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Inspection on 21/02/08 for The Croft Nursing Home

Also see our care home review for The Croft Nursing Home for more information

This inspection was carried out on 21st February 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The service continues to offer 24hr-nursing care to the service users in a warm and caring environment. The relatives and service users spoken to said they felt well cared for and respected by the staff and the meals were always lovely and nicely presented. Care staff spoken to was friendly and they were knowledgeable about the service users and their care. The home has good links with the local GP service and other nurse specialists in the community.

What has improved since the last inspection?

A new Healthcare company has bought the home since the last inspection and some improvements were in place already. Staff files contained most of the information necessary and this was being rectified by the introduction of new staff files. Satisfactory Protection of Vulnerable Adults checks and Criminal Record Checks were evidenced. The Statement of Purpose had been updated to match the requirements of Schedule 1 of the National Minimum Standards. Service users received a letter of confirmation once the preadmission assessment was completed and the service users needs, that were identified, could be met. The shower installation was complete, however the step into the shower was to be lowered prior to use. The operations manager had completed a Regulation 26 visit and the report was evidenced. Hot water testing was completed and signed. The gas fryer identified at the previous visit had been condemned and new fryers had been purchased. Work identified by the fire officer had been commenced and almost completed. The home is to be risk assessed by the companies Health and Safety advisor and action will be taken as necessary.

