Inspection on 31/10/08 for The Croft

This inspection was carried out on 31st October 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Croft 29/02/08

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

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Dovedale Court

Lyncol House

Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

CARE HOME ADULTS 18-65 The Croft Buckland Road Reigate Heath Surrey RH2 9JP Lead Inspector Jane Jewell Unannounced Inspection 31st October 2008 10:00 The Croft DS0000013619.V373721.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.V373721.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.V373721.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 Ltd Miss Susan Annette Berner Care Home 18 Category(ies) of Learning disability (0) registration, with number of places The Croft DS0000013619.V373721.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 18. Date of last inspection 29th February 2008 Brief Description of the Service: The Croft is a care home providing accommodation and personal care for adults with a learning disabilities, including some people who are over the age of 65 years. The home was opened in 1991. The premises are a large converted Edwardian 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, comprise 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. The fees for residential care are currently £570 to £1600 per week, depending on the services and facilities provided. Extra such as: newspapers, hairdressing, chiropody, transport , toiletries are additional costs. Refer to the homes literature for the actual amounts charged for any additional costs. The Croft DS0000013619.V373721.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 Two star. This means the people who use the service experience Good quality outcomes. The information contained in this report has been comprised from an unannounced inspection undertaken over six and half hours and information gathered about the home prior and following to the inspection. The manager had completed an Annual Quality Assurance Assessment form prior to the inspection and the information contained in this document has been used to inform the inspection of the home. The inspection was facilitated by Susan Berner (Registered Manager). The inspection involved a tour of the premises, observation residents and their interactions with staff, examination of records and discussion with residents and staff. There were seventeen residents living at the home at the home at the time of the inspection. Following the inspection seven relatives were contacted about their experiences of the home. The focus of the inspection was to look at the experiences of life at the home for people living there. Signs of resident’s well-being/ill-being (terminology used for observing behaviour for people who do no use verbal communication) were observed in order to make Judgements about their experiences and wellbeing. In order that a balanced and thorough view of the home is obtained, this inspection report should be read in conjunction with the previous inspection reports. The Inspector would like to thank the residents, staff and management for their assistance and hospitality during the visit. What the service does well: The home meets the needs of older residents who enjoy a relaxed lifestyle and slower pace of life. Services are designed to provide appropriate care and support in ways, which maximise independence and choice for the residents. The dependency of individual residents and the collective group continues to steadily rise owing to the ageing process and associated health conditions and the home continues to aim its services and facilities accordingly. All residents observed demonstrated well being signs and those consulted with spoke positively about their life at the home and included the following comments: “I like to live here I can do what I like” “I prefer living her as I have my own room and the staff are kind” and “nice place to live”. A sample of comments made by relatives regarding their experiences included: “Very good care home” “happy with everything they do always seem to have his best interest at heart” “so lucky to have got a place at the croft as she is so well The Croft DS0000013619.V373721.R01.S.doc Version 5.2 Page 6 looked after there” and “he seems to really enjoy living there always seems to be busy”. Resident’s benefit from a good care planning process, which provides up to date and accurate information about their needs and the supported needed to achieve them. Resident’s benefit from personal and health care support that is individual, respects their privacy and dignity and encourages them to remain as independent as possible. Relatives commented: “since she has been at the croft she has flourished, talks more, is more independent a lot is done to provide stimulus in her life” and “a real positive is that they really respect individuality and privacy”. Links with families are positively promoted and supported. All relatives consulted with spoke of being able to visit at any reasonable time and being made to feel welcome. A sample of their comments included: “very free and easy can come and go as I please treated like one of the family often invited to stay for supper” “Doors always open we can go whenever we want” “We can go any time the only problem is finding a time that she is not doing anything as she always seems to be going out or doing something”. Residents live in a clean, homely environment, which has been decorated and furnished to a good standard with their bedrooms furnished and decorated according to their individual lifestyles. A resident said “I really like my bedroom I have my own TV”. A relative