CARE HOME ADULTS 18-65
The Croft Nursing Home (Barrow) Hawcoat Lane Barrow In Furness Cumbria LA14 4HE Lead Inspector
Marian Whittam Unannounced Inspection 22nd November 2006 10:00 The Croft Nursing Home (Barrow) DS0000006138.V310058.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 Nursing Home (Barrow) DS0000006138.V310058.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 Nursing Home (Barrow) DS0000006138.V310058.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service The Croft Nursing Home (Barrow) Address Hawcoat Lane Barrow In Furness Cumbria LA14 4HE 01229 820090 01229 431645 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) The Croft Care Trust Mrs Carol Gillian Shirley Care Home 23 Category(ies) of Learning disability (23), Physical disability (23), registration, with number Physical disability over 65 years of age (6) of places The Croft Nursing Home (Barrow) DS0000006138.V310058.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home is registered for a maximum of 23 service users to include:*up to 23 service users in the category of LD (Learning disability), *Up to 23 service users in the category of PD (Physical disability), *Up to 6 service users in the category of PD(E) (Physical disability over 65 years of age) 20th February 2006 Date of last inspection Brief Description of the Service: The Croft Nursing Home is a purpose built home providing nursing and personal care for 23 people aged over 18 years, with either a physical or a learning disability. The home is run and operated by the Croft Care Trust, a registered charity. The home is in a residential area on the outskirts of the town of Barrow in Furness. The home is set back from the road in landscaped gardens and is on local bus routes and close to local amenities. The home is within the same grounds as the Croft Village residential care home, which provides accommodation in bungalows for less dependant service users with physical and learning disabilities. Both homes share the facilities of workshops, tuck shop, clubhouse, resident’s chapel and landscaped gardens. The gardens are accessible to wheelchair users and have seating and barbeque areas for residents. All the 23 bedrooms in the home are single occupancy and 15 of these have en suite facilities. The home is on two floors and there is a passenger lift and a stair lift. The home has ample communal space, a hydrotherapy pool, a light and sound stimulation room, treatment room for residents and a private room for family meetings or social worker reviews. Fees payable at the home range from £450.00 (Residential) to £650.00 (Nursing) a week as at 22nd November 2006. There are additional charges for newspapers and magazines, personal toiletries and sweets. The home makes information about its services available through its service user guide and statement of purpose. These and previous inspection reports are available in the home. The Croft Nursing Home (Barrow) DS0000006138.V310058.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This key unannounced inspection took place on 22nd November 2006. The inspector looked around the home and spoke with the Executive officer, Responsible Individual, the manager, residents and with staff members including the cook, domestic and laundry staff. Staff recruitment records, training records, medication handling records and care plans were examined and a selection of other records required by regulation. Time was spent observing staff and residents activities and interactions during the day. Information about the home and its services, asked for by the Commission for Social Care Inspection (CSCI), before the inspection was provided. Before the visit information was also gathered on the service from records of previous visits, notifications and other regulatory activity. Questionnaires from residents and relatives about the service, provided by CSCI, were returned before the inspection took place and also provided information about their experiences of the home What the service does well:
The home has an open and transparent approach to management and resident and staff involvement, consequently there is a shared vision of how the home can develop its services to reflect what the residents living there want from their home and care. Throughout the inspection the inspector saw that staff and residents get on well together, that staff know the residents well and interact with them sensitively and as individuals. The home provides a safe, welcoming and homely atmosphere. Attention is paid to detail and in helping residents to choose how they personalise and decorate their own rooms supported by their key workers. There is a high standard of catering with varied menus and a broad range of choice available to residents. The cook takes suggestions and ideas from the residents when preparing menus. Good procedures are followed to ensure that residents are protected through the recruitment and selection of staff and their induction to the home as well as by staff making referrals to other professionals for information and support when needs change or when issues are identified. The implementation of a clearly person centred approach to planning and providing care that reflects what individual residents want from their care and carers is in place and building on an already holistic approach. The combination offers great potential for resident autonomy and choice that should continue to develop as the system does.
The Croft Nursing Home (Barrow) DS0000006138.V310058.R01.S.doc Version 5.2 Page 6 The home is well staffed with an enthusiastic and highly motivated staff team, who after a period of management uncertainty now display great optimism in the future development of the home. The staff know the resident’s well and the staff are encouraged, by the management team, to come forward with ideas to improve the home and their work and training. One resident said in their questionnaire reply that the home is “brilliant and staff look after everyone very well and do a brilliant job”. Relative’s responses indicate that they have confidence in the home; one saying that they feel their relative is “happy and secure living at the Croft”. Training, professional and personal development are given a high priority by the management team and this is becoming very much a learning culture promoting staff projects and research. The staff are working hard to find opportunities to further involve residents in the daily life of the home and are creative in providing leisure and recreational opportunities for residents, often giving personal time to this. What has improved since the last inspection?