CARE HOMES FOR OLDER PEOPLE The Croft Nursing Home, 43-44 Main Street Stapenhill Burton On Trent Staffordshire DE15 9AR Lead Inspector Joanna Wooller Key Unannounced Inspection 21st February 2008 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Croft Nursing Home, DS0000022321.V359124.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 Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Croft Nursing Home, DS0000022321.V359124.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Croft Nursing Home, Address 43-44 Main Street Stapenhill Burton On Trent Staffordshire DE15 9AR 01283 561227 01283 562535 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) Tawnylodge Limited Ms Jane Measey Care Home 30 Category(ies) of Dementia - over 65 years of age (2), Old age, registration, with number not falling within any other category (30), of places Physical disability (1), Physical disability over 65 years of age (15) The Croft Nursing Home, DS0000022321.V359124.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 15 PD (E) - 1 may be PD over 42 years Care Manager commences NVQ level 4 in management within 12 months of registration 6th July 2007 Date of last inspection Brief Description of the Service: The Croft Nursing Home is registered to provide personal and nursing care for the following categories- Old age 30 beds. Physical disability aged over 65 years of age, 15 beds. Dementia over 65 years of age 2 beds. Accommodation is provided on the ground floor and first floor served with stairs and a shaft lift. There are 14 single bedrooms and 8 double bedrooms. One bedroom has an en-suite facility and the rest have a washbasin installed. There are three assisted bathrooms and one shower room; toilets are conveniently situated throughout the home. There is a large main lounge, a dining room and a conservatory on the ground floor. The home is located in the residential area of Stapenhill, Burton on Trent and is close to amenities and served by public transport. The home has limited garden areas due to its hilly incline but there is space for several cars to park. Additional charges are made for newspapers/magazines, telephones, toiletries and hairdressing services. The home has recently been bought by Monarch Healthcare but will continue to trade as Tawnylodge Ltd. The central registration team have been informed. The Croft Nursing Home, DS0000022321.V359124.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The overall quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. This unannounced inspection took place on 21st February by the lead inspector. The Manager was in the home and was working in a care role for the day supported by the care staff. The inspection included the following elements; A tour of the building, Observation and inspection of records relating to provision of care, Discussions with several service users in their bedrooms and the lounge, Discussions with several relatives and some staff members on duty, Observation and sampling of other services provided such as catering and laundry, and an inspection of the managerial aspects such as staffing issues, training, recruitment and health & safety. We were made welcome in the home and assistance was given to gain the evidence required for the report. No complaints had been dealt with by Commission for Social Care Inspection since the last inspection. Service Users spoken to at the visit were complimentary about the home. Information about the fees charged was not available during this visit and the reader may wish to contact the service to obtain this. What the service does well: The service continues to offer 24hr-nursing care to the service users in a warm and caring environment. The relatives and service users spoken to said they felt well cared for and respected by the staff and the meals were always lovely and nicely presented. Care staff spoken to was friendly and they were knowledgeable about the service users and their care. The home has good links with the local GP service and other nurse specialists in the community. The Croft Nursing Home, DS0000022321.V359124.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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 The Croft Nursing Home, DS0000022321.V359124.R01.S.doc Version 5.2 Page 7 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Croft Nursing Home, DS0000022321.V359124.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Croft Nursing Home, DS0000022321.V359124.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users have the information they need to make an informed choice about the home. Service users only move into the home when their individual needs have been assessed and a confirmation letter is received to ensure their needs can be met. EVIDENCE: The service now has an updated Statement of Purpose and this will continue to be developed as changes occur. The new service users now receive a letter of confirmation prior to moving into the home, to ensure that their current needs can be met. Service users and their relatives informed the inspector that they were invited to visit the home prior to admission and felt they were informed enough about the home and the services offered. The Croft Nursing Home, DS0000022321.V359124.R01.S.doc Version 5.2 Page 10 The Croft Nursing Home, DS0000022321.V359124.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users health and personal care needs are set out within an individual care plan. Further documentation is required with regard to individual social needs and how they will be met. Medication is administered following the homes policy and procedure to ensure safe practice is followed at all times. Service users are treated with respect. EVIDENCE: The new owners and inspectors (on previous visits) have identified that the care plans require personalisation and more extensive review to ensure that the nursing needs that are being delivered are clearly documented in the care records. There is evidence in the care plan of health care treatment and intervention, and a record of general health care information. The providers have held one accountability meeting with the trained staff to discuss record keeping and care record documentation. The Croft Nursing Home, DS0000022321.V359124.R01.S.doc Version 5.2 Page 12 Service users have access to health care services within the home and the majority are able to choose their own GP. The home is able to provide the aids and equipment recommended, but more attention is to be given to manual handling equipment and the changing needs of service users. Staff encourages individuals to be independent and to take responsibility for their own personal hygiene. Several service users spoken to at the visit commented that the carers are very sensitive to their personal care and show them respect and protect their dignity. Staff are aware of the need to treat individuals with respect and to consider dignity when delivering personal care. The home has a medication policy which is accessible to staff. Medication records are generally up to date for each service user and medicines received, administered and disposed of are recorded. The home has a training plan and intends to train its staff in health care to achieve accreditation. Individuals receiving services at the home are happy with the way that most staff deliver their care and respect their dignity and rights. One lady spoken to at length said “The carers give me time to remain independent but support me with some personal tasks.” However, decisions on how personal care is delivered are not consistently recorded in the care plan. The Croft Nursing Home, DS0000022321.V359124.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users lifestyles experienced in the home appear to match their expectations however more choice should be offered. Service users maintain contact with friends and family and are able to exercise choice over their lives. Service users receive a wholesome balance diet. EVIDENCE: Generally staff are aware of the need to support service users to maintain their skills, including social, emotional and communication skills. Relatives informed us that service users are consulted or listened to regarding the choice of daily activity, but the range of activities offered to the service users could improve this process. The service has a basic understanding of human rights and how this impacts on people using the service. There is some commitment being shown in the areas of respect, dignity and fairness, the relatives spoken to say that the staff is compassionate and friendly to all service users. The Croft Nursing Home, DS0000022321.V359124.R01.S.doc Version 5.2 Page 14 The menu is varied with a number of choices including a healthy option. It includes a variety of dishes that encourage individuals to try new and sometimes unfamiliar food. The meals are balanced and nutritious and cater for the varying cultural and dietary needs of individuals. The storage and preparation areas were found well kept, neat and hygienic. The care staff were seen to be sensitive to the needs of those service users who find it difficult to eat and gave assistance with feeding. They are aware of the importance of feeding at the pace of the service user, making them feel comfortable and unhurried. Several items of equipment were on order for the kitchen which were being dealt with by head office, and the cooks food hygiene certificate was recently out of date and required renewing. The Croft Nursing Home, DS0000022321.V359124.