Inspection on 12/10/06 for The Croft

This inspection was carried out on 12th October 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 30 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Croft 31/10/08

The Croft 29/02/08

The Croft 14/05/07

The Croft 07/09/05

The Croft 10/05/05

The Croft 07/10/04

The Croft 01/07/04

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 Croft (The) The Croft Buckland Road Reigate Heath Surrey RH2 9JP Lead Inspector Pat Collins Unannounced Inspection 12th October 2006 09:45 Croft (The) DS0000013619.V315860.R01.S.doc Version 5.2 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) DS0000013619.V315860.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 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. Croft (The) DS0000013619.V315860.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Croft (The) Address The Croft Buckland Road Reigate Heath Surrey RH2 9JP 01737 246964 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) Heddmara Limited Michele Anne Waddington Care Home 22 Category(ies) of Dementia - over 65 years of age (1), Learning registration, with number disability (15), Learning disability over 65 years of places of age (7), Physical disability (1), Physical disability over 65 years of age (2) Croft (The) DS0000013619.V315860.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The minimum age of those accommodated will be 40 years. Service users within categories DE (E), PD and PD (E) must have a learning disability as their primary condition. 7th September 2005 Date of last inspection Brief Description of the Service: The Croft is a care home providing accommodation and personal care for male and female adults with learning disabilities of whom seven may be over 65 years of age. The building is a large, three storey detached house situated in its own grounds set in a semi-rural location opposite Reigate Heath. The home is within close proximity of shops and all community facilities in nearby Reigate town. Communal areas are located on the ground floor. These comprise of two spacious lounges, a separate dining room, kitchen and utility room. Bedroom accommodation is mostly for single occupancy and arranged on all three floors. The home has a platform lift and communal bathing/ shower facilities and toilets are available on all floors. Provision includes an emergency call system and a mini bus and driver. The home’s car parking facilities are shared with staff and visitors of the day centre, which operates out of a separate building within the grounds. The day centre service is for adults with learning disabilities and operates under separate management, though under the same ownership. Weekly fee charges at The Croft ranged between £529.61 and £1635.69 at the time of this inspection. Additional charges applied for transport, hairdressing, holidays, toiletries, clothing and magazines. Prospective service users and / or their representatives can access information about the home’s purpose, care ethos, services and facilities directly from the home. A copy of the home’s latest inspection report is also accessible at the home. Alternatively the report can be obtained from the Commission for Social Care Inspection (CSCI) website at www.csci.org.uk or by telephone contact with the CSCI. Croft (The) DS0000013619.V315860.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the home’s first key inspection in 2006 by the Commission for Social Care Inspection (CSCI). The findings of this inspection are the cumulative assessment, knowledge and experience of the home’s service provision since the last inspection in September 2005. This inspection takes account of observations of one inspector at the time of an unannounced inspection visit on 12th October 2006. The duration of this visit was nine and a half hours when all key national minimum standards (adults) were assessed. The visit included a tour of the premises and sampling of records, policies and procedures. The inspector spoke with some service users who are referred to in the report as ‘residents’ in accordance with the expressed preferences of some residents. The inspector also consulted managers and various staff members and a relative present during the visit. Written feedback was received from seven residents in comment cards completed with the assistance of their key workers. Other sources of information were six comment cards from relatives/visitors and two from health/ social care professionals and verbal feedback received during telephone contact with a social care professional. The inspector would like to thank all who contributed to the inspection process; also to thank the residents and staff for their courtesy and cooperation during the inspection visit. What the service does well: The home manager and deputy manager were working collaboratively in their efforts to meet the individual needs of residents within the parameters of individual responsibilities for decisions about financial resources. The management of the home ensured staff received good leadership and direction to enable them to fulfil the home’s stated purpose. The routines and daily operation of the home created a supportive and enabling environment for residents, promoting independence. Residents were encouraged and enabled to lead fulfilled lives and have community presence and participation. They had individualised activity programmes which included skills building, opportunity for the majority to regularly attend a range of day centres/social and educational centres and to engage in domestic tasks in accordance with abilities and preferences. Some residents had evidently enjoyed escorted small group holidays with staff throughout the year. Others known not to be comfortable with staying overnight at holiday venues had enjoyed an organised ‘holiday week’ last summer when they had opportunity to go on various day trips. The week had been very successful. Staff were observed interacting with residents’ in an age-appropriate and respectful manner. All feedback from relatives/visitors and residents confirmed overall satisfaction with the care provided. One relative expressed the view that “staff are wonderful” A social care professional stated that standards of care at the Croft (The) DS0000013619.V315860.R01.S.doc Version 5.2 Page 6 home were excellent and that managers and senior staff were helpful and well informed of residents’ needs. There was evidence of a good awareness and understanding of equalities and diversity in the operation of the home. This translated into positive outcomes for residents. The staff team were striving hard to make information accessible and understandable to residents with the use of photographs, pictures and symbols. Examples of good practice observed were displays of photographs of staff, visitors and other people of significance to residents. There was also photographic information about the key worker system, an accessible complaint booklet and separate booklet informing residents of their rights to speak out if unhappy and to live without fear of abuse. A comprehensive service users guide containing useful information about the home had been produced in an accessible format. Copies of this document had been issued to all residents. The fire procedure had been produced in pictorial/widget format, also the menu and individualised weekly