A new management structure is now in place and this has resulted in a flatter hierarchy. The senior management team are clear about their roles and responsibilities and are working closely with the care staff as a cohesive team in developing services for the residents. The new team has made several improvements and changes to what were already effective systems and practices raising the standard even higher. The homes quality assurance practices and the professional development of staff are being given a higher priority indicating that the desire for continued improvement and development of services for residents is driving the changes. The Statement of Purpose has been updated to give a more up to date reflection of services within the home for residents and relatives. The care plans in use are consistently being improved using a person centred approach to planning and giving care that the home is continuing to develop with the residents to improve their quality of life. For the first time recently residents have been away on a holiday from the home with staff to support them in this choice. Improvements to the overall environment for residents are evident in better use of communal space, include opening up the entrance area and conservatory at the front of the home. This has been improved from a closed space that cut those using it off from the rest of the home to an open, welcoming communal space that is regularly used by residents and visitors. Alongside this new offices have been built that provide adequate working space for the staff using them and an additional room for resident’s private meetings with families and social workers and other representatives. The Croft Nursing Home (Barrow) DS0000006138.V310058.R01.S.doc Version 5.2 Page 7 Resident’s bedrooms are being redecorated and re carpeted using colours and materials the residents have chosen and door designs of their choosing denoting their room. Bedrooms are now assessed to provide additional equipment to better meet individual needs, such as overhead hoists. It is the homes policy now that as individuals needs change the necessary equipment and environmental changes are done to their room rather than move them to another room. New moving and handling equipment, especially a bath stretcher and shower chair in addition to existing equipment mean that whatever a residents disability there is safe and reliable equipment for them. Improvements have been made to lighting in the home, to call bells following staff suggestions to make sure there is no part of the home where bells are not easily heard by staff. Magnetic doors have been installed in the redecorated corridors to give easier access for residents moving around the home. Several new items of equipment have been bought for the kitchen. This includes new crockery and cutlery and dining aids, a microwave, deep fat fryer and a new cooker. Staff levels have increased with additional nursing and care staff on duty, allowing more time to spend with residents as on 1 to 1 activities and allowing residents greater choice of activities and going out during the day and at weekends. Staff morale is clearly improved with staff saying how optimistic they are about the home’s future development and what a well supported and open working environment they now have. This home has previously worked hard at achieving the National Minimum Standards and providing good, safe care. Some of the improvements noted during the visit are not the kind you see but about atmosphere, an awareness of equality and diversity and of the individual resident and their aspirations and individual details and knowledge. The management team have a real vision for the home that is all about the resident and their choices and aspirations that has not always been made as clear at previous inspections. Currently the home is taking a hard look at all its systems practices and environment and improving, on almost all levels, on an already good track record to provide in a very real sense a home. What they could do better:
The home has embarked on a broad review and evaluation of practices and systems across the home and through audit, monitoring and consultation are developing for themselves a clear development plan for the home and services to residents. The service has recognised using its own systems what it needs to change or improve and is working towards maintaining very high standards. However as a suggestion for good practice the home should look at checking any handwritten medication charts or changes, signed and dated by 2 staff members as an added safeguard for accuracy.
