Care Home: Butts Croft

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What the care home does well People who are considering moving into the home benefit from having a full and detailed assessment of their needs so that they can be sure the home can meet these needs. People are encouraged to look around before agreeing to move in. A visitor told us "they gave me all of the information I needed before we chose this Home", two residents said "we have settled in really well, we have no worries" Care plans are developed before admission to the Home for each need identified and then further developed upon admission. People have access to advice from health professionals where they need it, so their health needs can be met. People said "I see the Dr or dentist whenever I need to", "staff call the Dr whenever I need one", "staff are very attentive to my needs" Spiritual needs are met by representatives from local churches who visit frequently. Meals are nutritious and varied with people receiving a choice at each mealtime. Assistance to eat meals is provided in a sensitive way. Staff were aware of individual likes and dislikes and provided nutrition accordingly. People said "the food is excellent", "the food is good", "there is plenty of food and its good". The home`s complaints policy is on display for all to see. People living in the home were confident that their concerns would be listened to and acted upon. Documentation seen demonstrated that appropriate action is taken to address concerns raised. Residents said "there is nothing to complain about", "I have no worries, I haven`t had any since I moved in", "if I had any worries I would speak to the staff" Adult protection issues are dealt with in an appropriate manner. Staff receive training to recognise and respond to suspected abuse. Accommodation is clean, well furnished and comfortable. Improvements have been made to facilities at the Home. The manager is aware of maintenance issues which are addressed promptly. There are sufficient numbers of staff on duty to meet the needs of people living in the home. Recruitment procedures are robust and ongoing training ensures that staff have the skills and knowledge needed to meet individual`s needs. Residents commented "staff are all very good at helping me", "staff are lovely and everything is OK", "staff are all lovely". . . The management team at Butts Croft House are dedicated to improving the quality of care received by the people that live there. There is a clear management structure and one of the management team or a senior staff member is always on duty to allow for the effective running of the home. Staff are supported and supervised which improves their ability to carry their job out appropriately. Residents also said "I am happy here", "I am very well, everything is Ok". What has improved since the last inspection? This is the first inspection since the Home changed it`s number and category of registration in October 2008. What the care home could do better: Staff should sign documentation to demonstrate who has recorded the information in care files. Risk assessments should be available for all care plan needs identified. Risk assessments should be reviewed on a monthly basis and updated as necessary in accordance with the Home`s procedures. Care plans should be updated to record the most recent information including use of equipment. Daily records should record important information relating to the health and personal care needs of a person, for example ill health or visits made by a GP. A new controlled medication fridge should be purchased to store controlled medication in accordance with legislation. Staff should be made aware of the appropriate procedure to follow when blowing the whistle on poor practice. CARE HOMES FOR OLDER PEOPLE Butts Croft Tamworth Road Corley Coventry West Midlands CV7 8BB Lead Inspector Deborah Shelton Key Unannounced Inspection 2nd March 2009 09:10 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 DS0000072994.V374587.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. DS0000072994.V374587.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Butts Croft Address Tamworth Road Corley Coventry West Midlands CV7 8BB 01676 540 334 01676 549 154 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) Butts Croft Ltd Manager post vacant Care Home 28 Category(ies) of Dementia (28), Old age, not falling within any registration, with number other category (28) of places DS0000072994.V374587.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 28 Old age not falling within any other category (OP) 28 The maximum number of service users to be accommodated is 28. 2. Date of last inspection First inspection under new registration Brief Description of the Service: Butts Croft is registered to provide care for up to 28 people. It is a large detached converted house in a rural area situated between Coventry and Nuneaton. There are mature, extensive gardens to the rear, which are accessible to the people who use the service. The home provides accommodation on two floors, a shaft lift is available to gain access to the first floor. There are twenty single bedrooms and four double bedrooms. Nine of these rooms have en-suite facilities. All bedrooms are of a good size, though some parts are difficult to access for those with poor mobility or wheelchair users. The Home provides two bathrooms and five toilets on the ground floor and a bathroom, shower room and three toilets on the first floor. All communal areas are located on the ground floor and consist of three lounge/dining rooms. The current charge for accommodation and personal care at Butts Croft House is £500.00 - £580.00 per week. Additional charges are made for personal items, clothing, private chiropody, hairdressing and newspapers/magazines. DS0000072994.V374587.