Inspection on 26/07/05 for The Croft

This inspection was carried out on 26th July 2005.

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 12/01/09

The Croft 14/01/08

The Croft 27/11/06

The Croft 19/04/06

The Croft 27/01/06

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 WN2 5PR Lead Inspector Lindsey Withers Unannounced 26th July 2005 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 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 F06 F56 S38461 The Croft V231047 04.07.05 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service The Croft Address Barracks Road, Bickershaw, Wigan, WN2 5PR. 01942 867186 01942 867386 Telephone number Fax number Email 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 Physical Disabilty Elderly 4, Old Age 23, registration, with number Dementia Elderly 13. of places The Croft F06 F56 S38461 The Croft V231047 04.07.05 Stage 4.doc Version 1.40 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 13 service users in the category of DE(E) (Adults with Demenia over 65 years). 2. 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. 3. The Registered Person must ensure that at all times, there are sufficient numbers of domestic and catering staff on duty to allow care staff to focus on care rather than ancillary duties. Date of last inspection 7th March 2005. 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 13 with a diagnosis of dementia. Nursing care is not provided at this Home. The Croft F06 F56 S38461 The Croft V231047 04.07.05 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over four hours on one day and was unannounced. Part of the time was spent in the office talking to the Manager, looking at four care plans (that is, the records used to show the plan for caring for a resident), one staff file, and other papers used to manage the Home. The remainder of the time was spent in the lounges talking to six residents, having a walk around the garden with one resident, and talking to three members of staff. Other residents were spoken to over the course of the inspection. What the service does well: What has improved since the last inspection? What they could do better: When residents with dementia show a change in behaviour, staff must be quicker at arranging specialist help. The knowledge and experience of staff in dementia care at this stage is limited, and further training for all staff is needed. Extra care must be taken with residents’ records so that entries such as dates are correctly recorded, and so that additional action plans are included that set out how a resident’s special needs will be met. The supervision sessions for staff could be better if, as well as using standard questions, staff were asked to say what they would do in a given type of situation. The Croft F06 F56 S38461 The Croft V231047 04.07.05 Stage 4.doc Version 1.40 Page 6 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 Croft F06 F56 S38461 The Croft V231047 04.07.05 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection The Croft F06 F56 S38461 The Croft V231047 04.07.05 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 4 Assessment documentation is properly completed. This means that residents can be assured that their needs will be assessed before they are admitted to The Croft and that staff are aware of what those needs are. Residents are provided with support for their specialist needs by professionals from outside the Home. Specialist care needs provided within the Home is good at a basic level, but is less good when there are changes to a person’s mental health. EVIDENCE: Five residents’ files were looked at during this inspection. All contained a preadmission assessment that had been fully completed to show the extent of the care that would be needed for each individual person. Information provided by Social Workers had been included, where it had been received. Each assessment had formed the basis of the resident’s plan of care. There was evidence to confirm that a resident’s family or other supporter had been involved in the assessment process. The Croft F06 F56 S38461 The Croft V231047 04.07.05 Stage 4.doc Version 1.40 Page 9 One record in the sample contained information to show that specialist support had been needed for the resident from a health professional from outside the Home. Arrangements had been made for it to be provided. The Croft is registered to provide specialist care services for 13 people with dementia, and the majority of staff had had appropriate training so that they could provide a good level of care. However, two residents’ files stated that the Home should involve the Community Psychiatric Nurse (CPN) if there was a change to the person’s mental health. A change had been recorded for both residents, but there had been no referrals to the CPN. The records showed, therefore, that staff could not demonstrate that they fully understood the point at which external specialist help was needed. The Croft F06 F56 S38461 The Croft V231047 04.07.05 Stage 4.doc Version 1.40 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, and 10 Care plans were descriptive and so could show how well a person’s needs were being met, whether by the home or by community and hospital services. However, errors and omissions highlighted were the needs of some residents were not being met. Staff are not quick at getting specialist advice and support for people with dementia or other cognitive impairment. It was not clear that staff knew what to do when a resident showed signs of severe or different behaviour. Residents can be assured that they will be treated with respect, and that they will be assisted and encouraged to maintain their privacy and dignity. EVIDENCE: Each person’s plan of care had been developed using the assessment completed during the admission process. The presentation of care plans had improved since the last inspection and so were easier to read. The Croft F06 F56 S38461 The Croft V231047 04.07.05 Stage 4.doc Version 1.40 Page 11 Of the five examined at this inspection, two care plans were complete and up to date, but errors and omissions were found in the remaining three, all of them relating to residents with dementia. These were either simple errors around dates, for example, 17/6/06 or more serious, for example, a care plan not written to take account of a person’s arthritis (which would affect the person’s moving and handling requirements), and a night care plan not completed for a person who chose not to go to bed. All five care plans contained detailed entries made by staff to indicate the progress (or otherwise) of the resident’s state of health and well-being, but staff must remember to sign off each entry that they make in the care plan. Two care plans recorded increasing aggression in the resident, but there was no indication that specialist advice had been sought, even though the care plan gave this instruction. Care plans showed the level of contact that residents had had health and social care professionals, including tissue viability nurse, stoma nurse, continence nurse, district nurse, GP, chiropodist, and hospital consultants. Residents were seen to have been helped to access hearing and sight tests, and to obtain new or replacement aids, according to need. One resident spoke about having seen her GP recently, and the district nurse called to see several residents during the period of the inspection. There was evidence on several of the files to show that the resident or their supporter had been involved in developing the plan of care. One resident said he knew that a file was kept “in the office” relating to his care, and that that was the level of his interest in it. Reviews were a little behind at the time of the inspection, but had been maintained in the months