Inspection on 27/01/06 for The Croft

This inspection was carried out on 27th January 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 19/04/06

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 Unannounced Inspection 27th January 2006 08:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Croft DS0000038461.V269884.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.V269884.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.V269884.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 supernumerary 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. 26th July 2005 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. The Croft DS0000038461.V269884.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out over a 6.5 hour period and was unannounced. The main focus was on those areas not assessed during the previous inspection, so that over both visits all key standards were looked at. Part of the time was spent with the Manager and the administrator going through the paperwork that has to be kept to show that the home is being run properly. Part of the time was spent observing practice in the main lounges and dining areas. The Inspector had good conversations with four members of staff and nine residents. The Inspector spoke to other staff and residents over the course of the inspection. The Pharmacy Inspector made her own assessment of the systems in place that relate to medication. Her comments are included in this report at Standard 9. Since the last inspection, the home’s registration has been changed. The owner applied to increase the number of places for people with dementia or other cognitive impairment to 19. The CSCI and the owner subsequently agreed that 17 would be the maximum allowed at this time. What the service does well: What has improved since the last inspection? Since the last inspection, improvements have been made that relate to planning appropriate care for residents. Further formal training has been made available to staff that relates to the care of people with dementia. These matters were assessed by CSCI when the owner of The Croft made an application to increase the dementia registration of the home from 13 to 19, and when 17 places were subsequently agreed. The Croft DS0000038461.V269884.R01.S.doc Version 5.1 Page 6 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 Croft DS0000038461.V269884.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Croft DS0000038461.V269884.R01.S.doc Version 5.1 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 the following standard(s): 3 If the home is to concentrate its service provision on dementia care, a thorough pre-admission assessment, including the identification of triggers that might change or effect a person’s behaviour, will be vital to ensuring that the person’s needs have been identified and can be met by the home. This assurance is not yet guaranteed for all prospective residents. EVIDENCE: Because much of this inspection was focussed on providing care to people who have dementia, the pre-admission assessment forms for two people were looked at. One person had been admitted in October 2004 and, except for the lack of any social history, the assessment had been satisfactory. The second person had been admitted for respite care at the beginning of 2006. The preadmission assessment for this person had not been thorough enough and some entries conflicted with the mental health assessment conducted by a mental health professional – the home’s assessment recorded “mild” memory loss as against “extremely deficient”. The home’s assessment said that there was no history of challenging behaviour, but records provided by other interested parties said differently. The Croft DS0000038461.V269884.R01.S.doc Version 5.1 Page 9 The Croft DS0000038461.V269884.R01.S.doc Version 5.1 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 the following standard(s): 9 Systems were in place to facilitate the safe handling of medicines but the medication policy needs to be implemented and the record keeping improved. EVIDENCE: Medication policies and procedures were available within the home but had not been implemented and did not always reflect practise within The Croft. One resident is supported to self-administer some of his own medication, but written assessment has not been competed. Trained carers administer all other medication. Records of medication administration were generally complete but there were some missing entries (blanks) throughout. Two handwritten entries did not include full dosage instructions. Complete records of medication received into the home were not maintained. Medication was securely stored but there were some unlabelled or otherwise unwanted medicines in the medicines trolley. The Croft DS0000038461.V269884.R01.S.doc Version 5.1 Page 11 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, and 14 More efforts needs to be made on providing structure, activity and occupation to each resident’s day, that is appropriate to him or her. The majority of residents living at The Croft have good contacts with their families. There are regular visitors to the home. Residents at The Croft have the opportunity to make choices during the activities of daily living. EVIDENCE: Residents have access to some form of entertainment or occupation on a daily basis, whether this is listening to music or watching TV and videos, reading books and