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This is Butts Croft House’s first inspection since we registered it to have an additional six places. The category of registration was also changed to include care for people with dementia. The total number of people who are able to live at the Home is now twenty-eight. Registration was granted in October 2008. This was a key inspection visit and was unannounced. This means that the Home were not aware that we were going to visit. The visit took place on Monday 2 March 2009 between 9.10am and 7.45pm. The inspection process concentrates on how well the service performs against the outcomes for the key national minimum standards and how the people living there experience the service. Before the inspection we looked at all the information we have about this service such as previous inspection reports, information about concerns, complaints or allegations and notifiable incidents. This helps us to see how well the service has performed in the past and how it has improved. An Annual Quality Assurance Audit (AQAA) was completed by the manager and returned to us within the timescale required. This document gives information on how the Home thinks it is preforming, changes made during the last twelve months, how it can improve and statistical information about staffing and residents. During this Key inspection we used a range of methods to gather evidence about how well the service meets the needs of people who use it. Time was spent sitting with people in the lounge watching to see how they were cared for and how they spent their day. Discussions were held with people who use the service, staff and visitors to the Home. Information gathered was used to find out about the care people receive. We also looked at the environment and facilities and checked records such as care plans and risk assessments. Three people living in the home were identified for case tracking. This involves reading their care plans, risk assessments, daily records and other relevant information. Evidence of care provided is matched to outcomes for the people using the service, this helps us to see whether the service meets individual needs. DS0000072994.V374587.R01.S.doc Version 5.2 Page 6 What the service does well: People who are considering moving into the home benefit from having a full and detailed assessment of their needs so that they can be sure the home can meet these needs. People are encouraged to look around before agreeing to move in. A visitor told us “they gave me all of the information I needed before we chose this Home”, two residents said “we have settled in really well, we have no worries” Care plans are developed before admission to the Home for each need identified and then further developed upon admission. People have access to advice from health professionals where they need it, so their health needs can be met. People said “I see the Dr or dentist whenever I need to”, “staff call the Dr whenever I need one”, “staff are very attentive to my needs” Spiritual needs are met by representatives from local churches who visit frequently. Meals are nutritious and varied with people receiving a choice at each mealtime. Assistance to eat meals is provided in a sensitive way. Staff were aware of individual likes and dislikes and provided nutrition accordingly. People said “the food is excellent”, “the food is good”, “there is plenty of food and its good”. The home’s complaints policy is on display for all to see. People living in the home were confident that their concerns would be listened to and acted upon. Documentation seen demonstrated that appropriate action is taken to address concerns raised. Residents said “there is nothing to complain about”, “I have no worries, I haven’t had any since I moved in”, “if I had any worries I would speak to the staff” Adult protection issues are dealt with in an appropriate manner. Staff receive training to recognise and respond to suspected abuse. Accommodation is clean, well furnished and comfortable. Improvements have been made to facilities at the Home. The manager is aware of maintenance issues which are addressed promptly. There are sufficient numbers of staff on duty to meet the needs of people living in the home. Recruitment procedures are robust and ongoing training ensures that staff have the skills and knowledge needed to meet individual’s needs. Residents commented “staff are all very good at helping me”, “staff are lovely and everything is OK”, “staff are all lovely”. . . The management team at Butts Croft House are dedicated to improving the quality of care received by the people that live there. There is a clear DS0000072994.V374587.R01.S.doc Version 5.2 Page 7 management structure and one of the management team or a senior staff member is always on duty to allow for the effective running of the home. Staff are supported and supervised which improves their ability to carry their job out appropriately. Residents also said “I am happy here”, “I am very well, everything is Ok”. 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 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000072994.V374587.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 DS0000072994.V374587.