activity plans. It was good to note that feedback received from professional stakeholders involved with the home was positive about improvement in communication systems over recent years. What has improved since the last inspection? Staffing levels had increased in accordance with the revised minimum requirements. It was noted that there had been occasional staffing shortfalls when it had not been possible to obtain agency cover for staff reporting sick at short notice. The manager retained discretion in setting staffing levels during non-peak – activity hours in accordance with service needs. These judgements were based on numbers of residents at home during the day and their individual needs. The increased care hours were noted to have had positive outcomes for residents. The team was better able to respond to the increased dependency of all residents associated with the ageing process and specific health problems of individuals. Contractual staffing obligations providing named residents with higher staffing ratios at times could be now met without adversely detracting from the available care hours for the group. Records demonstrated residents had increased opportunities to be involved in the day to day running of their home in accordance with individual capacities and personal preferences. Records sampled demonstrated individuals’ engaging in domestic tasks with staff support. These included cleaning and tidying their bedrooms, shared responsibilities for cleaning communal areas, involvement in their personal laundry. Some residents prepared snacks, drinks and their packed lunches under staff supervision. One to one time was allocated by key workers to supporting residents’ in life skills activities in the home and in the community, providing opportunities for personal development and growth. New care planning formats had been developed. These were designed to underpin a person centred approach to care planning. Croft (The) DS0000013619.V315860.R01.S.doc Version 5.2 Page 7 It was positive to note investment in the premises since the last inspection. Improvements included radiator covers fitted throughout the home, replacement of television aerials, redecoration of the kitchen and additional kitchen shelving, some redecoration in rooms was noted and repairs undertake to sections of the roof. Other improvements noted were in respect of the staff recruitment and vetting procedure ensuring new staff were checked against the national protection of vulnerable adults list before taking up post. 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. The summary of this inspection report can be made available in other formats on request. Croft (The) DS0000013619.V315860.R01.S.doc Version 5.2 Page 8 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 Croft (The) DS0000013619.V315860.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standard: 1, 2, 3, 4. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Prospective residents and their representatives have the information they need to make an informed choice about where to live and whether the home can meet individual needs. Admission procedures were satisfactory. Evidence suggests past admissions had been on the basis of needs assessments carried out to ensure needs could be met. Meeting the needs of residents was a priority of the manager and staff team It was noted however that there were constraints outside their control to fully meeting needs. EVIDENCE: The home had produced a detailed Statement of Purpose document. An information booklet (Service Users Guide) had also been produced in pictorial format and a personal copy distributed to all residents. Both documents had been updated in January 2006. Discussion took place with the manager regarding recent amendments to the care homes regulations. The need to review the service users guide in light of these amendments was suggested to ensure new statutory information is included in the Service Users Guide. Croft (The) DS0000013619.V315860.R01.S.doc Version 5.2 Page 10 A concerted effort had been made by the team to provide residents with accessible information using widget and symbols. This included details of the service aims and objectives and philosophy of care, of services and facilities, terms and conditions of residency and of the complaint procedure. This information enabled prospective residents and their representatives to make an informed decision about the suitability of the home to meet individual needs. There were eighteen residents accommodated at the time of the inspection, nine male and nine female. The admission criteria included consideration to admitting adults with learning disabilities who have some behavioural problems or epilepsy. There had been no admissions to the home for some years and the home’s population was ageing. All residents were funded by Care Management and had been admitted on the basis of comprehensive needs assessments carried out by appropriate professionals. Three of the residents stated in comment cards they had not been asked if they wanted to move to this home. The statement of purpose described the home’s admission/assessment procedure, which was based on good practice principles. Staff consulted demonstrated understanding of the individual needs of residents. The staff- training programme ensured continuous learning and development for staff enabling them to meet needs. Health care professionals had input into the staff training programme, enabling staff to respond and manage complex health needs. The training programme was designed to equip staff with the knowledge and skills needed to understand and meet the needs of adults with learning disabilities. A recent development had been a certificated distance learning dementia course. Some staff had enrolled on this course and long term it was the intention for all staff to receive this training. Staff had received training to enable appropriate care of residents’ with mobility or sensory impairment, communication problems, incontinence, mildly challenging behaviours and epilepsy. Individual staff were observed using signing and other modes of communication in their interaction with residents during the inspection visit. An area for further development could be provision of additional communication aids further enabling residents’ involvement in care planning and reviews. Equipment was provided to meet the needs of residents with mobility and other health related problems. This included hoists, bath hoist, specially fitted chairs and wheelchairs for named residents’, height adjustable beds and suitable mattresses and commodes. The upgrading programme had included investment in a platform lift, which served all floors and a new wet room shower facility on the ground floor. A new development since the last inspection was provision of a suitable orientation cue outside the bedroom of a resident diagnosed with dementia to assist him in finding his bedroom. Observations confirmed the need for handrails to meet the needs of this individual who though ambulant was Croft (The) DS0000013619.V315860.R01.S.doc Version 5.2 Page 11 unsteady at times and prone to falls. It was understood that he was not capable of using walking aids. It is necessary to arrange an assessment by relevant professionals for this individual associated with his mobility problems and to provide handrails