Inspection on 19/04/06 for The Croft

This inspection was carried out on 19th April 2006.

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

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

Other inspections for this house

The Croft 12/01/09

The Croft 14/01/08

The Croft 27/11/06

The Croft 27/01/06

The Croft 26/07/05

The Croft 07/03/05

The Croft 16/09/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE The Croft Barracks Road Bickershaw Wigan Greater Manchester WN2 5PR Lead Inspector Lindsey Withers Pharmacy Inspection Stephanie West Key Unannounced Inspection 19th April 2006 08:15 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 DS0000038461.V288635.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Croft DS0000038461.V288635.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Croft Address Barracks Road Bickershaw Wigan Greater Manchester WN2 5PR 01942 867186 01942 867386 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Kevin Harper Charlene Chapman Care Home 23 Category(ies) of Dementia - over 65 years of age (17), Old age, registration, with number not falling within any other category (23), of places Physical disability over 65 years of age (4) The Croft DS0000038461.V288635.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 23 service users to include: up to 23 service users in the category of OP (Older People) up to 4 service users in the category of PD(E) (Adults with Physical Disabilities over 65 years) up to 17 service users in the category of DE(E) (Adults with Dementia over 65 years) The service should employ a suitably qualified and experienced Manager who is registered with the CSCI. The Registered Manager must be supernummary and not included in the staff to service user ratio. Sufficient staff must be on duty at all times who are trained and competent to meet the needs of service users, taking account of changing dependency levels and special needs. 27th January 2006 2. 3. Date of last inspection Brief Description of the Service: The Croft Care Home is located in semi-rural surroundings just off the main road through the village of Bickershaw, and provides residential care and accommodation for up to 24 male and female service users of retirement age. The Homes registration permits the Home to accommodate up to four service users with a physical disability and 17 with a diagnosis of dementia. Nursing care is not provided at this Home. At the time of this report, the scale of fees for this home is from £290.75 to £340. The fees include all costs with the exception of hairdressing, for which the visiting hairdresser makes a small charge. The Croft DS0000038461.V288635.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of this inspection was to look at the main “key” standards in order to assess the level to which The Croft meets the needs and expectations of residents. Part of this inspection involved unannounced site visits to the home on 19th April from 8.15 a.m. to 4 p.m., 20th April from 8.20 a.m. to 1.30 p.m. and 28th April from 8 – 9.30 p.m. In order to get a wider view of life at The Croft, as well as speaking to residents and staff at the home, the Inspector spoke to relatives and to health and social care professionals. Part of the time was spent looking at the paperwork that the home needs to keep to show that it is being run and managed properly. The Pharmacy Inspector (a CSCI Inspector who is a qualified pharmacist) made her own assessment of the systems in place that relate to medication. Her comments are included in this report at Standard 9. In making the judgements contained in this report, the Inspector has also considered: other visits that were made to the home; regulatory processes that have taken place, such as variations to registration (for example, increasing the number of beds available to people with dementia); information passed to CSCI from other sources, such as local Councils. CSCI had provided copies of comments cards for interested people to complete, and a total of 17 were returned. The home had not provided the right comment card to visitors in all instances. Therefore, the information received by CSCI was not as helpful as it might have been. What the service does well: What has improved since the last inspection? Since the last inspection, some cosmetic improvements have been made to the environment, including re-varnishing of the dining tables, and some painting and decorating. The group activities programme has been extended so that it runs throughout the day and occasionally into the evening. The Croft DS0000038461.V288635.R01.S.doc Version 5.1 Page 6 Residents were happier now that a new cook was in post, because her cooking was “better than the last cook”. What they could do better: This inspection showed that the service provided by the home has deteriorated in quality in a number of areas. These are discussed within the body of this report but include: • • • • • • • • • • • • • assessing the needs of prospective residents meeting residents’ needs planning and reviewing residents’ care dealing with residents’ medication making sure residents’ are treated with privacy and dignity planning activities for individual residents helping residents to maintain control over their lives making sure vulnerable adults are kept safe maintaining clean premises maintaining good ventilation and temperatures in areas used by residents making sure sufficient staff are on duty who can do their jobs properly lack of thorough checks on the service by its owner recording of accidents Dates for improvement had been set at the last inspection in relation to