Inspection on 18/04/07 for The Croft

This inspection was carried out on 18th April 2007.

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

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

Other inspections for this house

The Croft 21/11/05

The Croft 13/07/05

The Croft 01/12/04

The Croft 01/07/04

The Croft 14/01/04

The Croft 21/07/03

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

CARE HOMES FOR OLDER PEOPLE The Croft 94 Irby Road Heswall Wirral CH61 6XG Lead Inspector Inger Moynihan Key Unannounced Inspection 18th April 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Croft DS0000018944.V332943.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Croft DS0000018944.V332943.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Croft Address 94 Irby Road Heswall Wirral CH61 6XG 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) 0151 342 7004 Abbeyfield Heswall Society Limited Miss Anita Sharon Pickin Care Home 8 Category(ies) of Old age, not falling within any other category registration, with number (8) of places The Croft DS0000018944.V332943.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st November 2005 Brief Description of the Service: The Croft is a single storey building owned by The Abbeyfield Heswall Society. Service users bedrooms are large and are single occupancy. The communal rooms comprise of a lounge/dining room with a conservatory leading off this area. The bathing facilities comprise of a walk in shower and a special bath. The home is set back from the main road so providing a quiet environment for service users to live. The gardens are mature and comprise of lawns and shaded areas for service users to sit. There is parking space for about six cars within the grounds of the home. The home is situated in a quiet residential area on a bus route to local shops. Heswall town centre, which has a good selection of shops, banks and restaurants, is within a ten-minute drive of the home. The bus station in Heswall gives easy access to Liverpool and other parts of the Wirral. The Croft DS0000018944.V332943.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Information about The Croft was obtained through a pre-inspection questionnaire and examination of the homes policies and procedures and supporting documentation. Discussion took place with the Registered Manager and members of the staff team and service users. A tour of the building also took place. Prior to the inspection CSCI questionnaires were sent to a number of service users and healthcare professionals. Information from these questionnaires is included in the report and contributes to any judgements made. Fees - £331.00 per week What the service does well: Service users care needs are met and they have access to a range of health care professionals to ensure they maintain good health. The service users spoken to during the visit said they are satisfied with the care they receive. One service user said I always get to see my GP when I need to, the staff are very good when it comes to things like that. Another service user said the staff of very kind, homely and helpful. I really couldnt find a better home. Another service user said the manager is excellent she is ideal for this type of work. This information was also stated in the four service user questionnaires returned to the CSCI. One questionnaire recorded an excellent home; another questionnaire recorded a very happy home. All of the service users spoken to during the visit said they had no complaints to make. The homes routines and activities are flexible and varied and a range of social activities is provided to ensure service users stimulation and social interaction. One service user said the amount of activities suit me. Im happy to mix with other people but I also like to spend time on my own. A varied and nutritious diet is provided to ensure service users interest and good health. One service users said the food is very good and I always get plenty to eat. Another service user said nothing is ever any trouble for the staff when it comes to the food, if I dont like whats on the menu they will give me an alternative. Systems are in place to ensure service users are protected from abuse. The service users spoke highly of the staff saying they are all extremely kind, friendly and polite. One service user reported you couldnt get better staff they are all very kind. The Croft DS0000018944.V332943.R01.S.doc Version 5.2 Page 6 The standard of the decor at The Croft remains very high and provides a comfortable and pleasant environment for service users to live. The recruitment procedures ensure suitably qualified and competent staff are employed to work at the home. The staffing levels provided ensure service users receive the care and support they need. The health, safety and welfare of the service users are promoted throughout the home. What has improved since the last inspection? 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. The Croft DS0000018944.V332943.R01.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 The Croft DS0000018944.V332943.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are only provided with a service after their needs are assessed and they have been assured these needs will be met. EVIDENCE: An assessment of service users care needs is carried out to ensure the staff are able to support the service users in accordance with their particular needs. The service users spoken to said their individual care needs are fully met. Intermediate care is not provided at The Croft. The Croft DS0000018944.V332943.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. More detailed information needs to be recorded in service users care plans to ensure staff have all the information they need on how to monitor service users daily welfare. Service users have access to a range of health care professionals to ensure they maintain good health. Improvements need to be made to the medication administration procedures to ensure service users safety and good health. The arrangements for health and personal care ensure service users privacy and dignity are respected at all times. The Croft DS0000018944.V332943.R01.S.doc Version 5.2 Page 10 EVIDENCE: The service users spoken to during the visit confirmed their needs are fully met and they are satisfied with the care they receive. They confirmed the staff always treats them with respect and their privacy and dignity is always upheld; particularly when being helped with their personal care. One service user said the staff of very kind, homely and helpful. I really couldnt find a better home. Another service user said the manager is excellent she is ideal for this type of work. The service users spoken to during the visit said the staff always call their GP when