Inspection on 29/02/08 for The Croft

This inspection was carried out on 29th February 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Croft 31/10/08

The Croft 14/05/07

The Croft 12/10/06

The Croft 07/09/05

The Croft 10/05/05

The Croft 07/10/04

The Croft 01/07/04

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 The Croft Buckland Road Reigate Heath Surrey RH2 9JP Lead Inspector Pat Collins Unannounced Inspection 29th February 2008 08:30 The Croft DS0000013619.V357938.R01.S.doc Version 5.2 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 DS0000013619.V357938.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. 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 DS0000013619.V357938.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Croft Address Buckland Road Reigate Heath Surrey RH2 9JP 01737 246964 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) croftboss@yahoo.com Heddmara Limited Miss Susan Annette Berner Care Home 22 Category(ies) of Learning disability (0) registration, with number of places The Croft DS0000013619.V357938.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Learning disability (LD). The maximum number of service users to be accommodated is 22. Date of last inspection 20th August 2007 Brief Description of the Service: The Croft is a care home providing accommodation and personal care for male and female adults with learning disabilities including some people over the age of 65 years. The building is a large, three storey detached house situated in its own grounds. The home is within walking distance of Reigate town. Communal areas are on the ground floor, comprising of two spacious lounges, a separate dining room, kitchen and utility room. Bedroom accommodation is mostly single occupancy and is arranged on all three floors. These are fitted with an emergency call system and washbasins and are accessible to bathing and toilet facilities. The home has a platform lift and an outside furnished terrace. Service provision includes a mini bus and driver. The car park is shared with staff and visitors of the on-site day centre for adults with learning disabilities. This is operated by the same organisation under separate management. Weekly fee charges range from £529.61 to £1635.69. Additional charges apply for transport, hairdressing, holidays, toiletries, clothing and magazines. The Croft DS0000013619.V357938.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This unannounced inspection visit formed part of the key inspection process using the ‘Inspecting for Better Lives’ (IBL) methodology. One inspector carried out the visit, spending six hours in the home. The report will say what ‘we’ found as it is written on behalf of the Commission for Social Care Inspection (CSCI). Discussions with some people using service confirmed their preference to be referred to as ‘residents’. For this reason this term will be used hereafter in this report. We toured the building, looking at all communal rooms and some bedrooms, also the garden, to ensure residents who live in the home have a safe, wellmaintained and comfortable environment. Judgements about their wellbeing have been based on the personal appearance of residents and information obtained from records and discussions with some residents and staff. Observations made of the body language of residents with communication difficulties preventing them from telling us about their experience of life in the home, also their interaction with staff, other residents and their environment were used to inform judgements about their wellbeing. We observed care practice at breakfast and lunchtime and looked at various records. These included some care plans and the home’s statement of purpose, which is a book that tells people who the service is for. We also looked at the service users guide, the book that tells people how the home works, the complaint procedure and some staff files. Judgements about how well the home is meeting the national minimum standards for adults and about standards of care have been formed on the basis of these observations; also the cumulative assessment, knowledge and experience of the home since the last key inspection. This includes the findings of an unannounced random inspection we undertook in August 2007 and content of the home’s self - assessment of how well it is doing. We received this from the home manager before carrying out this inspection. We also took into account action taken in accordance with the home’s improvement plan and information received from a care manager. We wish to thank all who contributed information to the inspection process. Also all people using the home’s services and staff for their time, hospitality and assistance throughout the inspection visit. What the service does well: Individual care plans for residents are well written from the point of view of residents. There is evidence that the operation and management of the home The Croft DS0000013619.V357938.R01.S.doc Version 5.2 Page 6 is based on value principles that recognise residents’ rights. The staff team promotes residents’ independence and social inclusion and respects residents’ privacy and choices. Effort has been made to provide a non-institutionalised environment. Areas of the home viewed were clean and tidy and bedrooms were personalised. Discussions with staff and observations demonstrated commitment to meeting the interests and aspirations of residents’ where practicable. An individualised and varied programme of activities is provided and opportunities are available for residents