newspapers, or enjoying music provided by visiting musicians and singers. Staff were seen to be spending time with residents in group conversations and on a one-to-one basis. Staff had an easy manner with the residents who were becoming anxious: leading them and saying, “Come for a chat”. Some residents like to follow their only interests, for example, one lady was creating a picture in needlework. However, without detracting from the efforts of staff to entertain and occupy residents, a number of residents gathered in the main reception area who The Croft DS0000038461.V269884.R01.S.doc Version 5.1 Page 12 appeared to be aimless: without focus or routine. As routine is vital in caring for someone with dementia, a more structured approach to delivering activities will need to be introduced. Predictability and familiarity – doing the same thing at the same time of day – will help to reduce confusion. It will also help to remove residents away from the potential hazards in this area – the front door, the door to the medication room, and the door to the kitchen. The majority of residents living at The Croft have good contacts with relatives and friends. There are regular visitors to the home and residents receive phone calls. During the course of this inspection, residents were heard and observed to be making choices about their lives – deciding what to eat and where to eat it, what to drink (tea, coffee, oxo), who to sit with, what time to get up, etc. The Croft DS0000038461.V269884.R01.S.doc Version 5.1 Page 13 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): 18 The home has a policy and procedure that relates to the protection of vulnerable adults, but the Manager and staff were not sufficiently familiar with it. When an incident occurred, the procedure was not followed properly. Further training, scheduled for February 2006, should improve this situation. EVIDENCE: A recent incident at the home – arising from confrontation between two residents - has highlighted to the Inspector that the Manager and staff are not fully familiar with their obligations under the Protection of Vulnerable Adults (PoVA) procedures as set by the local authority, specifically in relation to recording the events that occurred. Subsequent to the inspection, the Inspector provided a copy of the most recent guidelines (April 2005) as the Manager was unable to get a copy from the local authority. The Manager had previously told the Inspector that staff received training in relation to PoVA at induction and during National Vocational Qualification (NVQ) training. It was noted that further PoVA training appeared on the training schedule for February 2006. The Manager said she would incorporate information from the most recent PoVA guidelines into this training session. Some members of staff have been on a “breakway” course which helps care workers deal better with difficult situations. Two of the staff interviewed as part of this inspection were able to tell the Inspector about the different types of abuse and how they might occur. Staff spoke about the types of techniques they might use to diffuse difficult situations such as when arguments and shouting broke out. They took the The Croft DS0000038461.V269884.R01.S.doc Version 5.1 Page 14 view that they would try to keep calm, ensure the safety of residents first, and then think about their own safety. Staff described The Croft as a “familyorientated” home where the safety of residents was “paramount”, as was ensuring their comfort and care. Staff spoken to during this inspection said they had never heard any other member of staff raising their voice inappropriately to a resident or demean or disrespect them in any way. The Croft DS0000038461.V269884.R01.S.doc Version 5.1 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 the following standard(s): 19 and 26 The home is not as well-maintained as it could be. Some areas are in need of repair, redecoration and/or refurbishment. While the home smelled fresh throughout, one carpet was dirty and required deep cleaning or replacement. Staff were seen to be observing the home’s hygiene policy. Residents can be sure, therefore, that the risks of cross-infection are minimised. EVIDENCE: On the day of this inspection the home was clean throughout, and there was no evidence of unpleasant odours. The home is now in need of some redecorating in order to eradicate scuffing and chips to woodwork and doors. The dining room tables need sanding and revarnishing as they are badly marked. The red carpet in the dining room near the smokers’ lounge needs to be deep-cleaned or replaced as it was very badly stained. The Croft DS0000038461.V269884.R01.S.doc Version 5.1 Page 16 Two bedrooms were visited as part of this inspection. In one room there was damage to the veneer on the bedside table and drawers, the border was coming away from the wardrobe door, and a repair around a plug socket had not been finished. In the second room, a repair had been made under the sink but had not been finished off. The carpet under the repair looked mouldy and requires attention. The sink in the corridor has been removed and the Manager is looking for a piece of domestic furniture – such as a small dresser – to fit into the space. The Manager said that keypads are being installed on the door to the kitchen. The use of keys in the home generally was observed to be quite a timeconsuming task for staff who were constantly looking for a key of some description. Residents’ clothing was seen to be clean and nicely laundered. Staff were observed to be using protective gloves and aprons. Staff said that the Manager was strict on health, safety and hygiene in the laundry. The Croft DS0000038461.V269884.