commented: “generally speaking the environment very good with the improvements made to the lounges even better”. The staff group includes a core group who have worked at the home for many years. Their experience, together with training indicates that they have a good level of competence and are motivated and committed to supporting residents. Comments about staff included: “the stability of the staff team and manager is the main contribution to the home working well” “staff stay a long time this a real positive” very good excellent very caring” and “Staff very friendly they do the best job possible”. Resident’s benefit from a well-motivated and knowledgably manager who promotes good care practices, leadership and runs the home in the best interest of residents. What has improved since the last inspection? The home continues to undergo a gradual programme of refreshment which has involved the redecoration and new carpeting of the lounge areas to a good standard. The Croft DS0000013619.V373721.R01.S.doc Version 5.2 Page 7 All of the previous shortfalls in practices noted a the last inspection have been addressed. This has improved residents safety through more robust recruitment practices. The management of training has improved which has involved staff undertaking more training. 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.V373721.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.V373721.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): 1 2 3 4 and 5 People who use the service experience good, quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides both prospective and existing residents with a range of accessible information about what services are provided and what to expect when living at the home. The home is able to identify and meet the needs of residents. The way in which prospective residents would be assessed ensures that the home admits EVIDENCE: There is a range of accessible information about the home and the services it provides, this includes a statement of purpose and service user guide which are available at the home and given to prospective residents, their representatives and other interested parties. Some of the homes literature is in a pictorial format for ease of understanding. To further improve the information available to prospective residents the manager felt it would be beneficial to further update the statement of purpose to make clearer the aims and objectives of the service and include the full range of services and facilities being offered at the home. The Croft DS0000013619.V373721.R01.S.doc Version 5.2 Page 10 There have not been any new admissions to the home in the last twelve months, therefore this standard was assessed in respect of the admission procedure for any future prospective residents. The manager was aware of the admission criteria for the home and knowledgeable about admissions practices that would ensure a comprehensive range of information is gathered about prospective residents. This would then inform their decision whether their needs could be met at the home. There are also policies to ensure an effective pre-admissions process and moving in plans. Residents ages range from 56 years to 83 years, the majority of residents are assessed as having low to medium level of need. Five residents are assessed as having high complex needs. Three residents were described as having dementia. Through observation, looking at records and speaking to relatives, evidence was gathered that the home is meeting the range of residents needs. All residents observed demonstrated well being signs and those consulted with spoke positively about their life at the home and included the following comments: “I like to live here I can do what I like” “I prefer living her as I have my own room and the staff are kind” and “nice place to live”. A sample of comments made by relatives regarding their experiences of the home included: “Very good care home” “happy with everything they do always seem to have his best interest at heart” “so lucky to have got a place at the croft as she is so well looked after there” and “he seems to really enjoy living there always seems to be busy”. The manager stated that prospective residents are provided with the opportunity to visit the home in advance to assess the quality, facilities and suitability of the home with their family and representative. The length and type of any visit would depend on the individual’s needs and preferences. The first six weeks of residency is looked upon as trial occupancy. Permanent residency is subject to a full review of care needs with the residents their representatives and care manager. Residents are provided with a written contract of terms and conditions of residency with the home which also contains pictures to aid understanding. This is used with residents and their families to make explicit the placement arrangements and clarify mutual expectations around rights and responsibilities. The Croft DS0000013619.V373721.