Inspection on 24/02/09 for The Croft Unit

This inspection was carried out on 24th February 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Croft Unit 02/04/07

The Croft Unit 25/04/06

The Croft Unit 26/10/05

The Croft Unit 12/05/05

The Croft Unit 18/01/05

The Croft Unit 28/09/04

The Croft Unit 25/02/04

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Belle Vue Country House

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Croft Unit 25-29 Ashburnham Road Hastings East Sussex TN35 5JN     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Michele Etherton     Date: 2 4 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: The Croft Unit 25-29 Ashburnham Road Hastings East Sussex TN35 5JN 01424434921 01424435895 kiincraft@craegmoor.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Parkcare Homes Ltd care home 12 Number of places (if applicable): Under 65 Over 65 0 mental disorder, excluding learning disability or dementia Additional conditions: 12 The maximum number of service users who can be accommodated is: 12 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: Mental Disorder, excluding learning disability or dementia - MD Date of last inspection Brief description of the care home The Croft Units are registered to accommodate younger adults with a pre senile dementia type illness. The property is detached and is set in a residential area of Hastings. The property is on four floors and the first two floors are registered as Kilncroft, a home for older people with a dementia type illness. The top two floors are separately registered as the Croft Units. Both homes operate independently of each other although there is only one registered manager. The whole building is owned by Parkcare Homes Limited, which in turn is owned by Craegmoor Healthcare Limited. The home is registered for 12 service users. The home has local shops and amenities close by, and is approximately one-mile form the centre of Hastings. The current range of fees are from #450 to #550 per week Care Homes for Adults (18-65 years) Page 4 of 32 Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: A key inspection of this service has been undertaken that has looked at all key standards. This has taken account of information received by us about the service and from the service since its last inspection in 2007 and an Annual Service Review in 2008. A new AQAA to inform our planning and inspection process was not avaialble on this occasion to inform our planning and inspection process. Our inspection of this service has also included an unannounced site visit to the home on 24th February 2009 between 10:25am and 16:45pm. The reader should be aware that for the purpose of this report those living at the Croft unit are referred to as residents. Care Homes for Adults (18-65 years) Page 6 of 32 During our visit to the service we undertook a tour of the premises encompassing both flats that make up the Croft unit, we spoke with staff on duty, the deputy manager and manager and met residents, an expert by experience was asked to participate in this inspection to spend dedicated time with residents and speak with them about their lives and expereinces of living in the Croft Unit, written feedback from the expert by expereince in respect of their findings has been incorporated into this report. Our site vist also included examination of various records including medication , care and staffing and health and safety records. In arriving at our judgement we have tried to be proprotionate in considering complinace with regualtion and outcomes for residents alongside overall risks and impacts of identified shortfalls. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 32 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents benefit from receiving an assessment of their needs prior to admission but the quality of information gathered for this process could be improved upon. Evidence: We spoke with the manager who told us about the assessment process and how prospective residents are visited in their home or placement and where possible background reports are sought and discussion held with existing carers or significant others to inform the assessment process, we looked at four sample files of current residents two of whom have only recently moved in, these provided evidence of initial assessment prior to admission, however the assessment form heading makes reference to the assessment of older people, and we found the overall completion of the form somewhat lacking in detail and content that should inform the development of a care plan. We recommend that the form is revised to make clear the assessment is for younger adults aged 45-65 years and that the content of the questions and information gathered is relevant to the needs of this group and thought is given to how Care Homes for Adults (18-65 years) Page 10 of 32 Evidence: these can be completed more fully. Care Homes for Adults (18-65 years) Page 11 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff demonstrate a good understanding and awareness of individual residents needs and routines but this is not always reflected in support plans for all staff to view. Residents are supported to make individual choices and to experience risk in a safe environment, although how risk has been assessed is not always evident. Evidence: We spoke with and observed some of the residents during our tour of the premises, we spoke with two of the staff who work regularly within the unit and demonstrate a very good knowledge and understanding of individual resident preferences routines and characteristics, any omissions of information within the care plans are compensated by their own knowledge of individual residents,, however, when we spoke with a staff member who was covering for staff absence and usually worked in the unit downstairs, they could not tell us about the individual routines of residents, we are aware from our discussions with unit staff about individual residents how important adherence to specific routines is to maintaining residents general state of mind and day to day Care Homes for Adults (18-65 years) Page 12 of 32 Evidence: experience of living in the home, and we were able to show staff where there are clear gaps within care plan information and their knowledge of individual residents and how important it is for their colleagues and for