to form friendships outside the home at the various social educational day centres they attend. The home has its own vehicle to transport residents to their day services activities. Key workers ensure all residents have at least once a week access to shops for personal shopping. Some residents told us about the enjoyable time they had last year on a range of escorted holidays that they had helped plan and told us they had booked holidays for later this year. The home supports and encourages residents to keep in contact with friends and family. Various communication systems and methods are used to engage residents’ in discussions and decision – making and helps them have control and make choices in their daily lives. These include residents’ meetings, a key worker system, use of signing and symbols, speech and gestures. Information of relevance to residents’ was displayed in suitable, accessible formats including pictorial and widget symbols, in bedrooms and communal areas. Systems were in place for involving residents in menu planning and in domestic routines within individual levels of capacity. What has improved since the last inspection? All twelve requirements made at the time of the last key inspection have been met. The home now has a registered manager and the management structure has been strengthened. Improvement in the home’s day-to-day management and administration was evident. Work to the premises has improved the environment, specifically bathing and toilet facilities, the safety of dining room floor surface, state of repair of the roof and the general décor of the home. Other improvements include increased provision of aids to promote the safety, independence and mobility of residents. Work to an outside terrace has been completed, affording a safe and comfortable furnished outside area for residents enjoyment and benefit. Support workers are gradually assuming increased responsibility for care planning, with support and guidance from line managers. Quality assurance systems have improved and are more inclusive and the complaint procedure and complaint forms are accessible to those who wish to complain. Other improvements are in the area of medication record keeping, health and safety risk assessments, recording induction training and mostly in the area of staff recruitment practice. The home’s management has responded to recommendations following a recent fire safety audit for improvement to the fire evacuation procedure. The Croft DS0000013619.V357938.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Croft DS0000013619.V357938.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Croft DS0000013619.V357938.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): People in this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Standards: 1 & 2 Prospective residents and their representatives have the information they need to make an informed choice about the home’s suitability to meet individual needs. The admissions assessments process ensures needs are assessed before admissions, to be sure people receive the right type of care. EVIDENCE: The home’s statement of purpose, which is a book that tells people who the home is for, had been updated since the last inspection. The service users guide, which is the book that tells people how the home works, had also been updated. The service users guide has been produced in a format intended to make this information accessible to residents, using photographs and widget symbols. This information would be sent to prospective residents and their representatives to enable an informed choice about the home’s suitability. Residents had received a personal copy of the service users guide. Photographs and information about key workers were displayed in the home. The complaint procedure was also in an accessible format and displayed in the bedrooms viewed and in communal areas. There were five vacancies at the time of the inspection. The last admission was in 2001 and the majority of the residents were admitted between 1991 and 1993. The needs and dependency of the existing group has increased substantially over the years owing to health conditions and the ageing process. The Croft DS0000013619.V357938.R01.S.doc Version 5.2 Page 10 Some residents receive additional funding for one to one staff care and support and to meet their social care needs. Admission assessment records were examined at the time of the last inspection. It was evidenced on that occasion that admissions had been on the basis of full needs assessments carried out by the home manager, to be sure needs could be met. Assessments had been carried out sensitively and competently, taking into account professional assessment information and involving prospective residents and their families in this process. The Croft DS0000013619.V357938.