assessing the needs of prospective residents, dealing with medication, and planning activities for individual residents, none of which had not been met. New timescales have been set within this report. Nine best practice recommendations have been made, which also relate to the areas listed above, and which the home is expected to consider, in order to provide residents with a better standard of care. Visiting professionals were critical of the care being provided at the home. In comment cards, they said that staff were “very often” or “usually” in the smoke room, hand “limited knowledge” of medication, and that “care directions were not often followed”. The home will need to provide a plan to the CSCI showing how it will make improvements. CSCI will use this plan to monitor improvements made by the home, so that the quality of the service gets better. Please contact the provider for advice of actions taken in response to this The Croft DS0000038461.V288635.R01.S.doc Version 5.1 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Croft DS0000038461.V288635.R01.S.doc Version 5.1 Page 8 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 DS0000038461.V288635.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 4. Standard 6 is not appropriate to this home. Quality in this outcome area is poor. This judgement has been made using available evidence, including visits to this service. Prospective residents cannot be sure that their needs will be thoroughly assessed or that they can be fully met by the home. This is particularly so for those residents with special needs, because the Manager and staff lack the relevant training and knowledge. EVIDENCE: The pre-admission assessment forms for three people were looked at to check whether the process had been thorough. One, for a person with dementia, was satisfactory. It included enough information to form a reasonable idea of the person’s needs. Two were not satisfactory. Both assessments had recorded the special needs of each person in a brief way. One resident had been admitted with a diagnosis of dementia. The family and social worker did not think this was correct. The home could not provide satisfactory information to confirm that the entry was correct. A piece of significant information relating to one of the residents had been largely disregarded from the care planning process. The Manager had not taken into account the fact The Croft DS0000038461.V288635.R01.S.doc Version 5.1 Page 10 that neither she nor her staff had the training or experience in providing care to people with these special needs. Neither resident wished to remain at the home. The Manager said that she was not under pressure from the owner to fill beds but the fact that people have been inappropriately admitted casts doubt on her statement. Pre-admission assessments had been highlighted in the last report as an area for improvement. The deadline for improvement had not been met. During observations, staff could not demonstrate that they fully understood the needs of the residents or that they could identify the triggers that might change or affect a person’s behaviour. They were unable to think of ways to deflect situations other than to offer a cup of tea, a sit down, or a walk (inside the home). One relative said that she had been called to the home because staff said they were unable to “manage” her relative. In a comment cards to the CSCI, a health professional wrote that, “staff never seem to know about their patients’ problems”. One relative said the assessment and admission process had, in her opinion, been satisfactory. Another said that The Croft had been recommended and that they had waited for a place to become available. One relative wrote that despite reservations about the surroundings, the resident “appears happy and settled”. The Croft DS0000038461.V288635.R01.S.doc Version 5.1 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is poor. This judgement has been made using available evidence, including visits to this service. Care plans do not demonstrate consistently that each resident’s health, personal and social care needs are based on a thorough assessment and review, or that the resident or their representative is involved. Elements have been missed from care plans, some of which would be significant in ensuring the resident enjoys good health and that their welfare is maintained. Systems are in place to facilitate the safe handling of medicines, but are still not managed well enough to ensure residents’ medication is handled properly. In the main, residents are treated with respect, though this is variable across the staff group. Several areas for improvement were identified in relation to the privacy of residents, which is sometimes compromised. EVIDENCE: The Croft DS0000038461.V288635.R01.S.doc Version 5.1 Page 12 Initially three resident’s files were looked at as part of the case-tracking exercise, then a further two as a result of matters arising during the inspection. The first impression of the documents was that they were – for the most part – untidy and poorly maintained. It was not easy to read through the paperwork and get a clear impression of the person’s care and the method used to determine that care. Some essential elements of care planning were missed, for example, continence management for one resident. The language used was sometimes disrespectful to residents, for example, one person was described by the Manager in a mental health assessment as “naughty with other residents”. As residents and their relatives are entitled to read care plans, staff must take care to be respectful