The Croft Nursing Home (Barrow) DS0000006138.V310058.R01.S.doc Version 5.2 Page 8 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 Nursing Home (Barrow) DS0000006138.V310058.R01.S.doc Version 5.2 Page 9 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 Nursing Home (Barrow) DS0000006138.V310058.R01.S.doc Version 5.2 Page 10 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): NMS 1, 2, 3 and 5 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Resident’s benefit from having their individual needs and aspirations thoroughly assessed and met. EVIDENCE: The home has a Statement of Purpose that gives up to date information about the home. Residents are admitted to the home only following a full needs assessment of their personal and nursing needs. Information and advice is taken from other agencies involved in the resident’s care before admission, such as physiotherapy, wheelchair services and speech therapy. Families and other supporters are also involved in consultations on meeting individual needs. The home obtains copies of social services care management plans for those admitted under such arrangements. Service user plans are developed from the initial assessments done by the home. The home cares for highly dependant people, with a range of complex needs and the assessment process reflects the need for thorough information gathering and consultation. Staff were seen to be able communicate effectively with the residents and are aware of the preferred communication methods of different residents. Projects
The Croft Nursing Home (Barrow) DS0000006138.V310058.R01.S.doc Version 5.2 Page 11 are underway to develop opportunities for residents to express themselves and communicate through the greater involvement of speech and language therapy, more focused use of the stimulation room and now there are higher staffing levels, more 1 to 1 working with residents. A written contract/statement of terms and conditions is given to each resident and/or their families and representatives and a copy is kept on file. The contract/terms and conditions states the responsibilities of the different parties and what is included in the fees. The Croft Nursing Home (Barrow) DS0000006138.V310058.R01.S.doc Version 5.2 Page 12 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): NMS 6, 7, 8 and 9 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. A consistent care planning and assessment system is in place, to provide information for staff on resident’s changing health, personal and social care needs and their individual goals. EVIDENCE: The individual care plans are clear, up to date and are being regularly reviewed. Residents and families are involved in developing the care plans and the work is viewed as the resident’s own property. Information is also gathered for this plan by the key worker, as well as with agencies advising on particular behaviours and/or conditions and a clear social and personal history is developed that is relevant to the resident. This plan includes what they want from personal care and how they like their days to go. Plans seen show the residents view of themselves, their stories and what they want for themselves, given the limitations imposed by individual conditions.
The Croft Nursing Home (Barrow) DS0000006138.V310058.R01.S.doc Version 5.2 Page 13 Clinical risk assessments and personal risk assessments are in place. Assessments outline the approach to risk management and any restrictive effect it may have on the resident. There is evidence in the care plans and from the homes procedures that residents are assessed for potential and already identified risks that might affect their choices and personal freedoms, such as the risks of choking, use of lap straps or where behaviour has been unpredictable. In cases where the resident had been unable to make their wishes clear and in health and financial matters family members and advocates have been involved in supporting them in decisions and getting what they want. All residents also have their own individual medical records. These are their own property and residents take these with them to record their health care needs and views and for professionals to use and write in, with the resident’s permission. The home is in the process of introducing into all care planning these very clear person centred approaches that promote resident’s choices and extends their opportunities to take part in the way the home is organised and run. All staff are being trained in this approach and the home is part of a local group developing this approach to care. The Croft Nursing Home (Barrow) DS0000006138.V310058.R01.S.doc Version 5.2 Page 14 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): NMS 12, 13, 14, 15, 16 and 17 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. Residents have opportunities for leisure activities, personal development and social inclusion that are culturally appropriate to them. EVIDENCE: Residents who want to can attend workshops at the adjoining Croft Village within the home grounds where they can develop craft skills or just make social contact if they want. Other residents go out of the home during the week to the local day centres and meet others and develop skills and interests that way. Some residents have just been on a holiday to Blackpool, choosing the venue and activities whilst there. One resident indicated how much they had enjoyed it and the places they had visited, especially enjoying the zoo. This holiday is the first time that residents have been able to choose to have an independent holiday and participate in such an experience. The home is planning more and is being led by resident’s choices.