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): People in this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Standards: 6, 7, 8, 9 Residents are involved in decisions about their lives and are consulted in planning the care and support they receive. EVIDENCE: The home’s management told us that improvement has been made to ways of gathering information from residents through use of communication aids and one to one time. Key workers are spending time with residents using a person centred approach to identify needs and aspirations of residents and increase choice in their daily lives. The manager has informed us that positive feedback has been received from relatives and care managers, at review meetings, about methods used to enable and promote independence and choice. Discussions with individual residents during the inspection visit to the home confirmed their involvement in the process for care planning. They were also consulted about where they were going to spend their holidays and supported in maintaining family relationships. Handrails have been fitted in parts of the home and on some corridors to promote independence and safety when mobilising. The Croft DS0000013619.V357938.R01.S.doc Version 5.2 Page 12 A part-time activity coordinator has been recruited, which has increased opportunities to access community facilities two evenings a week. Each resident is allocated one to one time with key workers on a weekly basis. This affords opportunity to go out shopping for personal items and engage in leisure activities in the home and in the community. One resident accompanies the cook each week when she goes out to bulk purchase food. Individual residents’ received active staff support in keeping their bedrooms clean and tidy. The cook stated she sometimes involves individual residents’ in cooking activities. Others took responsibility for making up their packed lunches to have at their respective day services. A recent development is the opportunity for people sharing a bedroom to have the choice of a single bedroom. The one remaining shared bedroom is occupied by residents’ who have chosen to do so. Three care plans and associated records were sampled. The plans were person-centred in their formation, involving residents’ in the process and using proven communication methods such as symbols and photographs. The care plans comprehensively covered all aspects of needs and risks. Those examined and discussions with support workers evidenced staffs’ understanding of the importance of residents’ having opportunity to make decisions and have control of their lives. Observations during the inspection indicated staff respect the rights of residents. The Croft DS0000013619.V357938.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): People in this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Standards: 11, 12, 13, 15, 16, 17. Residents have opportunity to make choices about their lifestyle and are supported in developing and practicing life skills. Social, educational cultural and recreational activities appear to meet their expectations and needs. EVIDENCE: A photo board is displayed in the general office to remind residents which staff will be providing their support on a day-to-day basis. Relationships between staff and residents were warm and friendly during the visit. Daily routines and house rules promoted independence, choice and freedom of movement, subject to any restrictions agreed in care plans. Some opportunities are available for residents to learn and use practical life skills and for their personal development. This included involvement, within individual levels of capabilities, in domestic and other housekeeping tasks. Residents participate in fulfilling activities in and outside of the home. Each person has a weekly timetable of activities, and many attend various day placements during the week. This affords opportunity to form friendships outside of the home. Some residents The Croft DS0000013619.V357938.R01.S.doc Version 5.2 Page 14 are retired and no longer attend day centres or workshops. A key worker system operates and most residents have a designated key worker who spends one to one time with them each week. This time is frequently used for support in accessing shops and engaging in other community based activities. Individual staff expressed the view that some residents’ may benefit from an increase in community activities. This is recognised by the home’s management. Since the last key inspection two new part-time activity coordinators posts had been created and filled. In addition to the activities coordinator supporting residents in the use of community facilities two evening a week, another activities coordinator was stated to provide social activities in the home twice a week. This was understood to be a new initiative. A large bedroom being used as an activities room could no longer be used for this purpose. This bedroom was now needed to accommodate equipment necessary to the needs of a resident awaiting discharge from hospital. Arrangements are in place to meet residents’ cultural and spiritual needs. The Croft facilitates a monthly in-house religious service and some residents attend places of worship. Discussions with individual residents confirmed they had already booked and were looking forward to holidays they had chosen. Two residents are going to stay in a chalet on the Isle of Wight with staff. One resident communicated that she wanted to go on a holiday that gave her opportunity for air travel. Staff confirmed that she went on an overseas holiday last year and enjoyed the experience of going on an aeroplane. Others had booked to go on a seaside holiday in Cornwall. It was noted that the residents enjoyed a pantomime last Christmas. Residents stated they enjoyed their meals. The kitchen was visited and found to be clean and tidy. A full time and part-time cook are employed and the fulltime cook on duty at the time of the inspection visit. Discussions took place with her about methods used to engage residents’ in menu planning. The home had recently been inspected by the Environmental Health Department and the cook confirmed two requirements had been made and had been met. A record of residents’ food preferences was in the kitchen and an alternative menu available. No special diets were required. The menus sampled were varied and a record of meals being maintained. Pictorial menus were sometimes used. Staff promote healthy eating options and portion control where necessary. The dining area was adequately spacious and the floor covering had been replaced since the last inspection. The presentation of the dining tables for meals was satisfactory. Not all residents came home for lunch, a number remaining at day centres where they ate a packed lunch. The lunch served in the home comprised of sandwiches and crisps and a choice of fruit and a hot or cold drink. Staff took time to encourage a resident who had lost his appetite following a recent illness to eat, patiently preparing various food options until they eventually found one he wanted and enjoyed. The Croft DS0000013619.V357938.