when writing in the records. The Manager acknowledged that she found it difficult to distinguish between the aim of each element of the plan of care, and the method to be used to bring about that aim. This lack of basic information, therefore, compromises the care being provided to residents. The majority of files had been reviewed but there was no evidence to show how the review had been done. Some changes, identified by the Inspector from conversations and from looking at other paperwork – such as the communication diary and accident reports - had not been recorded in the care plan. The documentation, as it is used by The Croft, was discussed with the Manager, who agreed that setting out the information differently would allow for reviews to be recorded better. Two out of three care staff spoken to during this inspection said they would look at the care plan to find out how to care for a resident. Both said they would also ask the resident as they thought communicating well with residents was “very important” in making sure their needs were met. Two relatives said they had not been involved in the planning process in terms of the care to be provided, but would like to be. However, the records showed that some relatives had written a brief social history of the resident. There was evidence to show that residents were helped to maintain their capacity to self-care. Staff said some residents needed the minimum of help, and that prompts or encouragement to carry out a task were sufficient. Some residents said staff helped them to wash, bathe and use the toilet. Observation of practice showed that staff were occasionally unable to ensure that good personal hygiene was maintained, particularly in those residents with dementia. Staff described the strategies they would use to encourage a resident to wash and have a change of clothes. This sometimes involved changing a resident in the snooze room or another resident’s room, as the Manager said, “.. to prevent a scene and to make the resident comfortable”. The Croft DS0000038461.V288635.R01.S.doc Version 5.1 Page 13 However, this action does not promote the privacy of the individual resident (as the snooze room is a communal room) or that of other residents (when their bedroom is used). The Manager was advised not to follow this practice but to guide the resident to their private room or a bathroom. There was evidence in care plans to show that residents had had access to specialist health care, such as District Nurse, Continence Adviser, physiotherapist, GP, etc. according to their needs. Three health professionals provided their written comments to the CSCI: all expressed dissatisfaction with the quality of care provided to residents at the home. The chiropodist visited on the second day of this inspection, and a social worker called to speak to a resident. Two residents went to hospital for routine appointments, each accompanied by a member of staff. Two of the five residents spoken to had a clear understanding of the care that they needed. One resident identified gaps in the plan of care that had been discussed with the Manager, but that were still outstanding. The manager is taking steps to improve the handling of medication within the home, but in some areas it remains poor. A complete list of current medication is not available for all residents and the application of prescribed external preparation (creams) is poorly recorded, putting residents at risk of not receiving their medication as prescribed. The pharmacy labels were missing from some of the prescribed creams increasing the risk that they may be used incorrectly. Good practice was observed in the management of the morning medication round but on the inspection day the time between the medication rounds was too short. There is a risk that some residents may be given their medicines too close together. Residents were supported to take their medication and records were completed before beginning administration to another resident. One resident self-administers his own inhaler and cream. The residents wish to self-administer is recorded but is not supported by written assessment of safe self-administration, or details of how this is supported by care staff. The dates on which new supplies of the medication are given to the resident are not recorded. The home need to keep a record of medicines received into the home this was correctly completed for medicines in traditional containers, but the quantity was missing from records of medicines in the monitored dosage system. A health professional wrote in a comment card regarding medication that, “staff have limited knowledge for use”. Too much information is being recorded in the communication diary, which should be written directly into the care plan. This had been introduced, the Manager said, “for the weekend staff” and had come about following a staff meeting. This suggests (1) that the handover between shifts is not thorough enough, and (2) that weekend staff do not read care plans. Because detailed The Croft DS0000038461.V288635.R01.S.doc Version 5.1 Page 14 and confidential information is written down about several residents in the one place, the privacy of each named person is compromised. The chiropody treatment for residents was administered from the dining room off the main reception area. The dining room was cleaned after being used by the chiropodist, but the lunch-time serving was delayed considerably on that day. Because of the location of the room used for chiropody treatment, residents - some in stages of undress – without socks, stockings or shoes, waited in