they want and they saw their chiropodist, dentist and optician on a regular basis. One service user said I always get to see my GP when I need to, the staff are always very good when it comes to things like that. This information was further confirmed in the four service user questionnaires returned to the CSCI. One questionnaire recorded an excellent home; another questionnaire recorded a very happy home. Two health care professional questionnaires were returned to the CSCI. They both indicated the service users are well cared for and they are satisfied with the overall care provided at the home. One GP had noted The Croft is an excellent home. A record of care provided to each service user is in place and provides staff with information on how to look after the service users in accordance with their individual care needs. While it is acknowledged the care provided to service users is certainly of a high standard, the Registered Manager must ensure more detailed information is recorded in all aspects of a service users care plan, including risk assessments, to ensure staff can accurately monitor their daily welfare and safety. For the most part the systems in place for the administration of service users medication are good. The supplying pharmacist has recently inspected the home and it was reported that no issues or concerns were raised. All of the service users spoken to during the visit confirmed they receive their medication as prescribed by their GP. Appropriate medication storage facilities are in place and all staff have been provided with training in this area of care provision. During this visit the following issues of concern arose. • • Medication risk assessments did not hold sufficient information. A hand written note had been attached to one medication that gave instruction to a family member of the circumstances under which this medication should be given. This was despite there being no The Croft DS0000018944.V332943.R01.S.doc Version 5.2 Page 11 • • corresponding directive from the service users GP and this medication no longer being prescribed. A copy of the medication administration record policy and procedure was not available in the medication storage room. It was recorded on a medication administration record sheet that prescribed soluble medication requires no water. The Registered Manager confirmed this directive was given some years ago and there was no documentary evidence to demonstrate this directive had been reviewed. Not following good medication administration procedures may lead to service users being left vulnerable to the risk of harm and not receiving their medication as prescribed by their GP. In the light of this, the Registered Person must ensure staff follow the homes medication procedures properly to ensure the safety and welfare of the service users. Concerns have been raised in the past about the way medication is managed in the home. While it is acknowledged that staff have already completed training in this are, in the light of the concerns raised, the Registered Person must provide staff with additional training and ensure they are competent to take on this responsibility. The Croft DS0000018944.V332943.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The homes routines and activities are flexible and varied to ensure service users individual preferences are catered for. A varied and nutritious diet is provided to ensure service users interest and good health. EVIDENCE: A number of social activities take place during the week to ensure service users stimulation and social interaction. The service users spoken to confirmed they enjoy the activities and acknowledged the staff respect their decision not to join in. One service user said the amount of activities suit me. Im happy to mix with other people but I also like to spend time on my own. The service users confirmed they can go about their day as they wish and their visitors are welcome at any time. General information about advocates and other agencies who support older people is available to service users and their carers. Service users had The Croft DS0000018944.V332943.R01.S.doc Version 5.2 Page 13 personalised their bedrooms with their own possessions, which gave the rooms a homely and comfortable feel. Service users confirmed they enjoy the meals and always have plenty to eat and drink. One service users said the food is very good and I always get plenty to eat. Another service user said nothing is ever any trouble for the staff when it comes to the food, if I dont like whats on the menu they will give me an alternative. A varied menu is in place which the service users confirmed always offers a choice. Homemade meals are provided and birthdays are always celebrated. Mealtimes are relaxed and informal. Service users are encouraged to have their meals in the dining room although they may eat in their rooms if they wish. Staff are aware of the service users dietary care needs and ensure their individual preferences are catered for. While information around their dietary needs is gathered and recorded when they first move into the home, the Registered Manager must ensure more detailed information is recorded to ensure staff can monitor service users daily welfare and to ensure their medical needs are met. The Croft DS0000018944.V332943.R01.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. 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 this service. Service users are aware of whom to contact if they wish to make a complaint. Systems are in place to ensure service users are protected from abuse. EVIDENCE: The service users said they are satisfied with the care they receive and have no complaints to make. They confirmed they knew who to contact if they were unhappy about any care practices. A copy of the homes complaint procedure is displayed and the staff spoken to were aware of the action they should take in the event of them receiving a complaint. The pre-inspection questionnaire indicated that 2 complaints had been made in the last 12 months. These complaints had been investigated and dealt with appropriately. The Registered Manager must ensure a detailed record of any complaint investigation is kept. All staff are trained on how to protect service users from abuse and harm and during discussion they demonstrated a basic understanding of the different types of abuse that can occur. The service users spoken to during the visit spoke highly of the staff saying they were all extremely kind, friendly and polite. One service user said you couldnt get better staff they are all very kind. The telephone number of the organisation Action on Elder Abuse is given to service users and staff so they can report any concerns about the home anonymously. While the Registered Manager is aware of her The Croft DS0000018944.V332943.R01.S.doc Version 5.2 Page 15 responsibilities with regard to service users protection, she was not entirely clear on the Wirral adult protection procedures. To ensure allegations of abuse are managed correctly, the Registered Manager must familiarise herself with this procedure. The Croft DS0000018944.V332943.