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): People in this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Standards: 18, 19, 20,21 Personal and healthcare support is provided to meet physical and social needs with due regard to residents’ privacy and dignity. Routines and practice promote independence and enable residents’ to have some control over their daily lives. The continuing increasing dependency of residents and ageing, illness and death is managed appropriately. Further attention is necessary to risk assessment and practice in the management of epilepsy. An area of medication practice must be reviewed in consultation with the pharmacist and general practitioner. EVIDENCE: During the inspection visit staff were observed to support and care for residents’ in a sensitive manner whilst offering choice and encouraging independence. Personal care practice was discreet and respected the privacy and dignity of residents. Good attention was given to the personal appearance of residents’, which was age appropriate and afforded choice. Since the last key inspection person-centred care plans and health action plans had been further developed and these documents and care notes are now held The Croft DS0000013619.V357938.R01.S.doc Version 5.2 Page 16 electronically. The need to supply residents with a personal hard copy of care plans was discussed. The inspection process included review of the care documentation of three residents. Essential life style plans and health action plans were examined, the latter containing details of health professionals involved in the care of each individual and dates for health checks. Discussion took place with a support worker about the care plans she had developed in collaboration with residents she was key working. These documents had been produced in accessible formats, using pictorial images and widget symbols personal to each individual, drawings on their experiences and addressing their needs and aspirations. These were of a high standard and the staff member noted to be motivated and enthusiastic in ensuring an inclusive, person centred approach to planning care and support. Regular review of care needs was evidenced. This was an inclusive process involving residents, care managers, other relevant professionals and invitations sent to relatives. On the day of the inspection visit a review meeting took place, though the resident concerned chose not to attend. A relative who takes an active interest in the care of this individual had not been invited as a result of a breakdown in communication between the home’s management and the care manager. The dependency of individual residents and the collective group continues to steadily rise owing to the ageing process and associated health conditions. At the time of this inspection, two residents required two staff to ensure safe moving and handling practice and for meeting personal care needs. This included one resident who had sustained a serious injury when she fell in the home. A second resident who had also sustained a serious injury from a recent fall in the home, remained in hospital. His discharge was understood to be imminent however could not take place until suitable floor covering laid in a bedroom, replacing carpet unsuited to using a hoist. It had been necessary to transfer this resident to a larger bedroom to ensure sufficient space for the equipment necessary to his changed care needs. The accident records and risk assessments for both residents were examined. These indicated that appropriate action had been taken in the management of these accidents and risk assessment for prevention of falls. Some other residents have varying degrees of mobility problems. The home’s management had acted on the recommendations of an occupational therapist following assessment of the needs of a resident. Mobility aids and equipment include additional handrails on stairways, along corridors and by the bedroom door of this individual had been provided. Also handrails by toilets, provision of hoists, bedrails, ‘wet room’ shower, accessible bath, electrically operated bed and electrically operated armchairs. There has been substantial investment over recent years in the environment, including provision of a platform lift. There is awareness of the need for signage in the environment to meet the needs of a person with a diagnosis of dementia. Discussions with the team coordinator in charge on the day of the visit, confirmed the ongoing The Croft DS0000013619.V357938.R01.S.doc Version 5.2 Page 17 programme for replacing carpets had taken account of the needs of this resident in the choice of carpet design. Alarms were fitted to external doors as a safety precaution to ensure this person did not leave