if recommended in corridors and other areas as needed. Areas of discussion with the manager included the failure to comply with the requirement made at the time of the last inspection for provision of a safe, suitable garden and terrace for residents use. The undulating surface of the grounds inhibited residents from the safe use of the garden. There had been no progress in the work programme to finish off the proposed wheelchair accessible terrace at the front of the building Whilst it is acknowledged that tables and chairs were available beside the side entrance, this area appeared hazardous due to regular vehicle access. Whilst acknowledging speed restriction signs were displayed the inspector was informed that drivers sometimes exceeded the same. Additionally a further consideration needs to be the impact on residents’ privacy in the location of garden furniture directly opposite the entrance to the day centre. During the inspection visit the manager confirmed advice had been sought recently from a dementia specialist regarding the future development of dementia services at the home for adults with learning disabilities. The manager informed the inspector that the advisor had recommended some changes to the premises and furnishings to create a positive environment for people with dementia. Croft (The) DS0000013619.V315860.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards: 6, 7, 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans were in place for each resident though some sampled required updating. Whilst progress in implementing new person centred planning documentation was slow, the care ethos and operation of the home demonstrated person centred care practice. Staff were observed to respect residents’ rights to be consulted about decisions directly affecting them. EVIDENCE: Care documentation at the home for each resident was organised into a ‘working’ file and files labelled ‘care’ and ‘health’. Standard documentation on the files sampled included social and medical history, needs and risk assessments, in – house and care management care plans, goal plans, behavioural management plans where applicable and pictorial, person centred, individualised day activity plans. Since the last inspection essential lifestyle plans had been developed however minimal progress made in their implementation. The old care plan format was still in place operating parallel to the essential lifestyle plans during this transitional period. The information in Croft (The) DS0000013619.V315860.R01.S.doc Version 5.2 Page 13 the essential lifestyle plans was in an accessible, part visual format. Essential lifestyle plans sampled were mostly incomplete or blank. Whilst effort had been made to maintain the old style care plans up to date it was noted that some did not accurately reflect recent changes in needs. A key worker system was operating and residents consulted knew the identity of their key workers. Discussion with staff confirmed that the role of key workers currently did not involve producing or updating care plans/essential lifestyle plans. The manager and deputy manager were currently responsible for implementing a person centred approach to care planning and transferring all relevant information to the new essential lifestyle plans. It was stated to be the intention in the long-term to provide key workers with training in person centred planning so they could be delegated care-planning responsibilities. The manager and deputy manager recognised the need to prioritise transferring to use of essential lifestyle plans. Competing pressures on management time however was a significant constraint to progressing this time-intensive activity. Feedback from a social care professional confirmed that both managers and senior staff were helpful and communicated well. Comment was received however that junior staff, some for whom English was not their first language, were less well informed. It was positive to note the expressed opinion of the same professional that the care practice at the home was excellent though improvement necessary to record keeping to demonstrate a person centred approach to care planning. Other records sampled included medical and specialist assessments and treatment. Ophthalmic, dental and chiropody care was recorded and weights were regularly monitored. Care notes and monthly care summaries were in place on the files sampled. Guidelines were also available on individual files for the management of specific health care needs, including stoma care and epilepsy. The manager reported work having taken place on health action plans for all resident and stated these were in draft. Appointments were being made with residents’ general practitioners involving residents where possible in discussions about health action planning. The care plans sampled also addressed equality and diversity including race and ethnicity, disability, age and religion. Internal care reviews were being carried out at approximately six monthly intervals. The manager reported that care management reviews were regular. At the time of the inspection visit four care management reviews took place, one at a day centre and three at the home. Residents and their key workers attended the same and the manager and deputy manager shared attendance. The process was inclusive of other relevant stakeholders, professionals and relatives who were invited to attend or contribute information. Discussion took place with a relative who attended a review meeting at the home during the inspection visit. Feedback received from this individual was positive regarding the care of her relative. It was noted that staff worked hard to support the relationship between residents and relatives/visitors. Croft (The) DS0000013619.V315860.R01.S.doc Version 5.2 Page 14 Staff encouraged residents to engage in life skills activities and domestic routines dependent on abilities and personal choice. There was evidence of an individualised approach in this area of care supported by improved staffing levels. Individuals’ engaged, with support, in activities such as tidying their bedrooms, menu planning, personalised laundry and cleaning tasks, preparing snacks, cups of tea and making their packed lunch to take with them to day centres. Some individuals shared responsibilities for domestic tasks. Examples included setting and clearing dining tables, washing up and mopping the dining room floor. Each resident had 1:1 allocated time with their key worker during the week and opportunity to go out in the community using social and leisure amenities, local cafes, pubs, cinemas, bowling venues and shops. Records were maintained evidencing these activities and visual cues used to as prompts to remind residents of their individual domestic responsibilities. Records demonstrated that staff had made a good effort to provide residents with information, assistance and communication support to assist them in decision-making. This area of practice could be further enhanced by provision of additional communication cues to support person centred care planning and aid contribution to their review meetings. It was positive to note that some residents were stated to attend a self-advocacy group in the community where they received peer and advocacy support. This enabled expression of individual wishes and personal aspirations. Record keeping systems at the home were noted to record instances when decisions for residents’ had been made by others and reason why. Discussions between the inspector and individual residents established they had some control over expenditure of their personal money. The inspection did not include examination of financial practice in any detail however or of financial records on this occasion. . Croft (The) DS0000013619.V315860.