The Croft Nursing Home (Barrow) DS0000006138.V310058.R01.S.doc Version 5.2 Page 15 Because there are now more staff available during the day residents have greater choice if they want to go out during the day. The home is actively trying to develop opportunities for greater involvement in the local community by supporting residents to go out more, to use the local pub and cinemas, have meals out, trips out in the bus, holidays and inviting the community in through its fetes and open days during the year and coffee mornings. One such day is due to take place the day after this visit. Some residents have community support workers that enable them to go out more and to shop and visit cafes and have a more varied social life. A full and varied activities programme is produced each month, with resident’s involvement, and displayed on the activities board. The home’s newsletter also carries information on what is going on in the home. Additionally there are activities taking place and organised outside the home that residents can attend, especially seasonal events such as a Family Disco at a local club and the staff, residents and friends Christmas Party at a local hotel. Menus and records of food served show a varied and nutritious diet and records of particular needs and food served. New crockery including appropriate aids to promote independence when eating and cutlery have been bought. In the kitchen the cook showed the several items of new equipment that have improved cooking facilities in the home. The Croft Nursing Home (Barrow) DS0000006138.V310058.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): NMS 18, 19 and 20 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Systems are in place to monitor and meet resident’s changing personal, physical and emotional healthcare needs with clear instructions for staff providing this support. EVIDENCE: The Croft Nursing Home (Barrow) DS0000006138.V310058.R01.S.doc Version 5.2 Page 17 Individual care plans show clearly residents preferences on their personal support, flexible daily routines and care and their personal moving and handling needs, along with assessments and instructions for staff to follow. It indicates what they expect from their personal carers. There are a variety of aids and equipment in use to promote resident’s independence and safe movement around the home and relevant assessments. These assessments indicate a move towards a person centred approach with equipment and aids being provided and improved for each resident as needs change such as overhead hoists in bedrooms and replacing baths with en suite showers where residents prefer this. Several items of bathing and moving and handling equipment have been bought recently to make sure that there is a piece of equipment suited to an individuals need. Advice is taken on how to meet particular needs from specialists such as a physiotherapist specialising in Learning Disabilities and a speech therapist. Residents have their key workers who know them well, know their likes and dislikes and work with them to give the care they want. There is evidence that management and staff have recently, and are still, actively supporting residents with advocates from ‘Mencap’ to gain access to the healthcare they want. Medication systems and storage are well organised and records are clear and up to date with systems in place for recording all medications received and the safe disposal of medicine waste. Medication policies, procedures and practices are subject to audit as part of quality monitoring. As a good practice measure the home should have any handwritten medication charts or changes checked, signed and dated by 2 staff members as an added safeguard for accuracy. The home has a new monitored dose medication system in place and records show staff have had training in using this. The carers also have notes on medication and as required medication checks, indications for use, administration methods and dosages. The Croft Nursing Home (Barrow) DS0000006138.V310058.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): NMS 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a complaint procedure and logging system to make sure any complaints or concerns will be dealt with promptly. Adult protection procedures and staff training help safeguard residents from abuse and harm. EVIDENCE: The home has a satisfactory complaint procedure and this is displayed and available in the home. This has recently been reviewed and is provided in pictorial formats for visual representation that many residents find easier to follow. There are systems for recording and investigating any complaints. One concern raised about some management practices, made before the recent management changes, has been fully addressed by the new management team. There are procedures in place to protect vulnerable adults and for whistle blowing. Multi agency guidance is available for staff in the home. Staff receive training on protecting vulnerable adults and dealing with challenging behaviour and aggression and policies and procedures underpin this. Two senior staff are due to attend a training course run by social services to be able to train staff on adult protection themselves. Questionnaire responses indicate that residents and relatives feel listened to and have faith in the staff to deal quickly with any problems. The Croft Nursing Home (Barrow) DS0000006138.V310058.R01.S.doc Version 5.2 Page 19 All financial transactions are recorded and residents have their own individual accounts and records of spending money. These are checked monthly for accuracy and receipts are retained. The home keeps only small amounts of resident’s spending money securely and individually for residents. The Croft Nursing Home (Barrow) DS0000006138.V310058.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): NMS 24, 25, 26,27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well maintained and provides a well furnished, clean, safe and comfortable environment for residents to live in with the equipment they need to promote mobility and physical independence. EVIDENCE: The Croft Nursing Home (Barrow) DS0000006138.V310058.R01.S.doc Version 5.2 Page 21 The home is well maintained, well decorated, is clean and tidy and has a range of adaptations to suit residents assessed needs. Many residents have their own individually adapted equipment in their bedrooms. Several bedrooms have recently been redecorated arranged according to resident’s wishes and for the use of equipment. Residents choose their decor and soft furnishings with the help of their key workers, several examples of individual choices were seen. Resident’s bedrooms have been altered and improved to meet their individual care and mobility needs and to accommodate the personal things that are important to residents from their flat screen televisions to music centres and items of furniture. Specialist equipment, for moving and handling, bathing and promoting physical independence are provided to meet the individually assessed needs of the residents and to promote independence generally such as weighing scales for wheelchair users. The home has appropriate sluicing and disinfection facilities and a well organised and tidy laundry with an assistant working 5 mornings a week. There is sufficient communal and outdoor space for residents including a clubhouse and places where they could go for more privacy, including a new chapel. There have been significant improvements under the new management structure around the use of shared spaces. There is a monthly premises audit done by a senior carer so maintenance staff quickly deal with any work that needs doing and call systems and lighting have already been improved for residents. A Committee room has been returned to its primary use as a lounge for residents and families and the conservatory at the front of the building has been opened up and merged with the foyer to make a welcoming communal space everyone can enjoy. Also in addition to new offices there is a private room for family meetings or reviews with social workers, as well as the treatment room. Externally the gardens are well kept and attractive with easy wheelchair access for residents. The Croft Nursing Home (Barrow) DS0000006138.V310058.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): NMS 31, 32, 33, 34 and 35 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. There is a well supported and appropriately trained staff team that works well with residents to promote independence and quality of life. EVIDENCE: Staff rotas indicate that sufficient nursing and care staff are on duty both day and night, with a mixture of skills and experience to meet residents assessed needs. The home has taken on more nursing and care staff to improve the carer to resident ratio and free staff to spend more time with residents not just on care. The home does not use agency staff. The home has a high percentage of staff with NVQ level 2 in care, with some carrying on to Level 3, and training and development generally is being given a high priority in the home. The home’s training and development plan for 2006 indicates that a range of training has been provided including first aid and resuscitation, infection control, tissue viability, medication handling and physical intervention techniques. A staff training calendar for 2006 to 2008 has future training and updates already in place and staff receive regular supervision and support to carry out their work effectively.