the premises unobserved. However at the time of the visit the alarm on one door was defective and assurance received this would be repaired the same day. Residents are registered with a general practitioner. They have access to primary and specialist health care professionals, ensuring needs are met and staff supported and trained to manage healthcare conditions. Suitable arrangements are in place for pressure sore prevention and management of incontinence. Following this inspection we were copied into correspondence from a care manager addressed to the home manager. This included information that highlighted need for improvement in the management of seizures for one resident. An inclusive approach was noted to end of life planning within residents’ individual levels of understanding. Satisfactory arrangements were made for responding to ageing, illness, death and bereavement. The staff team is well motivated to acquire new skills for the benefit of residents, ensuring they can remain in their own home though health needs have changed. Examples include peg feeding and the management of catheters. Staff responsible for administering medication receive appropriate training, including practice assessments. A monitored dosage medication system is supplied by a local pharmacy, the blister packs containing separate doses of prescribed medication. Printed medication administration record charts are also provided by the pharmacy. Storage of medication was secure and suitable storage available for controlled drugs, though none prescribed currently. Medication record keeping practices were satisfactory, providing an audit trail. A detailed medication policy and procedure is in place and a shorter, pictorial version had been produced for residents. No residents were self-medicating. We were told that none of the residents had the competency or capacity to safely store and administer their own medication. The home stocks some homely remedies. A covert medication practice for one resident was discussed with the person in charge. This had been authorised by the general practitioner and record keeping and practice was transparent. Observations in this matter identified the need for the home’s management to consult the pharmacist to ensure the practice of crushing the medication prescribed was safe and did not alter its effectiveness. The Croft DS0000013619.V357938.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): People in this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Standards: 22 & 23 Policies and practices are robust for responding to complaints and suspicions and evidence of abuse. Residents are protected by the staff recruitment and vetting procedures however not by the staff - training programme. Not all staff had received safeguarding adults training. EVIDENCE: The complaint procedure was clearly displayed in the home and in each bedroom. This was up to date, containing details of the registered manager and new contact information for the Commission for Social Care Inspection. The complaint procedure was in an accessible format, to aid residents’ understanding of how to complain. Since the last inspection individual complaint records had been implemented instead of the use of a complaint book, improving confidentiality of these records. It is important for team coordinators to have access to these records for the purpose of inspection. There had been one complaint since the last inspection that was dealt with under the home’s complaint procedure and recorded satisfactorily. Staff demonstrated skill in their understanding and use of sign methods for communicating with residents who have communication difficulties. They would need to rely on staff’s recognition of indicators of their unhappiness. Staff were noted to pick up on none verbal forms of communication, including facial expressions, body language and behaviours. Discussions with staff confirmed they would explore signs of distress or unhappiness in these individuals to find and resolve the cause. The Croft DS0000013619.V357938.R01.S.doc Version 5.2 Page 19 Systems were in place for the protection of residents from financial abuse. Residents were allocated a lockable cash box and detailed records were maintained of income and expenditure, There has been no safeguarding adults referrals since the last key inspection. Local multi - agency safeguarding adults procedures were in place also internal abuse procedure and whistle- blowing procedure. Not all staff had received safeguarding adults training which was proving difficult to source. The Croft DS0000013619.V357938.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): People in this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Standards: 24, 25, 26, 27, 28, 29, 30 An upgrading and refurbishment programme is ongoing to address shortfalls in standards relating to the environment and ensure the suitability, safety and comfort of the environment to meet residents’ changing needs. The home was clean and hygienic. EVIDENCE: The location of the home is suitable for its stated purpose. The environment is accessible and safe and there is an ongoing programme of upgrading and refurbishment. In recent years a two-storey extension was added providing additional single bedroom accommodation within the home’s existing numbers; this also providing more communal space. A ground floor shower room had been refurbished, a wet room added and a platform lift installed. This has substantially improved the home’s facilities, enabling needs to be met and facilitating safe moving and