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards: 12, 13, 14, 15, 16, 17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents were afforded opportunities for personal development and growth. They participated in appropriate activities in the home and in the community enabling them to lead fulfilling lifestyles. Visitors to the home stated they were made welcome by staff. Residents enjoyed the food served at home and were offered a varied diet. EVIDENCE: Residents were perceived to be content with arrangements for their day-to-day care and support. Relationships between staff and residents appeared positive and staffs’ approach to residents was age appropriate and respectful. Staff offered support and encouragement to residents, enabling them to make decisions and choices in their daily lives. Residents had a weekly timetable of activities. Individuals attended day placements during the week where they Croft (The) DS0000013619.V315860.R01.S.doc Version 5.2 Page 16 had opportunity to form friendships outside the home. Staff took interest in feedback from residents about their day at the time of the inspection visit. Residents had one to one time with key workers used in the provision of care and support including social and emotional support. Key workers spent time involving residents in domestic tasks, for example, personal laundry, cleaning and tidying bedrooms, budgeting their money and shopping for personal items. Key workers enabled residents to engage in leisure and social activities in the home and in their community. Residents had individualised weekly activity plans and most attended various day placements. Since the last inspection the Horley workshop had closed and subsequently reopened with a change of staff. Whilst this had been initially unsettling for individual residents it was said they had now adjusted to the staff changes. During the inspection visit there were times when there were very few residents home for parts of the day. Most were out attending various day placements and others went out shopping or for lunch with staff or key workers. Others visited a local park with staff support to feed the ducks, which they appeared to enjoy. Residents who had reached retirement age and no longer engaged in day services were occupied by staff in meaningful and stimulating activities. One to one supervision was provided for a resident who has dementia as a secondary condition. In the evening one resident accompanied staff to the vet with one of the home’s two pet cats. Others went to the pub with staff. A group activity took place also in the evening. Staff and residents could be heard in the day centre enjoying an interactive musical session using the day centre’s musical instruments. This was by prior agreement of the day centre’s manager. Other residents were meanwhile relaxing in lounges watching DVD films and chatting with staff and others were in their rooms. Various escorted small group holidays had taken place this year. Residents reticent to go on holiday had enjoyed a week of excursions visiting places of interest to them. Residents also enjoyed a varied social programme organised by various day services in addition to those arranged by the home. Records demonstrated that residents used trains and buses as well as the home’s vehicle when out in the community. Staff escorted them to Reigate town, which was within easy walking distance using wheelchairs as necessary. One service user informed the inspector of a new activity of carriage driving which he stated he very much enjoyed. Residents were noted to visit a local hairdresser in the community. Some residents had strong family links and others had infrequent or no contact with relatives. Staff were supportive of residents in maintaining relationships with family and friends. One resident had recently re-established contact with a family member, which had been a positive experience for that individual. Another resident with complex physical needs as a secondary condition was preparing to go on holiday to Europe with another residents and staff, staying Croft (The) DS0000013619.V315860.R01.S.doc Version 5.2 Page 17 in his relative’s villa. It was planned that he would have opportunity to spend time with his family whilst on holiday. Observations confirmed thorough planning and risk assessments in place to facilitate this holiday. Arrangements included rental of suitable hoists and other equipment to meet the needs of this individual whilst at the villa. Comment cards received from visitors/relatives confirmed they felt welcome when visiting the home. There had been a change in catering responsibilities since the last inspection. The senior team coordinator had handed over responsibility for cooking meals to a cook who worked five days a week. In her absence a second cook was employed and this cook was on duty at the time of the inspection visit. A recent inspection had taken place by the environmental health department and the senior team coordinator stated that requirements and recommendations made at the time had been met. Systems were in place for informing catering staff of residents’ dietary needs and preferences. The cook was stated to involve those residents who wished to be consulted in menu planning, using pictorial aids. The inspector was informed that residents received guidance and encouragement to select healthy eating options and plan a varied menu. Menus were available in a widget symbol format and prominently displayed in the dining room. Changes to the menu were recorded in records held in the kitchen. Advice was given on maintaining accurate records for individual residents who had substituted meals in accordance with individual preferences to the menu of the day. The cook on duty stated that most residents preferred traditional English cooking; examples given were fish and chips on Fridays, roast dinners on Sundays, casseroles and cottage pie. That said, the cook prepared a substantial and tasty evening meal of Mediterranean style chicken, potatoes and vegetables which residents clearly enjoyed, followed by a wholesome dessert. Residents were appropriately assisted by staff with their evening meal. The kitchen was clean and records of fridge, freezer and food probing temperatures were maintained. Overall food storage appeared satisfactory though advice given on dating jars and sauce bottles stored in the refrigerator when opened. Croft (The) DS0000013619.V315860.