line for treatment in the main reception area. Visitors to the home would be met by this scene, which is not appropriate as the privacy and dignity of residents is compromised. Staff said that residents were able to say who helped them to wash, bathe and go to the toilet, and staff accepted the resident’s wish. One resident said that she felt able to ask for certain staff to help her. On both days of this inspection, one resident was seen to make a call to his family, helped by a carer. His relative told the Inspector that staff knew the time when it was convenient for the resident to ring her. The Croft DS0000038461.V288635.R01.S.doc Version 5.1 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence, including visits to this service. Group activity planning has improved, but focus on activity and occupation at an individual level – particularly for those residents with dementia - has yet to be achieved. Residents are helped to maintain contact with people and places outside of the home. The Manager and the staff team are not always clear about when a person is exercising choice and control, and this area of care is not given any importance in the care plan. Residents can be assured that they will be provided with food that is of good quality, that is cooked well, and which is served in sufficient quantity. The home must provide the necessary cutlery and crockery to allow residents to eat independently for as long as they wish. EVIDENCE: The Croft DS0000038461.V288635.R01.S.doc Version 5.1 Page 16 The week’s activities programme was displayed in the main reception area, split into morning, afternoon, and occasional evening events. Residents said they liked the music and entertainers. The Inspector watched residents enjoy a game of hoops, when reluctant residents were encouraged by the care worker to join in and have some exercise and fun. One resident is still enjoying working in the garden, which he said keeps him occupied and in the fresh air. Other residents were seen to be taking a walk around the garden at different times. Music was playing on both days of the inspection - all types and all eras. Residents were seen to be listening and responding. One care worker has taken some of the responsibility for organising activities, and discussions have taken place with the Manager to introduce more activities in the evening. A “completed activities” sheet is being introduced to assess effectiveness and enjoyment of each activity. However, activities tend to be offered on a group basis, and a number of residents preferred not to join in. The social history sheets (contained in the care plans that were looked at) offered enough information on a person’s past lifestyle, hobbies and interests, for individual activities to be devised. The Manager agreed that activities needed to be more tailored to the individual residents in order to reduce inactivity, wandering, and lack of occupation. Two out of three staff said activities were improving but that they could be better. The Manager said that, “We could do a lot more”. Staff said that there were not a “huge” number of residents to the home, but that most residents had someone who called to see them. Most visitors call at the weekend. Two relatives said they were satisfied with the visiting arrangements. The Manager said she was aware that some residents wished to see a priest or a vicar (which is recorded in the care plan), but that she was having difficulty in making arrangements for members of the clergy to visit. Having tried telephoning, she said she would now write with her request in the hope that this would have more impact. Some residents were clear about how they wanted to spend their time, and were able to express their wishes. This might be what time they get up or go to bed, or whether they wanted to take their medication just at that time. One resident has expressed a wish to get changed into his nightwear directly after his evening meal. This is not recorded in his care plan but was discussed with the Manager, who agreed that this may be one of the few areas of his life over which the resident maintains some control. She accepted that it would be important, therefore, to ensure his wishes were adhered to. For other residents, the extent of true control was impeded by dementia and two The Croft DS0000038461.V288635.R01.S.doc Version 5.1 Page 17 members of staff said they were not sure that residents had as much control over their lives as they could have. There had been a change of cook at the time of this inspection. One resident said the previous cook had not been very good and a lot of food was sent back to the kitchen. The resident said that the new cook was still “finding her feet”, but that food was “better”. Residents were seen to be expressing a preference about what they had to eat at breakfast and lunch. Breakfast was served well into the morning, depending upon when residents got up. Staff checked to make sure everyone had eaten. Residents were heard to be saying that they enjoyed the hot lunch: “lovely”, “... enjoyed very much”. As noted previously on inspection and during visits to the home, portions are ample and there are “second helpings”. Residents at The Croft who have dementia do sit and eat at the table, and will eat full meals. Menus provided to the CSCI prior to this inspection were seen to be similar on some days at lunch and dinner, or the two choices at each meal were similar. The new cook was looking to review the menus, as she did not think the current choices were appropriate - “too much focus on bought-in” - and will re-introduce home-cooking