Inspection on 23/05/07 for The Croft

This inspection was carried out on 23rd May 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 22/08/06

The Croft 24/10/05

The Croft 25/10/04

Similar services:

Flint House

St Vincents

The Cotswold Home

Fairways

Newbeech House

Winton House

Treloar College

Rush Court

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

CARE HOMES FOR OLDER PEOPLE The Croft Chestnut Lane Amersham Bucks HP6 6EJ Lead Inspector Philippa MacMahon Unannounced Inspection 23rd May 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 DS0000023060.V335819.R03.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. DS0000023060.V335819.R03.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Croft Address Chestnut Lane Amersham Bucks HP6 6EJ 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) 01494 732500 01494 732 510 www.heritagecare.co.uk Heritage Care Mrs Lorraine Coe Care Home 60 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0), Physical disability (0) of places DS0000023060.V335819.R03.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 60 older people, some of whom may have dementia and/or physical disabilities 22nd August 2006 Date of last inspection Brief Description of the Service: The Croft is a residential home providing accommodation for sixty elderly residents in the categories of old age and dementia. The accommodation is over two floors and access to the first floor is via a shaft lift, or stairs. The home has sixty single bedrooms all having en-suite facilities. The communal areas are well situated on the ground and first floor. The layout of the home is conducive to meeting the needs of residents. The home is divided into four units supporting half the residents in the category of dementia care. The home is situated in Amersham, a small market town close to all local amenities. The home has good road links to other larger towns; it is also served by public transport. Information regarding the services offered is available from the home on request. The homes fees range from £418.60 per week to £514.00 per week. DS0000023060.V335819.R03.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection that commenced at 09:30 hours and the inspector was in the service for 7 hours. The registered manager was in attendance throughout the inspection. Information received from the home and from the Commissions “Have your say about The Croft” questionnaires, was used to formulate this report. The inspector examined care plans and followed this through by meeting the individual resident to see if the care plan matched their needs. The medication system was examined, and discussed with staff. The activities plan was examined and the inspector joined the residents over lunch in one of the dining rooms. A tour of the building took place, and records required by regulation were examined. Staff rosters and a sample of individual training and recruitment files were examined. The inspector would like to take this opportunity to thank everyone who contributed to this inspection in any way. What the service does well: What has improved since the last inspection? The care planning system is being replaced and contains all the necessary information. The medication system is now in good order and staff are trained to administer medication correctly. DS0000023060.V335819.R03.S.doc Version 5.2 Page 6 The programme of activities is developing. The complaints procedure is much more accessible and clear. Staff are trained in issues of elder abuse. The staffing cover is improved and recruitment into vacant post is occurring. Staff training is more proactive and relevant to the care provided. The senior management team is working well together and able to support all aspects of running the home. 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. DS0000023060.V335819.R03.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 DS0000023060.V335819.R03.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. People who use the service experience good quality outcomes in this area. Every resident has a comprehensive pre-admission assessment prior to entering the home. The service does not provide intermediate care. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The inspector examined a sample of care plans and discussed with the registered manager and senior staff the procedure for assessing prospective residents prior to admission to the home. All residents have a pre-admission assessment that is very comprehensive and includes information from care managers, and relatives. The assessment is carried out by the Deputy Manager and a Senior Team leader, and is documented and kept on file in the home. On admission a further assessment is made that forms the basis of the care plans. It is a good practice recommendation that the pre-admission DS0000023060.V335819.R03.S.doc Version 5.2 Page 9 assessments should form the basis of care planning and should be included in the care plan folder. A copy of the up to date statement of purpose and service users guide was presented to the inspector. DS0000023060.V335819.R03.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11. People who use the service experience adequate quality outcomes in this area. The residents are well cared for and treated with dignity and respect. Further work on the care planning process needs to be made. Medication administration is in good order. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The inspector examined a sample of care plans and followed this up by meeting with the residents to see if their care needs were being met. The care planning process is in a period of review and change to new documentation, and the prospect of computerised care plans in the future. At the last inspection a requirement was made that every resident must have a care plan that reflects the persons health, personal and social care needs. This has been met, however the present system is very cumbersome and whilst individual care needs are identified, the action required to meet the needs is not always clear, and records of various aspects of care are kept in different locations. The inspector discussed this with senior staff that understand this and are in the process of looking at ways of reducing the paperwork and forming one DS0000023060.V335819.R03.S.doc Version 5.2 Page 11 clear concise care plan that contains all the necessary information about the person and how their care needs will be met. There was no evidence of the resident or family involvement in the care planning process. It is recommended that work should continue in making the care plans more concise and easy to use to ensure that the residents identified care needs are met. It is further recommended that