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): 6 7 8 9 and 10 People who use the service experience good, quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Resident’s benefit from a good care planning process, which provides up to date and accurate information about their needs and the support needed to meet them. Services are designed to provide appropriate care and support in ways, which maximise independence and choice for the residents. The home generally balances well the rights of residents to take reasonable risks as part of an independent lifestyle, however clear guidance must be provided for staff on the safe manual handling techniques in order to ensure residents safety. EVIDENCE: The Croft DS0000013619.V373721.R01.S.doc Version 5.2 Page 12 Six individual plans of care were inspected and were found to contain detailed up to date information on resident’s needs and the appropriate guidance for staff on how to support residents to meet these needs. Examples were given where residents have been actively involved in developing their care plans including the use of various communication aids to enable their involvement. There were several examples noted of good practices in the care planning process, this included the development of clear behavioural management plans and the use of pictures to aid residents understanding of the contents of their plans. Changes in resident’s needs and preferences were identified through the regular review of care plans. Annual placement reviews are also held with the placement authorities and residents families. Residents were actively involved in developing written reviews which included pictures of their life at the home. Staff were observed using a variety of communication tools to provide appropriate choices regarding food, drink, activities and personal care. A staff member said that they often make choices on behalf of a resident based on their knowledge of residents’ likes and dislikes. Residents participate in the day to day running of the home in accordance with the range of their individual preferences and strengths. The home is proactive in involving residents in as much of planning their day as possible. One resident was observed involved in light domestic duties and making a light snack. The home has a developed system in place for enabling residents to take responsible risks as part of an independent lifestyle. Core risks faced and posed by residents are assessed and measures to reduce or manage the risk is generally recorded for staff to follow. However an example was noted whereby there was insufficient guidance for staff on the safe manual handling techniques to be used for a resident who was observed being handled inappropriately. To ensure residents safety and promote a consistent approach by staff it has been required that comprehensive manual handling risk assessments are completed which record significant findings and the actions needed to minimise risks. Staff demonstrated an awareness of good practices about confidentiality, ensuring that sensitive information is kept secure and knowledgeable about the circumstances under which information must be shared with management and others. Staff are also aware that residents have the right to ask that some information not be shared with family or others. The Croft DS0000013619.V373721.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): 11 12 13 14 15 16 and 17 People who use the service experience good, quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Resident’s lives are enriched by the promotion of independence, choice and being enabled to live their chosen lifestyle. Resident’s benefit by being supported to maintain relationships with their families. The meals are good offering choice and variety. EVIDENCE: It was clear from reading documents, speaking with staff and from direct observations that residents are given the opportunities to maintain and develop social independence, communication and living skills. A relative said: “since she has been at the croft she has flourished talks more, is more independent a lot is done to provide stimulus in her life”. The Croft DS0000013619.V373721.R01.S.doc Version 5.2 Page 14 Each resident has an weekly plan, which has been developed based on their individual preferences and needs. These plans showed that residents access a range of occupations and activities. This includes attending various day care services. Eight residents were reported to attend the onsite day care centre in the grounds of the home, while others attend services in the local area, or have individual day care provision. Residents and relatives spoke about the holidays that have been organised which residents have enjoyed. On the day of the inspection a Halloween party was being planned for which residents were looking forward to attending. Staff spoke of a range of leisure activities being provided including karaoke, nail painting, visiting local pubs and social clubs, however consistent feedback was received regarding the need for more frequent external activities. One resident has their own car and the home has one mini busses with staff reporting that outings are largely dependent upon the availability of staff who can drive. The manager agreed to review the current situation to identify if any further opportunities for outings could be made available. A resident is supported to keep a budgie and cat at the home, which they were observed positively interacting with. It was evident that residents are actively supported and encouraged to maintain family links through visits to their family, having family visit them at home and through telephone contact. All relatives consulted with spoke of being able to visit at any reasonable time and being made to feel welcome. A sample of their comments included: “very free and easy can come and go as I please treated like one of the family often invited to stay for supper” “Doors always open we can go whenever we want” “We can go any time the only problem is finding a time that she is not doing anything as she always seems to be going out or doing something”. On the day of the inspection, it was observed that the routines of the home were largely reflective of individual needs and their lifestyle. Residents were able to move around the communal space freely, choosing which rooms to be in and what level of company they wanted to enjoy. Staff spoke of the flexibility in daily routines regarding