and baking using good products. She agreed that the fruit and vegetable intake was not sufficient and will be addressing this. The new cook has asked staff not to enter the kitchen. Food is now served from the food hatch into the dining room. The cook said this “reduces the opportunity for cross infection”, and “keeps residents safe”. Special diets are catered for, including low fat and diabetic. Staff are ready to offer assistance with eating where necessary, but encourage independent eating so far as possible. One relative said that appropriate eating aids are not provided by the home; she has been instructed on what to buy and where to buy it. This is not satisfactory. The home must provide suitable eating aids if it is to demonstrate that it is meeting the needs of residents. The Croft DS0000038461.V288635.R01.S.doc Version 5.1 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is poor. This judgement has been made using available evidence, including visits to this service. The service has a complaints procedure that is accessible, appropriate to the service and which is up-to-date. Arrangements for protecting residents are not satisfactory, putting them at possible risk from harm or abuse. EVIDENCE: The home has a policy that relates to complaints. One complaint had been made to the Environmental Health department of the local Council, and had been investigated by them in October 2005. The complaint had been found not to be substantiated by the officer who made the inspection. Residents were seen to be taking their grievances to staff and the Manager. These concerned missing items of laundry, and wanting to be allowed home. One resident said she would tell the District Nurse if she had any concerns. Another said she would tell her relative. The home’s policy on the Protection of Vulnerable Adults has not been updated since September 2003, although the home now has a copy of the local authority’s most recent guidance. The Manager said she would look into updating the home’s policy. She said that staff have received training on the new guidance. One resident spoke about an incident when she had been showered in cold water. The Manager had been told about the incident, and The Croft DS0000038461.V288635.R01.S.doc Version 5.1 Page 19 had apologised to the resident. There was nothing on the member of staff’s file. The Manager said she did not feel that any disciplinary action had been necessary. The fact that this episode could be seen as act of abuse was discussed with the Manager during this inspection. Documentation will now be brought up to date, as will the care plan. The resident said that no further incidents had occurred. An incident between two residents occurred in January 2006 that could also have been seen as abusive. The Manager had not investigated the incident fully and had been prompted to write a report by CSCI. During this inspection, residents were heard to be shouting at one resident, primarily because they feared for her personal safety (resulting from her poor mobility) and expressing their concern: “You should be in hospital.” The shouting was causing some anxiety in the resident. The Manager said she had identified the concern of the residents and had been arranging a review for the resident. However, nothing had been recorded in the care plan to confirm this. Two members of staff spoke about residents’ rights and about negotiating and encouraging rather than forcing. One member of staff said that talking a situation through, advising and explaining, was effective. Another member of staff said that, “.. you have to weigh up the risks and any danger in a situation, use distraction when needed, and clear communication”. The Croft DS0000038461.V288635.R01.S.doc Version 5.1 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence, including visits to this service. The home offers a homely environment for residents. Issues of cleanliness need to be addressed. Improvements to ventilation and temperature control would make the environment more comfortable for residents. EVIDENCE: A copy of a maintenance programme is displayed on the wall in the office. A maintenance man is employed who undertakes painting, decorating, joinery and general household tasks. As a job is completed, it is recorded on the maintenance programme. Since the last inspection, some cosmetic improvements have been made to the environment. The dining tables have been varnished, and some internal and external painting has been done, though scuff marks still need attention on internal walls. Staff said they were aware that new furniture was being bought, and the Manager said that one more dining table and chairs set was being considered. The Croft DS0000038461.V288635.R01.S.doc Version 5.1 Page 21 Communal areas offer a choice of seating for residents, though the layout of the seating – because chairs are arranged as in a waiting room - does not allow residents to converse. A keypad has been installed on the door to the kitchen, which helped to prevent residents entering the kitchen. No offensive odours were in evidence. Staff described the Manager as being “demanding” in relation to the cleanliness of the home, and a member of staff commented that there might be an over-emphasis on night staff to carry out domestic work during the night. However, the pink/red carpets still need to be cleaned or replaced as they are badly stained. If they were to be replaced, a quality of carpeting other than Flotex is recommended, which will provide a softer surface and help to protect those residents who have a tendency to fall. During this inspection, there