residents that care plans accurately reflect individual resident preferences, and we recommend that this is addressed within the development of the new care plan formats. We observed staff interacting well with residents offering opportunities for decision making and choice. We noted residents moving freely around the unit and those in the top flat are encouraged to be much more independent making their own drinks and snacks and sometimes helping with preparation and cooking of cakes or light meals, none of the residents go out unaccompanied, residents are encouraged to participate in household domestic activities and enabled to take risks within a safe environment under the supervision of staff, residents are always accompanied when out. There are a range of environmental risk assessments in place but these are developed at organizational level and the manager should ensure these are relevant and specific to the needs and environment of the service. Risk information was in place for some residents but we did not note risk information in place for all activities they participate in e.g swimming, or use of the kettle for a resident in the lower flat where residents have higher dependencies and whilst we would encourage the home to offer a varied and stimulating range of activities and opportunities to residents it is important that risk assessment is undertaken in relation to internal and external activities. Care Homes for Adults (18-65 years) Page 13 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported to access a varied range of activities but will benefit from increased opportunty for stimulation and exercise within the wider community. Greater promotion of individual independence and skills should be implemented. More thought needs to be given to how residents make choices and decisions in their daily lives. A review of menu quality and variety should be undertaken and healthier options considered. Evidence: The expert by experience who spent time with residents and shared their lunchtime meal reports: Excerpt from Expert by Experience visit report Th February 2009 Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: Lunch with residents was a pleasant, relaxed experience, although I was surprised to be served baked beans with my fish & chips! I queried this & was told that the member of staff liked them & so did the residents. To encourage choice & independence, separate dishes with baked beans, peas or even salad could be provided on the tables so that residents could help themselves. Squash was rather watery & presented in plastic beakers. I inquired about the availability of fresh juice & was told that it was available if asked for but there was none in the fridge. Dessert was tinned fruit & cold custard. This was unappetizing. I asked about the availability of fresh fruit & again was advised this is available on request but I never saw any. Bowls of fresh fruit placed on tables would encourage healthy eating but apparently, certain residents hoard it so this had been discontinued. More resources should be made available to provide residents with a healthier, more varied diet. This client group is quite compliant & tends to accept without questioning too much. Apparently residents had chosen to have a main meal at lunch time & sandwiches or similar later but I saw no evidence of a collective decision. Consultation is on a one-to-one basis but residents meetings are not organized regularly. I observed two staff in particular working very hard during my visit but still finding time to talk to residents, checking they were OK & having a laugh & a joke with them. Residents obviously appreciated this & joked back, creating an easy, relaxed atmosphere. Comments made were the staff are all my friends & they do everything for you. This is encouraging but residents could be given more choices & supported to make decisions for themselves. Activities undertaken by residents included supervised outings & swimming every week. Residents would benefit from more community-based activities. Gym, dance or singing classes could be organized. Physical activities such as these have a pr oven beneficial effect on health & well-being. Residents go out for meals regularly & a takeaway is ordered once a week. The home would benefit from the use of a car for transportation as over reliance on taxis can be costly & inconvenient for residents. In conclusion, residents experience a good quality of life at this home but improvements need to be made to the environment & support provided to staff to maintain this. Independence needs to be actively promoted with access to community activities facilitated. Residents need to be consulted more to assess their group & individual needs. Improvements could be made to improving the quality of food provided. Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: Residents seem happy & healthy due to the care & support given by staff under sometimes difficult conditions. Care Homes for Adults (18-65 years) Page 16 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The personal, emotional and physical care needs of residents are well supported. Evidence: Staff we spoke with demonstrate a detailed knowledge and understanding of individual residents personal routines although this is not always adequately reflected in support plans for other to view. The home ensures that residents have access to routine health checks as required and liaise with other health professionals on their behalf. Nutritional screening weight monitoring, skin viability and continence assessments are undertaken and where necessary falls monitoring implemented. The home manager informs us that they are actively working with funding authority representatives to ensure capacity assessments are developed. The manager informs us that the home has actively sought the review of medications taken by residents to ensure they are not over medicated and as such most residents Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: are on a low level of prescribed medication which includes vitamin supplements for those whose condition requires it. We looked at storage for medication, the manager advises that currently no controlled drugs are received into the home and the medication storage is therefore adequately secure but in the event of controlled drugs being more frequently stored consideration