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards: 18, 19, 20, 21 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Personal and healthcare support was provided to meet the residents’ physical and social needs with due regard to privacy, dignity, independence and choice. The need to ensure professional assessment of the mobility needs of one resident was noted. Consideration should be given to making provision of handrails in corridors for the benefit this individual and others. Practice arrangements indicated a sensitive approach to issues of illness and death. The management of medication was considered satisfactory. EVIDENCE: Residents were registered with General Practitioners (GP’s). The manager confirmed recent work involved producing draft health action plans for each resident and arrangements for consulting GP’s to agree the same. Satisfactory arrangements were in place for residents’ to receive regular chiropody, dental and ophthalmic care in accordance with assessed needs. Support from primary health care professionals included district nursing and stoma care nurses, speech and language therapists, physiotherapist assessments as necessary and incontinence advisor. A recent development had been provision of incontinence supplies by the primary care trust driven by the intervention of a care manager. Croft (The) DS0000013619.V315860.R01.S.doc Version 5.2 Page 19 Staff had delegated responsibilities for ensuring programmes and instructions of therapists were followed. Feedback received from a health care professional was positive about improvements within the organisation and in communication over recent years. This was attributed by this respondent to the management skills of the manager and commitment and hard work of the deputy manager and permanent staff to provision of good services. Individual residents were noted to have reflexology sessions as part of their care packages. Staff stated residents enjoyed the one to one therapy provided by this trained therapist. It was noted that a care manager was intending to refer all the residents care managed by this individual for nursing needs assessments. The home’s management had been responsive to changes in the healthcare needs of residents and increased dependency related to ageing and specific health problems. The management of incontinence and stoma and catheter care at the home appeared satisfactory and underpinned by sound infection control procedures and practices as far as could be established. Residents’ health needs were monitored and potential problems and complications identified and referred to specialists. One resident who whilst still ambulant had some mobility problems was liable to falls whilst trying to get around and grabbing onto unstable objects, such as the backs of chairs. The care manager for this individual was aware and planned referral for assessment by a health care professional. Observations indicated the home should have handrails in corridors to aid mobility. If the needs assessment for this individual identifies this to be necessary then this provision must be made. Equipment and facilities for moving and handling residents based on assessed needs were available in the home. They included a bath and sling hoist and wheelchair accessible shower room. Adjustable height beds, special mattresses, commodes and individually fitted chairs and wheelchairs were also available. A resident with a diagnosis of dementia as a secondary condition of dementia received one to one staff supervision based on risk assessments for maintaining his safety at times of the day. This was when the side and front door alarms were deactivated for operational reasons. Alarms were fitted to external doors including fire exits. A second resident exhibiting signs of possible dementia was being assessed at the time of the inspection visit. Risk assessments and protocols for the management of the needs of service users with a history of epilepsy appeared satisfactory. Their seizures were infrequent and clear records of these were maintained. Routine checks were made on all residents at set intervals throughout the night. Consideration could be given to installing intercom facilities in the bedrooms of these individuals as an additional safeguard, with their agreement. Croft (The) DS0000013619.V315860.R01.S.doc Version 5.2 Page 20 Records on care files demonstrated discussion with residents where possible and their family representatives, about the home’s policy for managing ageing, physical disability, terminal illness and death. A speech and language therapist assessment had been sought for a resident as part of the process for trying to establish his wishes in the event of his death. Final arrangements and wishes were recorded on residents’ files following consultation with residents where practicable, their relatives and representatives. The staff had cared for a resident throughout his long, debilitating illness until his death earlier this year. Staff appeared to have managed his death with sensitivity and had involved all residents in a church service to celebrate his life. The service described had been personal and meaningful to all whom new and loved this individual. Observations confirmed the home’s medication policy and procedures were satisfactory. Medication storage, recording and administration practices met requirements. A monitored dosage medication system was used and named staff had designated responsibility for administering medication. They had received certificated training through a college, which included practice assessment. A recent development was noted to be periodical further medication practice assessments for staff. Croft (The) DS0000013619.V315860.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards: 22, 23. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Observations confirmed the need for revision of the home’s internal abuse and whistle blowing procedures to ensure these are compatible with local multiagency safeguarding adults procedures. The complaint procedure appeared effective in its operation relating to complaints made on behalf of residents. EVIDENCE: The home had a copy of the revised multi agency safeguarding adults’ procedures and the adult protection toolkit supplied by Surrey County Council. The manager and provider had recently attended a one-day training event organised by Surrey Adult Protection Committee for managing, preventing and responding to abuse in regulated care settings. Standard 23 relating to safeguarding adults has not been inspected since May 2005. In August 2005 an allegation of abuse was received from a resident and investigated under multi-agency safeguarding adults procedures. This allegation was unsubstantiated. The initial response by the home to this allegation identified weaknesses in the operation of internal procedures. These had since been addressed by the home training with support from the home’s consultant. The induction and foundation training programme for new staff incorporated adult protection awareness. Close scrutiny of the home’s abuse and whistleblowing procedure on this occasion identified both were in need of revision to ensure compatibility with Surrey’s safeguarding adults procedures. Also Croft (The) DS0000013619.V315860.R01.S.doc Version 5.2 Page 22 discussed was the need to evidence that staff are informed of the home’s whistle blowing procedure when revised. It was good to note the information booklet displayed on a notice board near the entrance that had been produced in a format that was accessible to residents. This contained information for residents about their right to speaking up if they are unhappy and live without fear of abuse. Recruitment procedures were noted to ensure new staff taking up post prior to receipt of CRB Disclosures were checked against the POVA list. The