meal times, going to bed, rising and bathing. Meals are prepared by cooks and shopping undertaken by them. It was said that residents are involved in menu planning through residents meetings. A picture board displaying the daily menu did not easily identify the menu options on the day of the inspection. It was said that more relevant food pictures are in the process of being made to help aid residents understanding. All residents consulted with spoke of enjoying their meals, a resident commented “the food is nice I can choose what to have in my sandwiches”. Although the cook said there was no specialist diets individual preferences are The Croft DS0000013619.V373721.R01.S.doc Version 5.2 Page 15 observed. A relative felt that although the home made an effort to reduce the amount of fatty foods prepared this needed to be replaced with more fresh fruit and vegetables. It was reported that no residents are currently involved in meal preparations but some residents do make themselves light snacks. The Croft DS0000013619.V373721.R01.S.doc Version 5.2 Page 16 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): 18 19 20 and 21 People who use the service experience good, quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Resident’s benefit from personal and health care support that is individual, respects their privacy and dignity and encourages them to remain as independent as possible. The recording of medications must be improved in order to further promote residents safety. EVIDENCE: All residents are assessed as needing some level of personal support with five residents described as requiring full personal support. Staff were largely observed providing dignified and sensitive care to residents which helped to maximise choices and independence. With the exceptions of a residents manual handling risk assessment care plans generally contained the guidance necessary to guide staff in the delivery of any personal care needs to help ensure that support was delivered in a consistent way. Staff consulted with showed a good understanding of good practices in preserving resident’s rights to privacy and dignity. Staff were able to give The Croft DS0000013619.V373721.R01.S.doc Version 5.2 Page 17 examples of how they promote these rights in their every day care practices. This was supported by the inspector’s own observations of the interactions between staff and residents and the experiences of a visiting relative who commented “a real positive is that they really respect individuality and privacy”. Another relative spoke of the care taken to ensure that their relative only wears their own clothes and that her personal belongings are not misplaced. Staff demonstrated a clear understanding of distraction techniques to be used to support residents who have more complex behavioural needs, as the home has a no restraints policy. Staff support residents to follow their individual health action plans, these contain a record of any visits or contact with health care professionals. There was evidence of current involvement from a variety of health care professionals including General Practitioners, Psychiatrist, specialist nurses, dentists, opticians and chiropodists. It was clear that where there are concerns regarding the health or welfare of resident’s medical advice and intervention is sough promptly. A relative spoke positively about the high level of support their relative received to recover from a serious health problem. None of the residents are assessed to self medicating. Staff who administer medication undergo training. Although there is an established system in place to record what medication is prescribed and when, records were not always clear as they contained many medicines previously prescribed, and did not always reflect the current prescribed instructions. In order to improve resident’s safety the management of medication administration records (MAR) must improve in order to ensure that they provide clear and accurate guidance for staff. To further promote residents safety it is recommended that additional instructions are provided for staff on the administration of “As required” medication, which make clear the individual requirements for when this medications was prescribed. This is necessary for staff to know when to administer these medicines. Hand written (MAR) charts should be signed and dated by the person recording and in order to fully eliminate the associated risk when copying prescribed instructions onto medication administration records, it is recommended that these records should be checked and countersigned for accuracy by a second member of staff. The manager and staff demonstrated a good awareness of the needs of older people and services and facilities were aimed appropriately for the age range of residents being accommodated. The manager demonstrated a clear knowledge of when a residents needs would go beyond that which the home could safely manage. The Croft DS0000013619.V373721.