more involvement with the resident and their families in the care planning process should be undertaken. The inspector spent time with a number of residents during the inspection and found that they are well cared for and very appreciative of the care provided. A number expressed “this is my home now and I am very comfortable and well looked after”. Care plans are reviewed regularly however risk assessments are generally not included in this review. It is recommended that all risk assessments should be reviewed and updated on an ongoing basis. Nutritional assessments are not carried out, however regular recording of weight was found in the care plans. It is recommended that the Registered Manager should seek advice from the community dietician and district nurses as to the most appropriate tool to implement. At the time of this inspection a Hearing Aid Technician from the District General Hospital was in the home attending to a number of problem hearing aids issues. Advice was given to staff as to how to care for hearing aids and the first line techniques to deal with issues as they arise. The system of medication was examined by the inspector and overall was found to be in good order. The Care Practitioner has been allocated responsibility for the management of the medication system within the home and also carries out some training and assessment of competence in the administration of medication for members of staff. Since the Commissions Pharmacy Inspection in September 2006 a lot of work has been put in place and the staff are feeling confident in their management of the medication. The inspector observed staff assisting residents in their activities of daily living and on each occasion saw that the residents were treated with dignity and respect. Residents were always called by their preferred term of address, and staff knocked on doors before entering any room. The inspector noted that the care plans did not indicate the resident’s wishes concerning the end of their life. It is recommended that staff should obtain the residents wishes concerning arrangements at the end of their life and document this in the care plans. DS0000023060.V335819.R03.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, People who use the service experience good quality outcomes in this area. Each of the residents has the opportunity to be involved in social and recreational activities to suit their individual lifestyle. Meals and mealtimes are of a good standard. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: There are two activities co-ordinators in post who between them manage to provide a programme suitable to the needs of the present client group. Records of the activity the individual has taken part in and their appreciation are documented. The programme includes outings, and a coach trip to the seaside is in the process of being finalised. Relatives and friends are always included in any social provision, and comments in the Commissions “Have your say about” from relatives expressed that they really appreciate being able to be involved in the life of the home. A number of volunteers also support this part of the provision by helping with taking people out for walks, helping with the gardening, and other activities. Residents spoken to say that there are a variety of activities for them to choose from and they are very happy living at The Croft. Relatives spoken to during the inspection said that they were always DS0000023060.V335819.R03.S.doc Version 5.2 Page 13 offered a warm welcome and that the communication between themselves and the staff was excellent. Church services including Holy Communion is available in the home and any residents wishing to is assisted to attend the local Churches. From the evidence seen by the inspector and comments received, the inspector considers that the home would be able to provide a service to meet the needs of individuals of various religion, race or culture. Age Concern Advocacy service hold regular meetings with the residents and are readily available to residents should they be needed. The inspector joined the residents for lunch and observed the staff assisting the residents in a kindly and appropriate manner. The tables are nicely set with tablecloths and paper serviettes. Water and fruit juice were readily available, and the meals were individually served from a heated trolley in the dining room. The meal provided was wholesome and nutritious and was much enjoyed by the residents. The residents did express that the standard of the meals was good and that they had a choice and there was always plenty of food available. Examination of the menus supported this view. DS0000023060.V335819.R03.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. People who use the service experience good quality outcomes in this area. The complaints procedure is accessible to all residents, relatives and visitors to the home. All of the staff working in the home understands the issues of elder abuse. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The inspector discussed the complaints procedure with the registered manager and she explained that they now had a more robust system in place. The complaints procedure is accessible to residents, relatives, and visitors in the service users guide, and copies are also available in the Foyer at the main entrance as well as in the lounges on the wings. No complainant has contacted the Commission with information concerning a complaint since the last inspection. All staff receives training about issues of Elder Abuse during their induction, and as an ongoing part of the training and development programme. Evidence of this was found in individual staff files examined by the inspector. There is an investigation in progress at the present time into an alleged incident and this is being dealt with within the policy and procedure of the company, and the Commission is being kept informed throughout. DS0000023060.V335819.R03.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26. People who use the service experience adequate quality outcomes in this area. The home provides a comfortable, homely, clean environment for the residents to live in. More attention needs to be made in ensuring that all areas of the home are free from offensive odours at all times. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The inspector toured the building and overall found all areas to be cleaned to a good standard. The décor furnishings and fittings were found to be in good order and provided a comfortable homely place for the residents to live. Since the last key inspection bedrooms that became vacant have been redecorated new lounge carpets in Balmoral and Buckingham wings has been fitted. The kitchen areas in Windsor and Balmoral wings have had new work surfaces. The Foyer, administrators and managers offices have also been redecorated. DS0000023060.V335819.R03.S.doc Version 5.2 Page 16 The resident’s individual rooms had been personalised with their own possessions and in some cases small pieces of their own furniture. There was however an offensive odour in Buckingham wing that the registered manager was aware of and action had already been put in place to correct this. The bathrooms have been decorated with pictures of dolphins in an effort to make the rooms less clinical. One of the bathrooms had a soiled linen holder in it that did not have a lid. It is recommended that if the soiled linen holder is stored in the bathroom it should be the type that has a lid, so that residents using the bathroom are not exposed to offensive odours. DS0000023060.V335819.R03.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. People who use the service experience good quality outcomes in this area. Significant improvement in the training and development of all staff has been made and now needs to be maintained, to ensure` the health safety and welfare of the residents. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The inspector examined the staff rosters and found that sufficient numbers and skill mix of staff were planned to be on duty at all times. It was noted that there are some staff vacancies and these were being filled by an Agency. Discussion with the registered manager about this issue revealed that active recruitment is occurring and dates for interviews of applicants were being made. Agency staffs are generally well known to the home so that there is some continuity for the residents. Staff recruitment is handled from the company’s head office. A sample of staff files were examined by the inspector and found to contain all the necessary checks and documentation. Since the last inspection significant input has been made into updating the training and development of all staff. Staff spoken to are appreciative of this and feel more confident in their role as a consequence. Evidence of training DS0000023060.V335819.R03.S.doc Version 5.2 Page 18 undertaken was seen in the staff individual files, and on the training matrix that shows all training planned and completed. DS0000023060.V335819.R03.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38. People who use the service experience good quality outcomes in this area. The home is well managed and run in the best interest of the residents. Every effort is made to ensure the health, safety and welfare of the residents and staff, is maintained at all times. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The registered manager has worked in the home for many years as a carer, senior carer, and was eventually promoted to be the manager. Since taking up the post she has carried out extensive training and has achieved the national vocational qualification Managers Award. The deputy manager is undertaking the national vocational qualification level 4 in care and the Managers Award at the present time. The appointment of a senior carer to Care Practitioner role has further strengthened the management team. There DS0000023060.V335819.R03.S.doc Version 5.2 Page 20 was good evidence of teamwork taking place and clear lines of accountability amongst the staff. The registered manager showed the inspector a copy of the business plan for the year and the action that had already taken place. Residents spoken to and comments the commission has received since the last inspection show that there is greater confidence in the running of the home, and residents are feeling safe and well cared for. The company has a quality assurance system in place that involves regular audits of various aspects of running the home. There is also an annual audit of the whole home carried out by a manager of another service within the company. This includes the resident’s points of view and comments about all aspects of the service provision. The home has achieved the Investors in People Award that concentrates on the staff provision in the home. This is a national initiative and the outcomes lead to improvements in the overall running of the service. The inspector met with the administrator and examined the system of managing the resident’s individual cash for incidental expenditure. The system is robust and receipts and records are up to date and complete. Records required by regulation about the health, safety and welfare of all people within the home were examined and found to be up to date and in good order. All staff receives mandatory training in fire safety, moving and handling and food hygiene. Evidence of training undertaken was seen by the inspector within the staff files. DS0000023060.V335819.R03.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 2 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 2 X 3 X X 2 DS0000023060.V335819.R03.S.doc Version 5.2 Page 22 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. Standard Regulation Requirement Timescale for action 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 OP7 Good Practice Recommendations It is a good practice recommendation that the preadmission assessments should form the basis of care planning and should be included in the care plan folder. This will ensure that all the identified care needs of the individual resident are included in the care plans. It is recommended that work should continue in making the care plans more concise and easy to use to ensure that the residents identified care needs are met. It is further recommended that more involvement with the resident and their families in the care planning process should be undertaken. It is a good practice recommendation that all risk assessments should be reviewed and updated on an ongoing basis. DS0000023060.V335819.R03.S.doc Version 5.2 Page 23 2 OP7 3 OP8 4 OP11 It is further recommended that the Registered Manager should seek advice from the community dietician and district nurses as to the most appropriate nutritional assessment tool to implement. It is recommended that staff should obtain the residents wishes concerning arrangements at the end of their life and document this in the care plans. It is recommended that if the soiled linen holder is stored in the bathroom it should be the type that has a lid, so that residents using the bathroom are not exposed to offensive odours. 5 OP26 DS0000023060.V335819.R03.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU 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 DS0000023060.V335819.R03.S.doc Version 5.2 Page 25 - 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. 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