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are confident that complaints will be listened to and that they feel protected from abuse. EVIDENCE: The home has an open door policy that allows service users to express their views and concerns in a safe and understanding environment. Service users feel safe and well supported by the staff and that their protection and safety is highly important. The service has a complaints procedure that is clearly written and easy to understand and it is available on request to help anyone living at, or involved with, the service to complain or make suggestions for improvement. No complaints had been received since the last inspection. The complaints procedure is supplied to everyone living at the home and is displayed in a number of areas within the service. The home keeps a full record of complaints and this includes details of the investigation and any actions taken. Unless there are exceptional circumstances the service always responds within the agreed timescale. The home learns from complaints, and it is rare that a complaint about the same issue is made twice. The policies and procedures for safeguarding adults are available and give clear specific guidance to those using them. There is a clear system for staff to The Croft Nursing Home, DS0000022321.V359124.R01.S.doc Version 5.2 Page 16 report concerns about colleagues and managers. Staff that ‘blow the whistle’ on bad practice are supported by the service and will be respected for their honesty. Training of staff in safeguarding is to be arranged by the management to refresh the staff. Other training around dealing with physical and verbal aggression will also be arranged. The Croft Nursing Home, DS0000022321.V359124.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 20, 22 and 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The service users do live in a safe environment, however issues were noted that the maintenance of the home needs to be improved. The home is clean and hygienic. EVIDENCE: The home was evidenced as being safe, however the home has not been maintained to the standards required by the National Minimum Standards. There are many areas that require refurbishment including the bedrooms, bathrooms and communal areas. The furniture is to be replaced in most areas of the home and this has been discussed with the new providers. The chairs in the main lounge areas are to be replaced to ensure the maximum comfort for the service users. The Croft Nursing Home, DS0000022321.V359124.R01.S.doc Version 5.2 Page 18 The providers are currently compiling an improvement plan for the home, prioritising certain areas. Plans to continue the improvement of the maintenance of the home are being organised to ensure the appearance of the home is acceptable. Service users do personalise their own bedrooms, but consultation for redecoration is to take place when the refurbishment commences. Several pieces of equipment are currently on order to assist the staff and service users with manual handling and assist the individual with their independence. Some beds are to be replaced with profile beds, which will assist the service users with comfort and also support the staff to manoeuvre the service users. The home is clean and hygienic and the staff and service users all commented that the home is always warm and welcoming. Bathrooms, bedrooms and communal areas were clean and tidy and corridors were free from hazards. The Croft Nursing Home, DS0000022321.V359124.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The numbers and skill mix of the staff meets Service users needs and service users feel they are in safe hands. Service users are now protected by the homes recruitment policies and practices. Staff training shortfalls is to be addressed as soon as possible. EVIDENCE: Service users are generally satisfied that the care they receive to meet their needs, but there are times when they may need to wait a short time for staff support and attention. Staffing must be adjusted to ensure that service users needs can be met in a timely manner. There is enough competent and experienced staff to meet the health and welfare of people using the service. The manager recognises the importance of training, but the previous provider has failed to deliver a programme that meets any statutory requirements and the NMS. The manager and the new provider are aware that there are some gaps in the training programme and plans to deal with this. The provider is also able to recognise that additional training is needed, but priority will have to lean towards the mandatory training first of all. The Croft Nursing Home, DS0000022321.V359124.R01.S.doc Version 5.2 Page 20 There is limited understanding of the person centred way of documenting the delivery of care and care plan writing - training is planned to rectify this. All staff is clear regarding their role and what is expected of them. People using the service report that staff working with them know what they are meant to do, and that they meet their individual needs in a way that they are satisfied with. Several relatives spoken to mentioned that the staff is very caring and thoughtful to the service users and the visitors. The service has a recruitment procedure that meets statutory requirements and the NMS. The procedure is followed in practice and there is accurate recording at all stages of the process. The Croft Nursing Home, DS0000022321.V359124.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager is fully aware of her responsibilities and she runs the home in the best interests of the service users. Service users are safeguarded form financial abuse. Staff supervision is to be recommenced and record keeping shortfalls are to be addressed. The health, welfare and safety of service users and staff are promoted but further protection would be given when update training is completed. EVIDENCE: From observations made, discussion with service users, and discussions with the manager and staff, it was evident that the home was being run in the interests of service users. The Croft Nursing Home, DS0000022321.V359124.R01.S.doc Version 5.2 Page 22 Quality Assurance surveys for service users and their representatives is in the process of being sent out, feedback form these surveys will be checked at the next visit. Following discussions with both service users and their representatives it was evidenced that all service users had the opportunity to handle their own finances if they wished to. Inventories of valuables and belongings brought into the home were recorded and kept in the care records. Health and safety issues were checked during this inspection, including a tour of the home. The manager and staff spoken to confirmed that health and safety issues are given a high priority. Documentation was being put in place to ensure that the maintenance of the home would be monitored and appropriate checks made for hoists, baths, service users equipment and electrical equipment. Fire drills were carried out and fire checks made and water temperatures were being recorded. Fire training, manual handling update and first aid training is all to be delivered in the home within the next few months to ensure staff is fully updated. This is being given priority over other training. The Croft Nursing Home, DS0000022321.V359124.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 2 X 2 X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 The Croft Nursing Home, DS0000022321.V359124.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard OP19 OP30 Regulation 23(2) (c) 18(1) Requirement Items of equipment identified in kitchen area must be replaced. Staff training required in Moving & Handling, First Aid and Fire prevention. Work identified in the Fire Officers letter dated 16/05/07 must be carried out. Regulation now met but contact with the fire officer to be made to check work. Timescale for action 21/04/08 21/04/08 3. OP38 23(4)(a) (b) 21/04/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP19 OP36 Good Practice Recommendations The refurbishment of the home should be planned and completed in a timely manner Staff supervision is to be completed and records are to be kept in the home. DS0000022321.V359124.R01.S.doc Version 5.2 Page 25 The Croft Nursing Home, 3. 4. OP30 OP19 The cook’s food hygiene certificate is to be renewed. Inappropriate items stored in laundry, sluice and bathrooms identified should be removed. The Croft Nursing Home, DS0000022321.V359124.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Nursing Home, DS0000022321.V359124.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!