was a puddle on the floor of the toilet available for use by visitors and there was no soap for handwashing. A relative said there was often a puddle on the floor and frequently neither soap nor paper towels for handwashing. On both days of this inspection it was evident that cigarette smoke was not being extracted efficiently from the smoke room. At one point the cigarette smoke reached the main reception area. The dining rooms (which are internal rooms with no windows to the outside) were very warm and lacked ventilation. Residents were removing their cardigans because of the heat. There were no room thermometers that would allow room temperatures to be monitored. In the main, residents were dressed in clean, tidy clothing. The hem of a resident’s dress was down and torn at the front but the resident said she didn’t mind. Residents were encouraged to change dirty clothing, such as a foodstained cardigan. A resident said his clothes were washed for him and put back in his room. Another resident said that staff were “very good” with her clothes. In a comment card, one relative said that clothes were not put away properly in the resident’s wardrobe. Staff were seen to be wearing protective gloves and aprons, in order to minimise the risk of cross infection. The Croft DS0000038461.V288635.R01.S.doc Version 5.1 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, and 30. Quality in this outcome area is poor. This judgement has been made using available evidence, including visits to this service. The home has a recruitment procedure that is based on good practice. Only staff who are deemed suitable are recruited. However, there is too much focus on tasks rather than care. Staff are not sufficiently trained and some demonstrated lack of competence. EVIDENCE: There have been several changes to the staff group since the last inspection, the most recent being the dismissal of the cook. A care assistant had moved into the vacant position. Other vacancies included a night cleaner and a care assistant (days). The Manager confirmed that no carer with experience of dementia gained from outside the home had been recruited. This action had been agreed with the Provider at a meeting in November 2005 when the variation to increase the number of beds for people with dementia was being dated. The Manager did not appear to have been giving this matter priority and was not sure whether the advertisement in the Jobcentre was still being displayed. The Manager said that she felt sufficient time was allocated to devote to care and supervision of residents as well as to laundry, bathing, bed-making, etc. Staff said that they did not feel too pressured, though sometimes their work was task- rather than people-orientated. Staff said that occasionally tasks get left, and one member of staff said that occasionally the toileting regime was The Croft DS0000038461.V288635.R01.S.doc Version 5.1 Page 23 not good enough and so residents are left wet. A health professional and a relative thought residents could be better supervised. They each told the Inspector that in the evenings and at weekend they frequently saw staff in the smoke room. On two days of this inspection, supervision of residents was seen to be adequate. On 28th April, when the Inspector and Regulatory Manager made a further unannounced visit at 8 p.m., residents were found unsupervised in the smoke room and the “front lounge”. Of the staff team, two have completed NVQ level 2 in care and four are currently going through the training. The Manager said she anticipated that this training will be finished in December 2006. This is well below the 50 target expected of staff in care homes with this qualification. One member of staff has achieved the NVQ level 3 in care, and another is working towards this qualification. The two members of staff currently undertaking the NVQ level 2 qualification said they were very much enjoying the course and that they were learning a lot. Both said they have changed practice and were more aware of what they should be doing as a result of the learning they had done. Employment files were looked at for three members of staff. All had been properly recruited; the necessary checks had been made as to suitability to work with older people and references had been taken up. Queries in relation to the previous employment of a care assistant had been explored and a satisfactory response provided to the Manager. Each new member of staff receives a copy of the code and conduct and practice set by the General Social Care Council. The Manager said that there was an overall training programme but that it was “not being followed at the moment”. Training for staff has included a Protection of Vulnerable Adults update (in-house) and a continence update (external provider). The Manager said that all staff had received dementia training, but only one of the three files looked at noted attendance on a dementia course. There has been no recent training recorded that is specific to the needs of current residents, for example, Parkinson’s Disease. The Manager said she was working on developing a new training programme, a copy of which she would provide to the CSCI for information. The Croft DS0000038461.V288635.R01.S.doc Version 5.1 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence, including visits to this service. The Manager has the required qualifications to run the home but the lack of emphasis on training, development and effective supervision of staff ultimately affects the quality of care being provided to residents. The Manager follows a quality audit process, and there