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): 3,6. Quality in this outcome area is good. People who are considering moving into the home benefit from having their care needs assessed before admission so that they can be sure the home can meet their needs. These people and their families are provided with information and visit the service prior to admission to enable them to make an informed choice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three people were case tracked during this inspection. This involved looking at their care files, talking to them and their family where possible and talking to the staff that care for them. Their living accommodation and the facilities available to them were also looked at. The care file of the person most recently admitted to the Home was reviewed to identify whether appropriate pre-admission processes take place at Butts Croft House. From documentation seen, discussions with the manager, newly DS0000072994.V374587.R01.S.doc Version 5.2 Page 10 admitted person and a visitor to the Home, it was noted that pre-admission processes are robust. Sufficient information is obtained about people before the Home confirm in writing that they are able to meet their needs. People who are considering moving in have copies of the Service User’s Guide and are told where to get copies of the most recent inspection report. Relatives and people who may wish to use this service are encouraged to visit, have a look around and stay for the day before they decide if they would like to move in. This ensures that people have enough information to make an informed choice about whether they would like to live at Butts Croft House or not. All three care files seen contained the standardised documentation used during the pre-admission process. All assessments were undertaken by the registered manager who has sufficient knowledge and training to be able to undertake these assessments. Information obtained during the pre-admission assessment was detailed. Relevant information regarding care needs, dependency and risk assessments are obtained. This information is used to decide whether the Home would be able to meet people’s needs. Once agreement to move in has been reached a pre-admission draft care plan is devised to give staff the basic information needed to care for the person as soon as they move in. A conversation was held with last person to move in to Butts Croft House. It was noted that she had settled in well, felt safe, thought the staff were all kind, friendly and attentive to her needs. This person said that she was happy to be living at Butts Croft. This service does not provide intermediate care. DS0000072994.V374587.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): 7, 8, 9 and 10 Quality in this outcome area is good People living in the home can be confident their health and personal care needs will be met. Medicine management is considered safe and protects the people who use the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care files of the three people being case tracked were reviewed to see whether the Home are recording and acting upon identified care needs. Conversations were held with two of the three people case tracked, plus five other people, to identify whether their needs are being met in a way in which they prefer. Conversations were also held with the manager, deputy and a team leader to identify their knowledge of the needs of people under their care. All three care files seen contained a pre-admission assessment undertaken by the manager. Plans of the care to be provided (care plans) were developed DS0000072994.V374587.R01.S.doc Version 5.2 Page 12 before each person was admitted to the Home. These contained enough information to enable staff to care for people within the first few weeks of moving in. Within the first two weeks of admission more detailed care plans are developed. These contained sufficient information to guide staff and included details of needs identified, how to provide care, the number of staff required to assist and timings for tasks to be completed. Independence, rights of choice and dignity are also mentioned. Risk assessments are developed for care needs identified. One care file did not have a risk assessment regarding medication, health and wellbeing, daily activities or going out into the community. The manager confirmed that a risk assessment should be available for each care plan need. Pressure sore risk assessments had been completed. This assessment identifies the risk of any person developing a pressure area. Two risk assessments were up to date and had been reviewed on a monthly basis, one had not been reviewed since December 2008. This person was at a low risk of developing a pressure area. Moving and handling, nutrition and fall risk assessments had also been completed and reviewed on a monthly basis. Appropriate action had been taken when a person is identified at high risk, for example turn charts and food and fluid intake charts were available for one person identified at risk of developing a pressure area. One care file needed updating as pressure relief mattress and a cushion had been delivered two days before the inspection and the person had been prescribed nutritional supplements but this was not recorded in their care plan. The manager was aware of this and had planned to update the file on the day of inspection. Although documentation had not been updated, the equipment and supplements were seen and in use for the person and staff were aware of their use. Care files are divided into sections for ease of finding information. All care plans were easy to read and in good order. Where a person had been diagnosed with a specific type of dementia the manager had written an explanation which tells staff what the disease is, how it manifests itself in the person for example, how the person may act or verbal aggression. Each person now has an identified key worker. A discussion was held with a member of staff regarding the key workers role and it was noted that staff are key workers for two people. They have additional responsibilities for these people to ensure that they have sufficient toiletries and clothes, that their rooms and wardrobes are tidy and that care plans are up to date. Key workers record a monthly review in care