The Croft Nursing Home (Barrow) DS0000006138.V310058.R01.S.doc Version 5.2 Page 23 The home has robust recruitment records procedures that are being followed to make sure that staff have the necessary Criminal Record Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks before starting work. The home has a clear staff handbook and staff are aware of their roles and responsibilities. The staff group after a period of change has become stable again with some staff that had left returning. Staff who were spoken with are motivated and enthusiastic about their work and the improvements and changes that have been made under the new management team. Some staff are being given the opportunity to look at nursing issues to further develop the service for residents, such as issues like aging and palliative care in this care environment. There are regular staff meetings with staff contributing to the agenda and staff are now much more closely involved in the running of the home as they are with social and recreational activities. The Croft Nursing Home (Barrow) DS0000006138.V310058.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): NMS 37, 38, 39, 41, and 42 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home is well run with systems that promote resident’s personal, financial and safety interests. EVIDENCE: There is a new more open and flatter management hierarchy in place and the team are clear about their roles and responsibilities and have a clear vision for the development of the home and services. There is a clear emphasis on residents influencing the running of the home. As part of this structure there is a new manager, formerly the Deputy Matron, who is registered with the Commission for Social Care Inspection (CSCI) and is The Croft Nursing Home (Barrow) DS0000006138.V310058.R01.S.doc Version 5.2 Page 25 experienced in this area of care and is being well supported by the rest of the management team as they take the Registered Managers Award. Speaking to staff, residents, examining records and development plans and observing the daily running of the home indicates a relaxed and open management style where staff and residents feel a sense of ownership in their home and are confident that they are listened to. A member of the management team is on call 7 days a week to provide support for staff. The home is reviewing its performance and objectives, its policies and procedures and using quality monitoring systems. The home is using satisfaction surveys to residents, families, staff and others involved in the life of the home to gather opinions on the service. This includes specialist nurses, community nurses, trainers coming into the home and GPs to get a broad range of opinions on the service and what they can do better. Resident’s surveys are in a pictorial format for those who prefer this. The home publishes a newsletter to promote information sharing, it has regular staff meetings and resident and family meetings to get opinions and feedback and deal with any issues. Audits are being done on care planning and medication systems, evident in problems being picked up and addressed quickly and in identifying areas to improve. The management team displayed a proactive approach and looks ahead to anticipate difficulties and the need for changes to improve the service and keep practice up to date. The home is shortly to begin a full audit of the service against National Minimum Standards and this will be done on a rolling programme. Management and financial systems in the home are subject to review and there is clear accounting and audit system. The standard of record keeping required by regulation is of a high standard and residents have opportunities to have control over their healthcare and care planning records with support. Records of maintenance indicate that the home has fire training and servicing and testing practices to promote resident health and safety. There was evidence that appropriate testing and servicing of equipment is being carried out and that the home does Legionella and water temperature testing. Insurance cover is in place for the home and is displayed. The Croft Nursing Home (Barrow) DS0000006138.V310058.R01.S.doc Version 5.2 Page 26 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 X 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 3 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 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 3 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 4 15 3 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 3 3 X 3 4 4 X 3 3 X The Croft Nursing Home (Barrow) DS0000006138.V310058.R01.S.doc Version 5.2 Page 27 NO 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. Standard Regulation Requirement Timescale for action 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 The home should have any handwritten medication charts or changes checked, signed and dated by 2 staff members as an added safeguard for accuracy. The Croft Nursing Home (Barrow) DS0000006138.V310058.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP 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
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