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): 22 and 23 People who use the service experience good, quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. An effective complaints procedure and appropriate adult protection policies helps to protect the rights and interests of residents EVIDENCE: There is an accessible complaints procedure in place for residents, their representative and staff to follow should they be unhappy with any aspects of the service. Although it is recognised by staff that some residents would require support to make a complaint and were knowledgeable on how they would support a resident to do this. Records of complaints made showed that the homes complaints procedure is followed with all concerns raised taken seriously and appropriately investigated. All relatives and residents consulted with said that they were aware of how to raise any concerns and felt comfortable to do so and that where they have raised minor concerns in the past these have been addressed promptly. The home has written policies covering adult protection and whistle blowing. These make clear the vulnerability of people in residential care, and the duty of staff to report any concerns they may have to a responsible authority for investigation. Staff consulted with have received formal training in safeguarding adults and prevention of abuse and showed an understanding of their roles and responsibilities under safeguarding adults guidelines. The Croft DS0000013619.V373721.R01.S.doc Version 5.2 Page 19 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): 24 26 27 28 29 and 30 People who use the service experience good, quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents live in a clean, homely environment, which has been decorated and furnished to a good standard with their bedrooms furnished and decorated according to their individual lifestyles. EVIDENCE: The location of the home is suitable for its stated purpose with local facilities within walking distance. The environment is accessible and safe and there is an ongoing programme of upgrading and refurbishment. Since the previous inspection the main lounge has been redecorated to a good standard, including new carpets. A relative fedback “generally speaking the environment very good with the improvements made to the lounges even better”. Resident’s bedrooms are highly individualised reflecting their tastes and lifestyles. A resident said: “I really like my bedroom I have my own TV” Communal space consists of a large interconnecting lounge, dining room and The Croft DS0000013619.V373721.R01.S.doc Version 5.2 Page 20 kitchen with much thought having been given to creating a domestic environment. The home is set in its own grounds with woodland at the back with the front set to lawn and a veranda which has seats and where resident’s access in warm weather The home is presented across three levels with level access to the first floor via a shaft lift, many of the top floor rooms are currently used for storage or offices. There are sufficient number of toilets and bathrooms located around the home which include two assisted baths and one standard bath. The home provides a range of individual aids and adaptations to assist resident’s mobility and independence, including height adjustable beds, ramps grab rails and individualised seating. Care plans showed the occupational therapy guidance on how to use specialised equipment safely and effectively. All areas seen were observed to be cleaned to a good standard, a relative commented “it is always kept very clean. Systems are in place for the control of infection and staff consulted with have been trained in this area and were observed to be working in ways that minimised the risk of infection, by wearing gloves and aprons when required. It was said that three commodes are currently in use and practices put into place to ensure appropriate infection control. The Croft DS0000013619.V373721.R01.S.doc Version 5.2 Page 21 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): 31 32 33 34 35 and 36 People who use the service experience good, quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The staff group includes a core group who have worked at the home for many years. Their experience, together with training indicates that they have a good level of competence and are motivated and committed to supporting residents. Staff are employed in sufficient numbers as is necessary to meet the needs of residents and who are robustly recruited in order to promote residents safety. EVIDENCE: Staff and relatives felt that there was usually sufficient numbers of staff on duty for staff to undertake their roles in a timely manner and for residents to receive the support they needed, when they wanted it. However consistent feedback was received on the negative impact that staff sickness has had on being able to ensure minimum staffing levels are always maintained. The manager was proactive in managing sickness levels in order to reduce any impact for residents. A sample of comments made about staff included: “Good staff who are always helpful polite” “very good excellent very caring” and The Croft DS0000013619.V373721.R01.S.doc Version 5.2 Page 22 “Staff very friendly they do the best job possible”. It was observed through the inspection that staff understood their roles and had a good rapport with residents and planning skills. The tasks of the day appeared well-organised and individual staff appeared confident in carrying them out. This helped ensure that residents knew who would be supporting them. Although staff were clear on who they were a key worker with and what this role involved, residents and their relatives were not always so clear. A relative spoke about the impact on their relative consistency of care due to what they felt was the number of key worker changes. The manager acknowledged that there had been some turnover of staff recently but felt that this had had minimal impact on residents and they were in the process of recruiting more staff. There is a core group of staff at the home that have worked there for a number of years and who residents and their relatives felt ensured that this promoted consistency of care. Two relatives commented: “the stability of the staff team and manager is the main contribution to the home working well” and “staff stay a long time this a real positive”. Less than the recommended number of staff have obtained a national recognised qualification in