should be given to ensuring the storage of such medication is in keeping with the requirements of the Medicines Act 1968 and the Royal Pharmaceutical Guidelines for Administration and Storage of medicines in Care Homes. The low level of medications for most residents has meant the home has not actively developed individual PRN guidelines for residents or medication profiles and we recommend these are implemented to ensure consistent administration of PRN medications and to inform staff about the reasons for resident medications and any side effects or preferences in respect of administration that need to be taken note of. In reviewing Medication records we noted these to generally be completed to a good standard with only one resident record where four recording omissions were noted, an audit of medication indicated that medication had been given but not signed for at those times and this has been discussed with the manager, a medication audit is informally conducted monthly and we have recommended that MAR sheets are checked weekly for accuracy so that any mistakes or recording omissions can be addressed quickly. We have also recommended as a good practice that any medication that is prescribed and is not contained with thin the MDS system e.g boxes and bottles drops or creams is dated upon opening. Care Homes for Adults (18-65 years) Page 18 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are listened to but are not able to express their concerns formally, systems are in place to safeguard residents from harm, but staff would benefit from improved guidance around managing behaviors Evidence: The AQAA information provided by the home tells us that no complaints have been received by the home since the last inspection and this was confirmed with the manager at inspection. In discussion with staff we were made aware that on the whole residents do not actively complain but do on occasion express minor concerns which are termed moans and groans but although staff may take action in response to these no record is retained, Staff confirmed that following the last inspection they had received an in house lecture about the complaints procedure and they reported a good understanding of their role and responsibilities in reporting complaints and safeguarding issues but recognize that they may need to be more actively advocating for residents around complaints issues where they may no longer have capacity to take this forward themselves. The expert by experience commented: I spoke with several residents & they all expressed contentment with life at the home & had no complaints. They had a good relationship with staff & felt able to discuss any concerns with them. Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: Since the last inspection there has been one adult safeguarding issue and this has been appropriately reported and investigated although delays in the notification of agencies has been discussed with the manager and reported on elsewhere in this report. None of the residents manage their own money and capacity assessments are underway to support this practice, most residents have small amounts of change that they may keep from outings where they have spent money but any such expenditure is taken out of petty cash and receipts are kept and residents representatives invoiced. The manager advises that residents responsibilities for meeting the costs of some transport and activities is made clear within contractual arrangements although this has not been checked on this occasion. Our discussions with unit staff highlighted some incidents of resident aggression, and staff informed us that they have been provided with training in interim intervention, which they found clear, easy to follow and helpful in their day to day management of situations. An examination of records relating to specific residents who have shown both physical and verbal aggression provided no guidance to staff for the individual concerned as to how specific behaviors are to be managed to ensure consistency in the way this is done and we recommend these are implemented and that all relevant parties are involved and in agreement. The home manager has been advised to ensure that copies of capacity assessments are maintained with in resident records and are subject to regular review. Care Homes for Adults (18-65 years) Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a homely and comfortable environment that will benefit from planned upgrading and improvements to reduce odour. Evidence: The service is made up of two flats which take up the upper two floors of the building the lower floors are given over to Kilncroft a service for older residents with dementia. Access to the Croft Unit can only be made via the front door to the Kilncroft unit downstairs. The expert by expereince who joined our site visit during the course of the morning has commented I rang & knocked at a door signed Croft Unit to no avail so moved on to what appeared to be the main entrance. A sign with an arrow directing visitors to the main entrance would be useful, Staff have tried to make the unit homely for the residents and where residents have no relatives and limited personal possessions staff have ensured that the resident has photographs in their room of themselves with other residents whilst out in the community to help personalize it. The expert by expereince present during the visit commented that: Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: Residents bedrooms were comfortable, bright & well-decorated, some with lots of personal touches according to taste. There were photos & pictures throughout the home & the lounge was comfortable, with a lovely homely feel. However, some redecoration is needed & old furniture needs replacing. The kitchen was modern & well-appointed incorporating a small but pleasant dining area. Bathrooms were clean & bright but there was a lack of shower cubicles. Residents should be given a choice of bathing facilities. One toilet was not working & one was hard to flush, creating an unpleasant smell. Repairs need to be carried out before the health & safety of staff & residents is compromised. Toilet rolls were missing from several toilets despite a member of staff saying she was addressing this. I returned some time later to find this had still not been done. This is a basic requirement & simply remedied & residents should not have to compromise their dignity & ask for a toilet roll every time they need to use the toilet. Whilst there has been some redecoration and minor works undertaken the overall appearance of the unit is somewhat shabby e.g. we found carpet in the hallway stained and worn, a shower curtain rail had gone rusty, a window handle in a bathroom was broken, the unit we understand is due for some planned upgrading, but in discussion neither the manager or staff could give confirmation of when works are due to begin although assessment for this work has been carried out but no firm timescales are yet in place, we consider that the environment is long overdue and have required confirmation of the planned dates for works to commence. Residents have previously made known their desire for the redecoration of the lounge in the lower flat and this is to be taken into consideration as part of the overall refurbishment. On the day of our visit we found on entering the unit there was a strong underlying and unpleasant odour,the expert by expereince commented the first thing I noticed was an overpowering stench of urine, in the main this would seem to emanate from one resident bedroom where there are issues of continence, in viewing this room we found the level of odour to be unacceptable. Discussion with the manager and staff indicate that whilst there is a cleaning schedule in place this is inadequate to address the current level of the problem, the floor covering in the resident bedroom needs urgent replacement for something more suitable and we have issued a requirement in respect of this. Whilst we are supportive of staff working with residents to undertake domestic household routines of cleaning dusting hoovering etc we do not consider that the current arrangements provide staff with enough time to carry this out effectively particularly in relation to carpet cleaning, and paying attention to everyday activities, Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: the expert by expereince commented on an overflowing bin in the kitchen area which required staff and residents to remove the lid in order to fit rubbish in this does not promote good infection control and a bin with a pedal should be provided and the bin emptied more frequently, consideration must be given to how this can be improved, in support of residents taking on more daily household chores this should include opportunity for residents to be more involved in their own laundry arrangements, and some thought should be given to reinstating laundry facilities within one of the flats. Staff we spoke with demonstrated a reasonable understanding of infection control in relation to managing soiled laundry and have received some training in this area and more is to be offered shortly. We observed a resident asking for toilet roll and also noted these to be absent in some toilets staff reported that residents often take these away to their rooms and consideration needs to be given to the provision of more effective roll holders that prevent toilet roll removal by residents. paper towel was also not provided in some toilets visited and cloth towels had been left there by residents with no scheduled replacement of towels by staff there is a need to promote good hand washing amongst residents and this should be resourced accordingly and is a recommendation. Care Homes for Adults (18-65 years) Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are safeguarded by a robust recruitment procedure. There are enough trained staff on duty who will benefit from continued opportunities to expand their knowledge about the specialist needs of the residents and to access NVQ programmes Evidence: Staff we spoke with confirmed that there are always enough staff on duty and that the waking night staff member can call on the waking night staff in the Kilncroft unit downstairs if necessary. A programme of NVQ2 training is provided but the service is still to achieve 50 of staff trained to NVQ2. We looked at four staff files one of these being for a staff member on duty during our visit, we found files all contained the necessary vetting and checks, and the content is compliant with that required by schedule 2 and Regulation 19 of the Care Homes Regulations 2001(amended 2004) evidence of interview notes and/or questionnaires were also noted. We are advised that the organization is seeking to improve the robustness of staff recruitment and a new interview recording questionnaire is being rolled out,whilst this does address the issue of gaps in employment histories this does Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: not seek verification from applicants for reasons for leaving previous care roles where this does not feature as a reference and we would urge that this be incorporated also. The quality of some photocopies of passport photographs and information used for ID purposes should be improved upon and we have discussed this with the manager during our visit. New staff are provided with induction in keeping with Skills for care Common Induction standards, staff we spoke with felt they are provided with a varied range of training and if a specific training need was identified felt confident that the manager would arrange for staff training in this area. Staff completed specific training in dementia following the last inspection, but the majority of residents now within the unit are suffering from Korsakoffs and although this was touched on within the training completed there is a need for the manager to now seek specific training for herself and her staff in this area to inform and guide their practice and this is a recommendation. A review of staff training profiles indicates staff to have completed all mandatory training and updates are routinely provided, infection control has previously not been provided as a separate course but this is now being offered and the manager should ensure all staff complete this. All staff spoken with demonstrated a commitment and dedication to the well being of the residents in their care, they are enthusiastic about training but sometimes feel undervalued as a staff team, this would seem to stem from the unit being given a lesser profile than Kilncroft with both internal and external documentation records all referring to Kilncroft and not the Croft unit as a separate unit. Staff sometimes