prior. Reviews were more detailed than previously, demonstrating how the review had been undertaken and any outcomes that had arisen. Risk assessments had been included, some on all plans – for example, in relation to risk of falls – and some that were specific to the individual, for example, for a person at risk of leaving the home unsupervised. Residents were seen to be encouraged to remain active, whether this was moving around the house and garden, or joining in with household tasks, or getting out and about outside of The Croft. Nutritional screening had been monitored regularly and, where needed, a food and fluid chart had been completed. The record of weights had been maintained, alongside the record of food provided to residents. Those weights checked at this inspection showed that residents were responding well to the food provided by the new Chef: the residents’ records looked at during this The Croft F06 F56 S38461 The Croft V231047 04.07.05 Stage 4.doc Version 1.40 Page 12 inspection showed that all the residents had put on weight, which the Manager said made for positive results in relation to the general well-being of residents. Staff demonstrated a positive and inclusive approach to the way that they cared for residents. Efforts were seen to be made to discuss personal matters in a confidential manner. Residents said that staff were “lovely” with them. The Croft F06 F56 S38461 The Croft V231047 04.07.05 Stage 4.doc Version 1.40 Page 13 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 standard(s) EVIDENCE: This section was not assessed on this occasion. The Croft F06 F56 S38461 The Croft V231047 04.07.05 Stage 4.doc Version 1.40 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18. Residents and their supporters are empowered to raise issues or concerns with the staff at the home. Staff receive training and the recruitment process is thorough, so that residents are protected from abuse in any form. EVIDENCE: No complaints had been received at The Croft, and none had been received by the CSCI. The complaints procedure is not displayed in the Home, but is included in the handbook that each resident and/or supporter keeps. Residents were confident about making their grumbles known, and any issues raised were quickly sorted out by staff. Staff at The Croft work on the principle of “nipping problems in the bud” so that they do not turn into complaints. The Manager was aware of her obligations in relation to the Protection of Vulnerable People and to ensuring staff are properly trained and supervised. Each member of staff had been provided with a copy of the Code of Conduct from the General Social Care Council, and had signed to confirm receipt. PoVA training is covered during induction and during National Vocational Qualification training. Staff are not allowed to work at The Croft until satisfactory checks have been made, for example, from the Criminal Records Bureau. The Inspector agreed to provide the Manager with details of how to include someone on the PoVA list, should this ever become necessary. The Croft F06 F56 S38461 The Croft V231047 04.07.05 Stage 4.doc Version 1.40 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: This section was not assessed on this occasion. The Croft F06 F56 S38461 The Croft V231047 04.07.05 Stage 4.doc Version 1.40 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 and 30. The approach to staffing the home brings benefits to residents: the recruitment process is good; there is professional legal support and advice available to the Manager, if it is needed; the staffing level and skills mix of the staff group is good; and staff are keen to attend training courses and are supported by management so they can complete that training. However, further training is needed for all staff in relation to the care of people with dementia or other cognitive impairment to improve competence in this specialist area. EVIDENCE: The Home had a full staff complement at the time of this inspection. The staffing level was good. The Manager said that only occasional gaps were appearing in the rota, due to summer holidays, and these were being covered by other members of staff. Though the Manager is supernummary to the rota, she will fill in where necessary. Staff employed at The Croft have a range of skills, including nursing or specialist knowledge that had been learned in previous jobs, and appear keen to continue with their training and personal development. Four carers had achieved the NVQ Level II in Care Award, and six more are working towards the Award. Training in relation to meeting the changing needs of people with dementia has not been sufficient for staff to identify when external professional help is needed. Training in this area is, therefore, required. The Croft F06 F56 S38461 The Croft V231047 04.07.05 Stage 4.doc Version 1.40 Page 17 The file for the most recent recruit was looked at and found to be in good order. A review had been carried out after an initial probationary period, at which time the employment had been made permanent. The Manager has good support from Peninsula (employment law specialists) in relation to employment matters, and could demonstrate that she was familiar with accessing this service for advice and support. The majority of care staff had attended the dementia course delivered by Manchester University. The Manager and the deputy had been on a “breakaway” course and other staff were scheduled to attend. This course is designed to help staff to deal with difficult situations. The Cook had attended an advanced food hygiene course, and training in the safe use of substances harmful to health (COSHH). The Croft F06 F56 S38461 The Croft V231047 04.07.05 Stage 4.doc Version 1.40 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 36 Staff are properly supervised on a regular basis. EVIDENCE: The records showed that staff were formally supervised on a regular basis, as well as being supervised on a day to day basis. In order for the Manager to assess a staff member’s understanding of situations that might arise, it was suggested that she include scenarios into the formal supervision sessions. This will give her a clear indication as to whether any additional training might be needed. The Croft F06 F56 S38461 The Croft V231047 04.07.05 Stage 4.doc Version 1.40 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 2 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x x 3 x x The Croft F06 F56 S38461 The Croft V231047 04.07.05 Stage 4.doc Version 1.40 Page 20 Are there any outstanding requirements from the last inspection? 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. 2. 3. Standard 4 7 8 Regulation 12 17 12 Requirement Access to specialist care must be arranged for residents with changing mental health needs. Information in care plans must be correctly recorded. Residents psychological health must be monitored in a measurable way, and action taken in the event of significant changes. Staff must receive further formal training in relation to dementia care. Timescale for action 1st September 2005 1st September 2005 1st September 2005 31st December 2005 4. 30 18 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 36 Good Practice Recommendations Supervision sessions should include questions where staff would explain what they would do in a given situation. The Croft F06 F56 S38461 The Croft V231047 04.07.05 Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection 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. Extracts may not be used or reproduced without the express permission of CSCI The Croft F06 F56 S38461 The Croft V231047 04.07.05 Stage 4.doc Version 1.40 Page 22 - 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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