provider acted as appointee for a number of residents. The manager described systems for safeguarding residents’ money. Each resident was allocated a lockable cash box and detailed records were maintained of income and expenditure for each resident. These were subject to random sampling and checks made on cash box balances by the management consultant who carried out the monthly statutory visits on behalf of the provider. The inspection did not include examination of financial records on this occasion. A complaint procedure had been produced for considering complaints made to the registered person by resident or person acting on a resident’s behalf. This was produced also in a pictorial format and a personal copy issued to each resident. It was noted that three of the five comment cards received from relatives/visitors stated they were unaware of the complaint procedure. Consideration could be given to drawing this to the attention of visitors. It is acknowledged however that all respondents stated that they had never had cause to make a complaint about the home. The complaint procedure included the stages and timescales for investigation. Discussion with the manager about independent advocacy as part of the complaint procedure confirmed past experience of difficulties in accessing advocacy services. The manager advised that effort would be made to do so if thought necessary. Record keeping did not identify any complaint made by residents since the last inspection. Discussions with management, staff and individual residents indicated staff dealt with complaints from residents informally, rectifying problems as they occurred. Complaint records for two interrelated complaints from a care manager evidenced an audit trail of the action taken to resolve the issues and concerns and the conclusion was clearly recorded. The outcome of two complaints from a neighbour however was not recorded and the available information indicated the complaint remained unresolved. The manager had acknowledged the complaint in writing but a resolution to the concerns was outside of her control. It was established that the provider was aware of the complaints but not known what action was proposed, if any. Croft (The) DS0000013619.V315860.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards: 24,29, 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home was clean and tidy and areas of the home recently refurbished and upgraded were overall of a good standard. A number of shortfalls however were identified with the premises and the home required to produce an improvement plan to demonstrate a planned maintenance and renewal programme to address deficiencies. EVIDENCE: The location of the home was considered suitable for its stated purpose; the home is accessible and had been recently extended and partially upgraded and refurbished. The new extension registered in 2005 afforded additional single bedroom accommodation within the home’s existing numbers. The upgrading programme had included provision of some new furniture, a platform lift, additional office accommodation and a wet room. Staff were noted to have improved the appearance of the wet room using tile transfers to make this area less clinical. It was stated by the manager that four residents sharing twin occupancy bedrooms did so through personal choice. Croft (The) DS0000013619.V315860.R01.S.doc Version 5.2 Page 24 Observations confirmed all areas of the home were clean and mostly tidy at the time of the inspection visit. Bedrooms were personalised reflecting the interests and tastes of their occupants. Residents had evidently also had a choice of colour schemes in their bedrooms. Bedrooms could be locked and some had been issued with keys to their bedroom doors. Staff were observed to respect the privacy of personal space in bedrooms, knocking on bedroom doors and waiting for a response and invitation to enter before opening doors. The lounges were comfortable, spacious and airy. A new wardrobe was on order for a resident. Comment has been made under standards 3 and 18 on adaptations and equipment in place and needed to maximise residents’ independence and meet individual needs. It was positive to note investment in fitting radiator covers throughout the home since the last inspection. Also to note the new development of a small furnished patio area accessible from a ground floor bedroom for the occupant’s sole use. Areas for attention and improvement included the need for assessment of the construction and state of repair of the roof. There was a recent history of recurrent leaks and arrangements then made with a local builder to carry out repairs. In the interest of safety it is important for management to take a more proactive response to roof maintenance. An improvement plan must be produced to address shortfalls in environmental standards. These include problems with the floor covering in the dining room creating an uneven surface that could pose a hazard for residents who have mobility difficulties. Worn and shabby carpets in corridors and on stairs need replacing. Consideration could be given to replacing these with carpet more suitable for people with dementia. It is essential for provision to be made of a safe and private area for residents to sit outside and enjoy the garden. There had been no progress since the last inspection on finishing work to a wheelchair accessible terrace and provide a safe, enclosed garden area. The timescale for meeting this requirement had been substantially exceeded without explanation. Work necessary to upgrade bathroom and toilet facilities remained outstanding. Malodour in some toilets and bathrooms was discussed with the manager. The manager agreed to ensure that a missing window restrictor in the corridor on the second floor was replaced as a matter of urgency the morning after the inspection visit. The floor covering in the utility room also needed to be replaced following a recent flood in this area caused by the washing machine door opening whilst the machine was in operation. Infection control procedures were underpinned by provision of hand washing facilities in bedrooms, bathrooms and toilets; also prominently sited in areas where infected material and/or clinical waste was handled. Soap dispensers and paper towels and dispensers were provided in communal toilets, bathrooms, the utility room and kitchen. Supplies of disposable aprons and gloves and antibacterial hand rubs were available in the home. The washing machine had a specified programming ability to meet disinfection standards. Croft (The) DS0000013619.V315860.R01.S.doc Version 5.2 Page 25 Pressure on car parking facilities on the day of the inspection resulted in the inspector having to park on the drive close to the gate for most of the morning. In the event of this being a frequent occurrence care needs to be taken in not blocking access for emergency vehicles. Consideration could be given to extending the care park at the front of the day centre. Croft (The) DS0000013619.V315860.