is evidence to confirm that the home seeks the views of residents and others on the quality of the service. However, the owner does not place sufficient importance on thorough and regular monitoring of the home. Residents can be assured that they will be helped to manage their personal monies and to keep personal money and items safe. With the exception that accidents are not recorded as well as they should be, the home strives to ensure that the health, safety and welfare of service users and staff are promoted. The Croft DS0000038461.V288635.R01.S.doc Version 5.1 Page 25 EVIDENCE: The Manager has achieved the NVQ level 4 in care and the Registered Manager’s Award. She has been the Manager at The Croft for several years, and has worked at the home since leaving school. Her experience, therefore, has been gained only at The Croft. The Manager has had no recent training and was unfamiliar with some conditions, for example, Parkinson’s Disease, although she said she had downloaded information from the internet after residents were admitted and had tried, unsuccessfully, to meet with a specialist nurse. She said she enjoys working with the residents. The Manager admits when she is struggling with something, for example, care planning, and is open to suggestion, for example, in relation to changing the method of supervision from that currently being used. She works quickly to try to make improvements when they have been identified to her. The Manager said that she sees the home’s owner “about once a fortnight, for an hour or so”, and that she feels supported by him. She also said she feels she has enough time to get through the paperwork and to manage the staff team. Three members of staff said that formal staff meetings were held “fairly regularly”. Staff said that the content of the meetings is mostly instructional rather than an opportunity for discussion. Records of meetings are kept. The home has a procedure for auditing the systems used in the home, for example, for care planning. Evidence showed that the system was followed. Systems had been audited. The documentation recorded what action had been taken. However, the quality of the care plans showed that the audit had not been thorough enough and it must be remembered that the Manager had expressed her own difficulties with the difference between ‘aims’ and ‘meeting needs’. The Manager said that ensuring care plans were kept up to date was a frustration for her. She said audits regularly show discrepancies, errors and omissions. She agreed that a different approach to training the staff in care planning might be appropriate, and the options were discussed. The home had sent out its annual satisfaction questionnaires in March 2006. Five had been returned, all of which were mostly positive. People had taken the opportunity to include constructive comments with suggested improvements. The home contracts with an external organisation to evaluate the quality of the service it provides. The last evaluation had been done in December 2005 when the home was awarded 4 stars. However, 5 stars are still displayed at the front of the building. The owner of the home had been completing his monthly assessment of the home (known as Regulation 26 visits) until November 2005, but none were recorded beyond that time. Those that were recorded included only cursory comments, such as, “OK”. There was no real evidence that the visit had been done thoroughly and in accordance with regulation. In November 2005, at a time when the home applied to CSCI for a variation to its registration, the Social Services department of Wigan Council recorded the view that they had no concerns about The Croft. The Croft DS0000038461.V288635.R01.S.doc Version 5.1 Page 26 The home’s policies and procedures are managed by an external organisation who ensure that they are kept up to date and in line with the most recent legislation and good practice. The Manager was asked to contact the organisation to ensure the Equal Opportunities policy was up-to-date as it did not appear to have been updated recently. The home has a policy and procedure for ensuring residents’ money is kept safe. One resident knew that his daughter had his Bank card. There are secure facilities for money and items handed over for safe-keeping. Because of comments made by staff, Standard 36 – Staff Supervision was looked at. Staff thought that supervision sessions were often too brief and sometimes they had no time to prepare for the meeting. The home’s policy records that preparation time is recommended, and a 15 minute meeting is suggested. The records showed that staff supervision is not done regularly and the Manager said she wanted to introduce monthly supervision. Records had not been filed for two members of staff though the care plan audit showed that a meeting with staff had taken place. The different methods of supervision were discussed with the Manager, and she agreed to review practice. Health and safety checks had been recorded on the pre-inspection questionnaire completed by the Manager and returned to CSCI for information. Mandatory training for staff appeared to be up-to-date. The Manager said more training was planned for the coming year: it just needed to be arranged. Accident, injuries and illness had been recorded, and had been advised appropriate to CSCI and other organisations (such as the Health and Safety Executive), as appropriate. However, the recording of accidents for one resident had stopped after 4th April, following which there had been a high number of falls. This was discussed with the Manager at the time of this