking and one sleeping care assistant that can be called upon if needed with a senior member of staff on call. Planned rotas demonstrated that staff were finishing a day shift to continue with a night shift or finishing a night shift and continuing into the day shift. Whilst this night shift was allocated to be a sleep shift this cannot be guaranteed as the needs of the residents can fluctuate. Planning such work patterns is not good practice as staff will be tired and this will affect the standard of care provided. The home also needs to be aware of the possible forthcoming changes in the working times directives in the near future. Homecroft DS0000016760.V305324.R02.S.doc Version 5.2 Page 18 The home has a training matrix, which demonstrates training has taken place but does not indicate when this training is due for renewal. One member of staff spoken to indicated that they had recently received training in a number of mandatory areas but they were due for renewal in food hygiene and first aid. Discussions with the Care Manager revealed that over seventy percent of staff were trained to either NVQ2 or 3 and several other staff were undertaking this qualification. A sample of staff files were inspected and the home had a good recruitment procedure to ensure that all staff are recruited in line with current guidelines. The home has an induction programme for new staff but has not implemented the new Skills Council induction training. The Care Manager had documentation in relation to Skills Council induction and was due to attend a study day for implementing this the following day. Homecroft DS0000016760.V305324.R02.S.doc Version 5.2 Page 19 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The health, safety and well being of residents are promoted and protected, however further work is required to ensure all risks are minimised. EVIDENCE: The home has a new Registered Care Manager who has many years experience in caring for older adults. The quality assurance system continues to evolve although the home does not employ an external agency to do this for them. Nevertheless, the staff have to actively seek residents and relatives opinions. At present questionnaires are available for relative and visitors to fill in. but due to the low response from this method it was discussed with the homes management team whether to adopt a more proactive approach by actually requesting from relatives and Homecroft DS0000016760.V305324.R02.S.doc Version 5.2 Page 20 visitors feedback in the form of a twice yearly questionnaire. The management team carry out a variety of audits to monitor the quality of service provided, but the result of these questionnaires needs to be made available to residents and prospective residents. Residents’ meetings are taking place. Residents’ finances are held in a safe and secure place. Each resident had an individual transaction sheet, which was auditable. Supervision for staff was taking place and was of a good quality. The home needs to ensure that all staff receive a minimum of 6 in a twelve-month period. Health and safety at the home was generally well maintained. Fire alarm testing and servicing was taking place. Two fire drills had occurred at the home since the last inspection and a new method of recording the outcomes of these drills has been introduced. The management team need to ensure that all staff attend a fire drill and this was discussed during the inspection. Evidence of a hardwiring electrical safety certificate was received by the Commission postinspection. Lift servicing and maintenance was taking place. Gas equipment maintenance and servicing was taking place on a regular basis. A premise and grounds risk assessment was in place and had been reviewed recently. Homecroft DS0000016760.V305324.R02.S.doc Version 5.2 Page 21 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 2 3 2 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 3 3 x 2 Homecroft DS0000016760.V305324.R02.S.doc Version 5.2 Page 22 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 OP2 Regulation Sch 4 Requirement The Registered Person must ensure that the contract clearly states at what time period the fees will be reduced and by what amount or percentage. 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. (Outstanding requirement from Jan 06 inspection) The Registered Person must ensure that care plans are signed and dated by the person drawing them up or making enters in the care plan. The Registered Person must ensure that mental health, manual handling and falls assessments take place for all residents and that these are linked into the care planning process. (Outstanding requirement from Jan 06 inspection) Timescale for action 30/12/06 2 OP7 15(1) 30/12/06 3 OP7 13(4)(b,c) 30/12/06 Homecroft DS0000016760.V305324.R02.S.doc Version 5.2 Page 23 4 OP8 15(1) 17(1) The Registered Person must ensure that a detailed record of multidisciplinary input is recorded in the service users care plan. The Registered Person must ensure that they have a home remedies policy for all medication administered via this method. The Registered Person must ensure that all prescribed creams are dated on opening. The Registered Person must review the number of hours worked by staff and ensure that they have sufficient time to rest between shifts. The Registered Person must ensure that the induction programme carried out in the home is in line with Skills Council recommendations. The Registered Person must ensure they actively acquire feedback from residents, relatives and representatives and ensure that the results of these surveys are published The Registered Person must ensure that all staff attend a fire drill twice a year. 30/12/06 5 OP9 13(2) 30/10/06 6 OP27 18(1) 30/10/06 7 OP30 18(1) 30/12/06 8 OP33 24(1) 30/10/06 9 OP38 23(4)(d) 30/10/06 Homecroft DS0000016760.V305324.R02.S.doc Version 5.2 Page 24 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 OP35 OP4 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. It is recommended that the home looks at further dementia training courses for staff. Homecroft DS0000016760.V305324.R02.S.doc Version 5.2 Page 25 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.V305324.R02.S.doc Version 5.2 Page 26 - 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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