handling practice. It was noted further work is planned to resolve the drainage problem in the wet room. Safety measures were in place in the interim including use of a shower chair in this area. A programme of upgrading all bathroom and toilets facilities had been completed The Croft DS0000013619.V357938.R01.S.doc Version 5.2 Page 21 including new floor coverings. Other improvements include replacement of part of the roof though further attention planned following reports of further leaks. A terraced furnished area has been completed at the front of the building with ramped access, providing a safe and suitable area for residents to sit outside. The home was clean and tidy for the time of day. The cleaner had a planned day off which was exceptional and support workers required to undertaking basic cleaning tasks. The floor covering in the utility room had been replaced and a new washing machine purchased. Major work had also been completed to resolve the uneven floor covering in the dining room. A redecoration programme is ongoing and we were informed the lounge areas are to be redecorated this year and new carpets laid. Improvement has been made to lighting. Also to safety by fitting gates to the side of the building, restricting cars from accessing this area which is used by vulnerable residents for sitting outside and crossing to and from the home on their way to the on-site day centre. Action had been taken following the recommendation of an occupational therapist to improve the safety of the access to the lift. A defect was noted to the interior light in the lift, which the home’s maintenance person was aware of and said to be receiving attention. Four bedrooms were sampled and all where nicely personalised, clean and safe. Those residents who could manage use of keys were supplied with keys to safety locks fitted on their bedroom doors. Restrictors were fitted to windows and covers to radiators throughout the building. Hot water temperatures were safely regulated and monitored and odour control was well managed. The Croft DS0000013619.V357938.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): People in this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Standards: 31, 32, 34, 35 Mostly staff recruitment and vetting procedures ensure the protection of residents though a shortfall in vetting procedures identified. A rolling programme of staff training was ongoing. Some gaps in statutory training exist and the manager noted to be actively trying to source this training. EVIDENCE: Staffing levels remained the same as at the time of the last key inspection and staff expressed the view that these were adequate though this could change upon the discharge of a resident currently in hospital. Care and support hours are flexibly organised, dependent upon the activities of residents, numbers attending day centres and of those remaining in the home. We were told that wherever possible, effort is made to have five support workers on duty at peak times during the waking day, though this can at times reduce to four. Two cooks work across the week and a cleaner is employed six days a week. The home manager is supernumerary to staffing levels. Night staffing levels remain two awake and one sleeping on the premises. The home has dedicated night staff, though some day staff undertake sleeping- in duties and staff are required to be flexible with their shifts to cover absences and needs of the service. Use of agency staff is permitted where necessary. The agency used The Croft DS0000013619.V357938.R01.S.doc Version 5.2 Page 23 has confirmed staff all statutory vetting checks have been undertaken for agency staff and they have received all statutory training. There were no staff vacancies at the time of the inspection. Some turnover in staff had taken place since the last inspection. The files of three staff were sampled and evidence found of all necessary vetting and good practice procedures for two new staff. The omission to obtain two references for another was identified also the need to obtain a current photograph of a staff member which must be kept on file. Improvements to recruitment procedures included a revised application form and recruitment checklist. Discussions with staff and residents and observations of care practice confirmed staff have a clear understanding of their role and responsibilities and the home’s stated purpose. The team coordinators stated that teamwork was much improved of late. Issues and problems with individual staff had been causing divisions and affected team working however these problems had been managed effectively and resolved. A new induction format had been introduced and workbook. Shortfalls in statutory staff training were identified during this inspection. The manager had already identified these gaps and stated to be pursuing training courses to address the same. Recent training included a four- day first aid training course attended by the manager and a team coordinator. Other staff had already received this training. There was stated to be ongoing dementia training. Improvement was necessary in record keeping for staff training. A central record of training was in place though not all training had been transferred. The team coordinators were responsible for this work and acknowledged this shortfall. We were told that 90 of the team had NVQ qualifications in care at level 2 or above. It was noted that four staff were undertaking quality and diversity training through a college. Both team coordinators and a member of night staff had also recently undertaken fire marshal training. The Croft DS0000013619.V357938.