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 The staff rota showed that there is a good ratio of staff to resident. Staff have received training appropriate to the work they are employed to do. EVIDENCE: There had been some changes to the staff group since the last inspection with a Senior Carer and the Cook leaving to take up alternative employment. Recruitment to these posts had been successful and the two new members of staff appeared to be settling well into their roles. The staff rotas are produced on a computer so are clear and easy to read. The rota also identifies what roles staff will be undertaking, such as activities, bathing, laundry, etc. Through the day Monday to Friday, as well as the Manager who is supernummary to the rota, there is a senior carer and two care assistants on duty. At night, the staffing level reduces to one senior carer and one care assistant. The care staff are supported by domestic, catering, and administrative staff. Staffing levels do not drop at the weekend. At the time of this inspection staff were providing care to 19 residents. There were four vacancies. All staff have received training in the care of people with dementia. The Croft DS0000038461.V269884.R01.S.doc Version 5.1 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 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 The Manager is suitably qualified to run a care home. The home’s owner gives her the autonomy she needs to fulfil her role. There are internal audit systems and periodic satisfaction surveys are sent out. Improvements or changes to the service are made as a result of comments received. The home’s systems make sure that residents’ financial interests are safeguarded. EVIDENCE: The Manager has the qualifications and training required to carry on the work she is employed and registered to do. In conversations with four members of staff, all expressed satisfaction with the Manager’s style and appeared to The Croft DS0000038461.V269884.R01.S.doc Version 5.1 Page 19 respect her as a person. They believe she is committed to providing good care for residents. She was described as “very approachable” and “very focussed”. The Manager’s weekly meeting with the provider keeps him up to date with events at the home. The home keeps a record of audits that are done on a regular basis including catering, care, personnel, administration and house-keeping. The home had recently maintained its 4 star accreditation with the RDB when questionnaires had been sent out to residents and their supporters. The home’s own satisfaction survey is due to be sent out in March 2006. The Manager gave an example of how these satisfaction surveys can make changes at the home: one respondent had suggested a security light on the path at the front door. This was accepted as a good idea and a security light has been installed. The home keeps very little money on behalf of residents, usually only for hairdressing. The administrator said that the contract for each resident takes account of everything that they might need, including excursions and toiletries. Occasionally, a resident might wish to make an individual purchase of something, but mostly the costs are met by the home within the contract price. The Croft DS0000038461.V269884.R01.S.doc Version 5.1 Page 20 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 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X X The Croft DS0000038461.V269884.R01.S.doc Version 5.1 Page 21 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. The registered person must ensure that medication is handled according to policies and procedures describing safe medication handling. The registered person must ensure that all medication records including those for: • Self-administration • Administration • Receipt of medication are clear, complete, accurate and up-to-date The registered person must ensure that unlabelled or otherwise unwanted medication is promptly segregated from that in-use. A more structured programme of activity and occupation – relevant to the individual residents - must be devised and introduced. The Manager and staff must ensure they are fully familiar DS0000038461.V269884.R01.S.doc Timescale for action 28/02/06 2 OP9 13(2) 28/02/06 3 OP9 13(2) 28/02/06 4 OP9 13(2) 28/02/06 5 OP12 16 31/03/06 6 OP18 16 28/02/06 The Croft Version 5.1 Page 22 7 OP19 23 with the policy and procedure that relates to the protection of vulnerable people. A programme of maintenance and renewal for the coming year must be devised, and a copy sent to CSCI. 28/02/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP9 OP9 Good Practice Recommendations Handwritten MAR entries should be signed, independently checked and countersigned. Eye drops should be dated on first opening. The Croft DS0000038461.V269884.R01.S.doc Version 5.1 Page 23 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. Extracts may not be used or reproduced without the express permission of CSCI The Croft DS0000038461.V269884.R01.S.doc Version 5.1 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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