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards: 32, 33, 34, 35 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Staffing levels were considered sufficient to meet the needs of residents and support the home’s stated purpose .The staff training programme ensure a competent workforce to meet residents needs. The staff - training programme needed to ensure that key workers and team coordinators were trained in person centred planning. Recruitment procedures were satisfactory and mostly followed. A shortfall in recruitment practice was drawn to the attention of the manager at the time of the inspection visit. EVIDENCE: Staffing levels had increased in accordance with requirements made at the time of the last inspection. At peak periods staffing levels during the waking day were mostly a minimum of eight support workers excluding the home manager, cleaner, cook and driver/maintenance person. Night staffing levels comprised of two waking staff and one on-call asleep on the premises. The manager retained discretion in setting staffing levels during non-peak periods based on the service needs and numbers and needs of residents present in the home. Staff rotas demonstrated some shortfalls in staffing levels when bank or agency cover staff could not be obtained to replace staff reporting sick at short notice. The home usually Croft (The) DS0000013619.V315860.R01.S.doc Version 5.2 Page 27 employed regular agency workers who were known to the residents and had some awareness of their needs. Since the last inspection four staff had resigned and one retired. Nine staff had been recruited, including two bank staff. Personnel files sampled mostly demonstrated statutory recruitment procedures were followed and statutory documentation obtained. A shortfalls in practice was identified however by the failure to obtain two written references and health declaration for an employee employed since the last inspection. There was also a need to have a photograph of this employee on his personnel record. The inspector also established a change in circumstances of this employee that could impact on the conditions of his work permit and had not been notified to management. . A system needs to be in place for identifying such changes in circumstances for employees. Consultation with a support worker about recruitment procedures confirmed residents were not involved in the recruitment process. A record of CRB Disclosures had been produced and this indicated that all staff had CRB Disclosures. It was noted that checks against the POVA list were now carried out for new staff before taking up post prior to receipt of CRB Disclosures. The need to review the content of the CRB record was discussed with the manager to ensure accuracy of dates of receipt of POVA checks and CRB Disclosure and to record the date that staff took up post. Records sampled evidenced that new staff received induction and foundation training. There was a rolling programme of training for the staff team to meet statutory training requirements and service specific training needs. There was also an ongoing programme of NVQ training. Areas of discussion with the manager included the new common induction standards for social care that have been required to be used since September 2006. Also the need for key workers and team coordinators to be trained in person centred planning. Croft (The) DS0000013619.V315860.R01.S.doc Version 5.2 Page 28 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standard: 37, 39, 40, 41, 42. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The manager and deputy manager communicated a clear sense of direction and leadership to staff. They managed the home as far as possible within their control, in the best interest of residents. Areas identified for improvement by managers included care planning, health and safety risk assessments and systems. Attention was necessary also to some policies and procedures and to recruitment practices. Whilst acknowledging that had been some investment in the premises since the last inspection there remained significant shortfalls in standards relating to the environment. EVIDENCE: The manager is registered by the Commission for Social Care Inspection and is suitably experienced and qualified to manage the home. The manager had attained NVQ qualifications in care up to level 4 and is an NVQ assessor. She Croft (The) DS0000013619.V315860.R01.S.doc Version 5.2 Page 29 also has achieved the registered managers award. The management team comprised of the provider, manager, deputy manager, and senior team coordinator and team coordinator who had clearly defined individual roles and responsibilities. The provider was stated to regularly visit the home, usually at least once a week and was responsible for business and financial planning for the home, budget monitoring and financial control. Arrangements were in place for the home manager to receive support from a specialist consultancy service. The home’s consultant had made an important contribution to the home’s development and modernisation of practice and management over recent years. The consultant had delegated responsibility for carrying out comprehensive statutory visits each month on behalf of the provider; also for generating a detailed written report of the outcomes of these visits. Record keeping at the home was mostly satisfactory, files were well organised and with the exception of some care plans, mostly up to date. Delays in implementing new person centred plans was noted to be due to the reliance on managers for producing and updating care plans which was not manageable within the management time allocated. Responsibilities for care planning need to be devolved to key workers under the supervision of team coordinators. Managers confirmed that long term it was the intention to delegate this task however before this could take place a programme of person centred careplanning training for the team was required. Discussions at the time of the inspection visit included the need to strengthen support to the management team to enable more management hours to be spent on care planning. Consideration could be given to recruiting an administrator to provide clerical support that could relieve managers of some administrative duties that are time consuming. An example of this is the book keeping responsibilities relating to expenditure of residents’ personal money that is a major workload for managers in this large home. Based on information provided by the home the policies and procedures were all reviewed in September 2006. Observations during the inspection visit identified amendments necessary to the home’s abuse and whistle blowing procedures. It was positive to note investment in the safety of the environment since the last inspection. Radiators covers had been fitted throughout the home in the last twelve months. Team coordinators were responsible for health and safety checks. Discussions with the manager included a need to review the frequency of these checks based on observations of hazards found in the environment at the time of monthly statutory visits. Also direct observation by the inspector of a missing window restrictor on a second floor corridor window that had not been reported by staff. The manager agreed to ensure additional risk management measures were implemented immediately this was drawn to her attention until the window restrictor could be replaced the following day. Croft (The) DS0000013619.V315860.R01.S.doc Version 5.2 Page 30 The importance of carrying out regular risk assessments for all residents using the side door access from the dining room on route to boarding transport, to the day centre or when sitting