care. The manager is being proactive in trying to address this. . The personal files of four staff were inspected and these showed that the shortfalls in recruitment practises noted at the last inspection have been addressed. Records now show that a good recruitment process is followed which includes the use of an application form, interviews, Criminal Records Bureau (CRB) checks and written references prior to employment commencing. In line with previous requirement a training and development has been developed which highlights staff training undertaken and the training necessary to meet the service aims and residents assessed needs. Staff consulted with spoke of having undertaken all of the mandatory training necessary for them to work safely with residents. And had also undertaken some specialist areas of training including epilepsy, learning disability and dementia. To further improve staffs knowledge of residents assessed needs it was highlighted that some mental health training might be beneficial, which the manager spoke of looking into further. There is a programme of formal staff supervision which included addressing performance and attendance issues. Staff consulted with said that they received regular supervision with the manager and felt supported to be able to undertake their roles. The Croft DS0000013619.V373721.R01.S.doc Version 5.2 Page 23 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): 37 39 42 and 43 People who use the service experience good, quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Resident’s benefit from a well-motivated and knowledgably manager who promotes good care practices, leadership and runs the home in the best interest of residents. The home regularly reviews aspects of its performance through a program of self-review and feedback. A range of regular health and safety checks helps to promote the health and safety of residents and staff. EVIDENCE: The manager has worked at the home for a significant number of years in various positions and has been the registered manager for one year. They hold The Croft DS0000013619.V373721.R01.S.doc Version 5.2 Page 24 the recommended management qualifications and have undertaken ongoing training to keep updated in best care practice issues and changes in legislation. They demonstrated a clear understanding of the daily running of a care home for people who have a learning disability. They have been instrumental in improving practices at the home over the previous eighteen months. All persons consulted spoke positively about the manager with particular reference to their approachability. A sample of comments included: “known her a long time, easy to talk to acts on things promptly and listens” “very good always approachable she does a brilliant job” and “easy going”. The owner of the home was stated to visit regularly and employs a care consultant who visited the home regularly. The consultant also undertakes monthly statutory visits on behalf of the responsible individual and completes a comprehensive report about their visit and their findings, which is used to highlight areas of good practices as well as areas for further service development. There are also several other mechanisms in place for the manager to obtain feedback on the services of the home and whether it is achieving its aims and objectives. These include: annual placement reviews, residents and staff meetings, written feedback from relatives. Examples were noted whereby improvements to working practices and the environment have been made based on this feedback. Written guidance is available on issues related to health and safety. Records submitted by the manager prior to the inspection stated that all of the necessary servicing and testing of health and safety equipment has been undertaken. Systems are in place to support fire safety, which include: regular fire alarms and emergency lighting checks, staff training and maintenance of fire equipment and fire drills were reported to have been undertaken. The manager reported that a fire risk assessment has been undertaken by a fire safety consultant. This records significant findings and the actions taken to ensure adequate fire safety precautions in the home. The Croft DS0000013619.V373721.R01.S.doc Version 5.2 Page 25 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 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 2 3 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 3 2 3 3 x 3 x x 3 3 The Croft DS0000013619.V373721.R01.S.doc Version 5.2 Page 26 YES 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 Standard YA9 Regulation 13(4)(c) Requirement That comprehensive manual handling risk assessments are completed for all service users which are reviewed regularly and records significant findings and the actions needed to minimise risks. That there are arrangements in place for the adequate recording and safe administration of medicines at the home to ensure that service users receive medication in accordance with their prescribed instructions. Timescale for action 28/02/09 2 YA20 13(2) 30/01/09 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 YA20 Good Practice Recommendations That Hand written (MAR) charts should be signed and dated by the person recording and in order to fully eliminate the associated risk when copying prescribed instructions onto medication administration records, these records should be checked and countersigned for accuracy DS0000013619.V373721.R01.S.doc Version 5.2 Page 27 The Croft by a second member of staff. The Croft DS0000013619.V373721.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone 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. 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