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The standard of the decor at The Croft remains very high and provides a comfortable and pleasant environment for service users to live. EVIDENCE: The standard of furnishing throughout the home remains very high and the grounds are well kept. There is a programme of refurbishment in place to ensure this standard is maintained. There was only a trickle of hot water to one of the bathrooms and two of the toilets. The Registered Person must ensure this issue is addressed to maintain good standards of hygiene and to ensure the staff can carry on with their work properly. The Croft DS0000018944.V332943.R01.S.doc Version 5.2 Page 17 An efficient cleaning schedule is in place and on the day of the visit the home was clean and tidy throughout. Sufficient laundry facilities are in place along with systems to prevent cross infection. The Croft DS0000018944.V332943.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staffing levels ensure service users receive the care and support they need. Staff are provided with a range of training to ensure the service users are cared for appropriately. The recruitment procedures ensure suitably qualified and competent staff are employed to work at the home. EVIDENCE: Staff are provided with a range of appropriate training to ensure they know how to look after the service users in accordance with good practice. The Registered Manager acknowledged she needs to develop the training programme for the forthcoming year. Since the last inspection all staff have completed training in relation to equality and diversity which ensures they have an understanding of issues relating to service users age, disability, gender, race, religion or belief and sexuality. Plans are being made for a number of new staff to be employed at the home. While all staff are provided with induction training when they are first employed, the Registered Person must ensure this training programme is in The Croft DS0000018944.V332943.R01.S.doc Version 5.2 Page 19 line with Skills for Care which is the recognised training programme for staff working in a care home. This will ensure staff have information on how to look after the service users which is in line with current good practice. The recruitment procedure used by the home ensures suitably qualified and competent staff are employed. The Registered Manager agreed to ensure that the issue of equality and diversity is explicitly addressed during the staff recruitment procedures to ensure she can assess an applicants understanding of this issue. The staff spoken to during the visit confirmed they enjoy their work and are well supported in their role. They confirmed they meet regularly with the Registered Manager to discuss their development in their role. They confirmed the Registered Manager is always available to support and advice. The Croft DS0000018944.V332943.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 35 37 38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Some changes need to be made to the management systems to ensure the effective and efficient running of the home. Service users take responsibility for the management of their own financial affaires. The policies and procedures must be streamlined to ensure staff are clear on their responsibilities with regard to the care of the service users and the running of the home The health, safety and welfare of the service users are promoted throughout the home. The Croft DS0000018944.V332943.R01.S.doc Version 5.2 Page 21 EVIDENCE: The Registered Manager is qualified and experienced to run the home. She has introduced systems to ensure the ongoing monitoring and improvement of the standard of care. While it is clear that the service users living at The Croft are well cared for, some changes need to be made to the management systems to ensure the issues raised in this report are addressed. Service users handle their own financial affairs. The Registered Manager holds money for one service user; all records and receipts were accurately maintained. Three policy and procedure files are in place; one compiled by the Registered Manager and two issued by the Abbeyfield head office in London. Holding policies and procedures from different sources may lead to confusion amongst the staff as to exactly how specific situations should be managed. In light of this situation, the Registered Person must streamline this information so staff are clear on exactly which policy or procedure they should follow in different circumstances. The health, safety and welfare of service users and staff are promoted through the provision of policies and procedures and regular staff training. The pre inspection questionnaire indicated that regular health and safety checks are carried out around the building. Supporting documentation is in place to confirm this information. The Croft DS0000018944.V332943.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 4 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 4 x x x x x x 4 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x 2 4 The Croft DS0000018944.V332943.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement The Registered Person is required to ensure more detailed information about service users general welfare and safety is recorded in their care plan. The Registered Person is required to ensure staff follow the homes medication administration procedures. The Registered Person is required to ensure the Registered Manager is familiar with the Wirral adult protection procedure. The Registered Person is required to ensure there is always a full supply of hot water in the identified bathroom and toilets. The Registered Person is required to ensure the homes policies and procedures are streamlined to ensure staff are clear on their responsibilities with regard to the running of the home and the care of the service users. Timescale for action 01/06/07 2 OP9 13 01/06/07 3 OP18 13 01/06/07 4 OP19 23 18/06/07 5 OP37 12 18/07/07 The Croft DS0000018944.V332943.R01.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. Refer to Standard Good Practice Recommendations The Croft DS0000018944.V332943.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS 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 The Croft DS0000018944.V332943.R01.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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!