inspection. From observation over the course of the inspection, staff demonstrated awareness of safe working practices. The Croft DS0000038461.V288635.R01.S.doc Version 5.1 Page 27 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 2 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X 2 X 2 The Croft DS0000038461.V288635.R01.S.doc Version 5.1 Page 28 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 OP3 Regulation 14 Requirement A thorough pre-admission assessment must be carried out prior to admission of any prospective resident. TIMESCALE 28/2/06 NOT MET. A person who is suitably qualified and trained must carry out pre-admission assessments. The Manager must take account of the skills and experience of the staff team when deciding whether a person’s needs could be met by the home. Each resident must have a plan of care that sets out the person’s needs. The plan of care must be kept under review and amended at least monthly. The resident or their supporter must be consulted with about the plan of care and any revision. Record Keeping: The registered person must ensure that all medication records including those for self-administration and DS0000038461.V288635.R01.S.doc Timescale for action 19/05/06 2. 3. OP3 OP4 14 18 19/05/06 19/05/06 4. 5. 6. OP7 OP7 15OP7 15 15 15 19/05/06 19/05/06 19/05/06 7. OP9 13 22/05/06 The Croft Version 5.1 Page 29 8. OP9 13 9. OP9 17 10. 11. OP9 OP10 13 12 12 OP10 17 13. OP12 16 14. 15. 16. OP15 OP18 OP18 12 16 16 receipt of medication are clear, complete, accurate, and up-todate. EXTENDED FROM 28/02/06. Storage: The registered person must ensure that unlabelled or otherwise unwanted medication is promptly segregated from that in-use. EXTENDED FROM 28/02.06. Record Keeping: The registered person must ensure that there is a complete, accurate and up-todate list of all currently prescribed medication for each resident and a record of the date on which it was administered. Administration: The registered person must audit the timing of the medication rounds. The privacy of residents must be maintained, particularly when assisting residents with personal hygiene. Confidential information for each resident must be kept separate from that which refers to other residents. A more structured programme of activity and occupation – relevant to the individual residents – must be devised and introduced. TIMESCALE 31/03/06 NOT MET. The home must provide suitable crockery and cutlery to assist residents to eat independently. The home’s policy must be updated to reflect current best practice guidance. The Manager must ensure she is fully familiar with the systems for recording incidents that relate to the protection of vulnerable people so that good records are kept. DS0000038461.V288635.R01.S.doc 22/05/06 19/04/06 22/05/06 19/05/06 19/05/06 31/05/06 19/05/06 31/05/06 19/05/06 The Croft Version 5.1 Page 30 17. 18. 19. 20. 21. 22. OP19 OP19 OP19 OP19 OP27 OP28 23 23 23 23 18 18 Stained carpets must be cleaned or replaced. Toilets must be kept clean and stocked with liquid soap and paper towels. The ventilation in the smoke room must be reviewed and improvements made. Room thermometers must be placed around the home so that temperatures can be monitored. A carer with experience of dementia gained from outside of the home must be recruited. The Manager must provide a programme to ensure that at least 50 of staff employed as care workers have the NVQ level 2 or equivalent. The Manager must provide a programme to show that staff receive training appropriate to the specific conditions of residents. The owner of the home must ensure that his monthly, unannounced visits to the home are conducted thoroughly and that full records are available for examination. Copies must be provided to CSCI until further notice. The Manager must ensure that staff supervision is linked to the aims of the home, and to the needs and expectations of the residents. Supervision must be carried out regularly. Records must be kept. All accidents, injuries, and incidents must be recorded. 31/05/06 19/05/06 31/05/06 19/05/06 31/05/06 19/05/06 23. OP30 18 19/05/06 24. OP33 26 19/05/06 25. OP36 18 31/05/06 26 OP38 17 19/05/06 The Croft DS0000038461.V288635.R01.S.doc Version 5.1 Page 31 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. 7. 8. 9. Refer to Standard OP7 OP9 OP9 OP10 OP14 OP19 OP27 OP33 OP33 Good Practice Recommendations Care plan information should be set out differently to allow reviews to be recorded better. Handwritten MAR entries should be signed, independently checked and countersigned. The medication policies and procedures should be reviewed. Consideration should be given to providing chiropody treatment to residents away from the main reception area. Where residents have expressed areas of control, such as wishes and feelings, these should be recorded in the care plan and taken into account. Where carpets are to be replaced, flooring other than Flotex should be considered. Staff should be reminded that the smoke room might only be used by them when supervising a resident or during their break. The Manager should consider different approaches to training senior carers in care planning, so that errors diminish and auditing improves. The Manager should seek to ensure the Equal Opportunities policy is up-to-date. The Croft DS0000038461.V288635.R01.S.doc Version 5.1 Page 32 Commission for Social Care Inspection Bolton, Bury, Rochdale and Wigan Office Turton Suite Paragon Business Park Chorley New Road Horwich, Bolton BL6 6HG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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