feel the unit is overlooked and undervalued as a service in its own right. They feel well supported at local management level but feel distanced from senior management within the organization, they feel confident and able to express their views through supervision and staff meetings, they feel listened to but admit to some frustrations with how slow processes are within a big organization sometimes. I really love my job, residents are like family and we all get on well as a staff team Care Homes for Adults (18-65 years) Page 25 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed but would benefit from the development of its identity as a separate service and a recognition of this within organizational documentation, a more proactive and timely approach is needed to progressing quality issues. Evidence: The management of the home at local level remains unchanged and staff and residents benefit of this continuity of an experienced and qualified manager who they find supportive. Some changes have taken place within the area and regional management structure. Our findings from the inspection suggest that although there are good systems in place to monitor quality the organisation should be more proactive in dealing with issues that impact on the quality of life of residents in a more timely manner. The home has continued to notify us about significant events that effect residents and we have discussed with the manager the reasons as to why there are delays in these notifications being received by us, we understand this is mainly due to notifications Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: being directed to a senior manager before being sent onto CSCI, we have reminded the manager that regulation 37 makes clear that such notifications must be made known to CSCI within 24 hours of the event and discussion will need to take place within the organization as to how timescales in this area can be improved upon. We are satisfied that the organization representative is undertaking regular visits to the service in compliance with regulation 26 responsibilities and that these are now conducted on an unannounced basis which was not always the case previously. Our examination of both provider visits and quality audits undertaken indicates these to be conducted on the building as a whole which encompasses both the Croft unit and Kilncroft, records do not make clear issues specific to the croft unit and we have discussed with the manager the need for the unit to be defined separately within all such documentation. We have undertaken a random sampling of health and safety servicing and checks in regard to Gas, electrical installation and lift servicing and found these to be in date. A review of accident records indicates that a low level of accidents have occurred in the home since the last inspection and these have been dealt with appropriately. A current Insurance certificate is in place Care Homes for Adults (18-65 years) Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 31 2 The Organization must 04/05/2009 provide clear timescales for the redecoration and refurbishment of the unit Regulation 23(2)(b)(d)of the Care homes regulations 2001 so that the premises to be used as a care home are of sound construction and kept in a good state of repair externally and internally are kept All parts of the care home are kept clean and reasonably decorated The organization must replace the flooring in one resident bedroom to reduce issues of soiling and odour. Cleaning schedules must be revised to ensure soiled flooring and carpets is cleansed more frequently using carpet/floor cleaning 12/04/2009 2 31 2 Care Homes for Adults (18-65 years) Page 29 of 32 equipment to minimize risk of odour and infection Regulation 13(3) The Registered Person shall make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care Home Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 The assessment information should make clear the assessment is of younger adults. assessment information would benefit from improved completion in content and detail to inform judgments about admission and care plan development. 2 6 care plans would benefit from more detail in respect of residents personal preferences in relation to day to day routines to inform staff who support them risk information should be specific to the home The home must ensure that assessment of risk reflects external activities as well as those undertaken in the home 3 9 4 16 The home should provide improved opportunity for residents to make active choicesand decisions in their day to day routines and to take a more active role in maintaining skill levels and independence. menus should be reviewed to offer a more varied and healthier diet that takes account also of resident choices and preferences which should be recorded, consideration must be given to presentation of meals and drinks e.g use of condiments, discontinue plastic mugs Medication administration records should be reviewed more frequently for accuracy. The development of individual residents PRN guidelines would ensure a more consistent administration by staff of this medication. 5 17 6 20 Care Homes for Adults (18-65 years) Page 30 of 32 The development of medication profiles would better inform staff about the reasons for medication, side effects and resident preferences in respect of administration. Prescribed Medications outside the MDS system should be dated upon opening for audit purposes 7 22 Where residents lack capacity to formally complain staff should more actively advocate for them where they consider an incident or experience would have precipitated a complaint or concern ordinarily, Behavior guidelines should be developed for individual residents to inform staff practice and ensure a consistent approach is maintained. these should be subject to review for their effectiveness Interview records should show verification of reasons for applicants leaving previous care roles where this has not been covered within applications or references sought Staff will benefit from further specific training in respect of Korsakoffs to inform and guide their practice. 8 23 9 34 10 35 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: 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 We want people to be able to access this information. 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