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): People in this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Standards: 37, 38, 39, 41, 42 The home manager had been registered since the last key inspection. Positive improvements were found in the home’s management and administration. Quality assurance systems are effective and inclusive of residents and their representatives. Whilst residents’ health, safety and welfare is promoted and protected by the homes policies and procedures and most practices, shortfalls in this area were identified. EVIDENCE: Since the last inspection the home manager has been registered. The manager is suitably qualified and had recently attained the registered managers award qualification and NVQ Level 4 in the management of care. The responsible individual was stated to visit regularly and employs a care consultant who visited the home every two weeks. The consultant also undertakes monthly statutory visits on behalf of the responsible individual and her findings are documented in reports available to the manager at the home. These were sampled during this inspection. The Croft DS0000013619.V357938.R01.S.doc Version 5.2 Page 25 The new management structure comprised of a full-time manager and two fulltime team coordinators. Discussions with staff indicated that they found the new management structure supportive. The manager has told us that the team responded well to changes in management and teamwork was stated to have improved. At the time of the inspection visit both the registered manager and the responsible individual were on leave. Acting management arrangements had been made and a team coordinator designated responsible for the home’s management. She stated she had the support of the care consultant who was contactable on a 24- hour basis. The second team coordinator arrived during the morning. This had been prearranged to enable the ‘acting’ manager to attend a review meeting at the home. The ‘acting’ manager competently and calmly facilitated both the inspection process and preparations for this review meeting. She was observed to provide staff with clear direction and guidance, ensuring effective management of the home. Her approach fostered an atmosphere of openness and respect and she provided staff with a good role model in her practice. Both team coordinators demonstrated a good knowledge of residents’ needs. Since the last inspection a fire audit had been undertaken by a fire officer and some changes implemented to the home’s fire-evacuation procedures. There was now a designated ‘holding’ area for evacuation, fire evacuation chairs had been purchased and seals fitted to all fire doors. Other areas of discussion included an incident in which the lift had been stuck between floors whilst occupied. Though staff had been shown how to deal with such an emergency, they did not follow the correct procedures. Since then all staff said to have received further training in the emergency procedures for lift breakdowns. A notification of this incident had not been made to us; additionally it was not evidenced that RIDDOR notification had been made to the Health and Safety Executive regarding the lift incident or the two recent falls in which residents’ sustained serious injuries. The home manager is reminded of the statutory requirement to notify us of all events affecting the welfare of residents. Guidance is available on out web site to support managers in judgements about incidents that must be notified to us. It is acknowledged that the home does not have a history of failure to comply with this regulation. Records examined included maintenance and fire safety records, risk assessments and residents’ financial records. Other areas for improvement identified to be necessary are in respect of staff recruitment and training and risk assessments relating to the management of seizures. The Croft DS0000013619.V357938.R01.S.doc Version 5.2 Page 26 The home’s management routinely carries out risk assessments and audits. It was suggested that the environmental health and safety assessment incorporates risk assessment of the access to the terrace near the front door. Whilst acknowledging this is not used by residents to access the terrace there is the potential for visitors and residents to fall over trip hazards left by the finish in this area, which is next to the front entrance. The Croft DS0000013619.V357938.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 2 33 x 34 2 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 x LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 3 2 3 3 2 x 2 x The Croft DS0000013619.V357938.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA35 Regulation Requirement Timescale for action 29/04/08 2. YA37 3. YA37 18(1)(a)(C)(i) For a programme of staff training to be instituted to ensure staff receive all outstanding statutory training and refresher training, including safeguarding adults training. 37(1)(e) For notification of all events that adversely affects the well-being or safety of any resident. 19(10(b) For staff recruitment Sch 2 procedures to be more robust ensuring all statutory information and documents obtained on all applicants. 01/03/08 01/03/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Croft DS0000013619.V357938.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Croft DS0000013619.V357938.R01.S.doc Version 5.2 Page 30 - 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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