outside on garden furniture in this area. It was noted that this is accessible to cars and the inspector was informed that the speed restriction of 5 miles per hour is not always adhered to. Serious consideration should be given to restricting car access in this area. This safeguard was advised in recognition of the increasing vulnerability and frailty of residents due to the ageing process, mobility and sensory problems. It was of concern that action had not been taking in response to an environmental hazard identified by the home’s systems. Specifically the need to make safe or replace the hazardous floor covering in the dining room. There is also an outstanding requirement to make provision of a safe and suitable external area for residents to have access to a garden. Croft (The) DS0000013619.V315860.R01.S.doc Version 5.2 Page 31 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 3 2 3 3 2 4 3 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 1 25 x 26 x 27 x 28 x 29 2 30 2 STAFFING Standard No Score 31 x 32 3 33 3 34 2 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 2 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 3 3 3 x x 2 2 1 x Croft (The) DS0000013619.V315860.R01.S.doc Version 5.2 Page 32 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 YA3 YA6 YA9 YA18 YA24 YA29 YA42 YA3 YA9 YA24 YA24 Regulation 12(1)(a), 13(4)(c), 16(2)(c) 23(2)(n) Requirement Timescale for action 30/11/06 2. 12(1), 13(4), 23(2)(b)(o) 3 YA3 YA9 YA24 YA42 12(1) 13(4)(b)(c) 4 YA6 YA35 15(1)(2) For the registered persons to arrange for a professional assessment of the mobility needs of a named resident and if necessary fit handrails in corridors and any other areas to meet the assessed needs of this individual. For the registered persons to 31/03/07 ensure completion of work to provide residents with an accessible, safe and secure outside terraced area. The timescale for completion of this work by 07/03/06 has been exceeded. For the registered persons to 23/10/06 carryout risk assessments for the safe use by residents of the area outside the side door off the dining room, which is accessible to cars and other vehicles. Where risks are identified appropriate action must be carried out to safeguard residents from harm. For the registered person to 12/01/07 ensure person centred care planning is in place and care DS0000013619.V315860.R01.S.doc Version 5.2 Croft (The) Page 33 5 YA23 YA40 6. YA24 7. YA24 YA42 8 YA24 9 YA24 YA42 10 YA24 plans are maintained up to date. There is a need to implement a programme of staff training in care planning if it is the intention to delegate care-planning responsibilities to key workers. 13(6) For the registered persons to ensure revision of the home’s abuse procedure and whistle blowing procedure and to ensure staff are informed of the changes and have access to both revised documents. 23(2b) For the registered persons to upgrade and redecorate bathrooms and toilets in the original building as necessary and replace worn and malodorous floor coverings in these areas. 23(2)(b) For the registered persons to be proactive in ensuring the safety of the construction and state of repair of the roof. This needs to be properly assessed by a suitably competent person and work carried out if necessary to prevent further occurrences of flood damage and risk of the roof collapsing. 23(2)(d) For the registered persons to make good the decoration of rooms that have been water damaged at the time of recurrent leaks in the roof. 12(1) For the registered persons to 13(4)(a)(b)(c) arrange for remedial work to 23(2)(b) be carried out to the floor covering in the dining room which is hazardous to residents with mobility problems or replacement of the same. 23(2)(b) For the registered persons to institute a programme with DS0000013619.V315860.R01.S.doc 30/11/06 12/01/07 30/11/06 12/12/06 30/11/06 12/01/07 Croft (The) Version 5.2 Page 34 11 12 YA24 YA34 13 YA42 14 YA42 timescales for replacing worn and shabby carpets on stairs and corridors. 23(2) For the registered persons to provide suitable floor covering in the utility room. 19 Sch2 3, 8. For the registered persons to ensure recruitment practice is in accordance with the home’s procedures and statutory requirements for two references to be obtained for all employees and statement from prospective employees as to their mental and physical fitness. 12(1) For the registered persons to 13(4)(a)(b)(c) ensure the missing window 23(2)(b) restrictor on the corridor window on the second floor .is replaced. Adequate risk management measures must be implemented until this work is carried out to ensure the safety of residents. 12(1) For the registered persons to 13(4)(a)(b)(c) review the home’s systems 23(2)(b) for monitoring health and safety environmental risks and frequency of carrying out these checks to ensure these are sufficiently robust. 12/01/07 13/10/06 13/10/06 17/11/06 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 YA3 Good Practice Recommendations For the registered persons to make arrangements for additional visual communication aids to be developed to enable residents to actively participate in person centred planning of their care and review meetings. For the registered persons to consider use of monitors in DS0000013619.V315860.R01.S.doc Version 5.2 Page 35 2 YA19 Croft (The) YA42 3 YA24 YA42 4 YA22 5 YA22 6 YA34 7 8 YA34 YA37 bedrooms at night for residents liable to have nocturnal seizures as an additional safeguard. This should be with the agreement of these individuals and in consultation with relevant professionals and their representatives. For the registered persons to review the adequacy of current car parking facilities to ensure sufficient to meet the needs of the home and day centre without risk of cars parked on the drive close to the gate obstructing access by emergency vehicles. For the registered persons to respond to all complaints in a professional way, taking into account and concerns of neighbours in an effort to maintain positive relationships with the local community. For the registered persons to consider reissuing copies of the home’s complaint procedure to all relatives/representatives of residents to ensure they are aware of how to make a complaint. For the registered persons to ensure there is a system for identifying changes in staff’s circumstances, which may impact on home office work permits. As a suggestion, responsibility for notifying management of these changes could be included in staff’s employment terms and conditions. For the registered persons to consider further ways for involving residents in staff recruitment processes. For the registered persons to consider recruiting an administrator to support managers with clerical and bookkeeping responsibilities. This would alleviate pressure on management time which would assist managers in allocating more time to care planning until such time as team coordinators and key workers are trained to be delegated care planning responsibilities. Croft (The) DS0000013619.V315860.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Surrey Area Office The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN 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) DS0000013619.V315860.R01.S.doc Version 5.2 Page 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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