plans. Those seen were detailed and included DS0000072994.V374587.R01.S.doc Version 5.2 Page 13 details regarding any health problems, Doctors visits and any other important information. There was no documentary evidence to demonstrate that people or their representatives have been involved in planning care. The manager said that she sits with the people and relatives if appropriate and discusses care with them. There is a section for them to sign but none had been signed. There is therefore no documentary evidence to demonstrate that people and or their relatives are involved in the care planning process. All three files contained a “getting to know you form” which had been completed by the person and family members. This form records useful information which gives staff an insight into the person, their life, likes and dislikes. It also can be used to initiate conversations between staff and residents. One of the forms seen had not been fully completed and had not been signed by the person recording the information. It is important to obtain as much information about preferences, routines and likes and dislikes as possible to maintain individual’s preferred daily routines. Admission forms recorded the person’s consent to resuscitation (two signed by family members, one not yet signed). A discussion was held with the manager who confirmed that one of the people has the mental capacity to sign this form but had not been asked to. The manager confirmed that she has recently undertaken mental capacity training and will devise forms regarding this issue to identify whether the resident has capacity or not. Family members should not sign these forms unless it has been identified that the person does not have the mental capacity to do so. Living wills also should be considered for those who do not wish to be resuscitated. Professional contacts sheet records names, addresses and phone numbers of doctor, dentist, chiropodist, optician to enable staff to make contact with these professionals when needed. One of the forms seen had not been fully completed. Daily records are completed per shift. These record information about the daily life of a person for example; food intake, medication, where they have spent their day, care or health issues. Some of the daily records mention when a Doctor has been called to see a person, but this was not recorded on each occasion. Also staff had not recorded in detail on each occasion details regarding the health care needs of a person. Daily hygiene records are completed and documentary evidence is available to confirm that staff are changing bedding, checking skin integrity, changing clothing, nail care, hair brushed, cut, washed, hearing aid care, shoe/slipper care, spectacles care, wash lower/upper body. All forms seen had been completed and were up to date. DS0000072994.V374587.R01.S.doc Version 5.2 Page 14 Discussion held with two of the people being case tracked and four other people identified that “staff are all good and kind, they call the Doctor, Dentist when needed, staff are very attentive”, “I can’t fault the Home everything is going well”, “the staff are lovely, we have both settled well, the rooms are comfortable, the whole Home is comfortable, they call the Dr and dentist whenever you need them”. Medication records, administration and storage was reviewed. The Home now have three medication trolleys as well as a lockable medication fridge and a metal box to store controlled drugs. At the time of inspection there were no controlled medications in use. However, the metal box used would not be sufficient to meet legal requirements regarding the storage of controlled medication. An air conditioning unit is in place in the medication room, this is used to keep the temperature at a satisfactory level for the storage of medication (below 250C). Records are kept to show that the temperature of the room is monitored on a daily basis. The room was not excessively hot on the day of inspection. The temperature of the medication fridge is also monitored and recorded on a daily basis. Medication to be returned to the pharmacy is recorded and stored appropriately. A book which lists the medication to be returned is signed by the pharmacy before it is removed from the premises. The medication and records for the three people being case tracked were reviewed. All medication available was appropriately stored and medications available balanced with records held. All medication storage facilities were appropriately locked. Key custody practices were discussed and found to be satisfactory. Documentary evidence is available to demonstrate this. All care staff have undertaken some medication training. Team leaders have undertaken an additional distance learning course regarding the safe handling and administration of medication. Records were available to demonstrate this. The manager reported that the Doctor is good at undertaking three monthly medication reviews, however there was no documentary evidence to demonstrate that these take place. The manager confirmed that peoples’ medication is not reviewed by the doctor upon admission to the Home. This is because all people are now admitted by the community mental health team and the manager felt that their medication would have been reviewed by them. Any medication that is received in pharmacy boxes is audited after every time it is administered. This is completed to ensure that records are up to date and the correct number of medication is available. DS0000072994.V374587.R01.S.doc Version 5.2 Page 15 During the inspection the privacy and dignity of the people who use the service was maintained, people were clean and dressed appropriately for the time of year. Ladies were in the process of having their hair washed and set by the hairdresser. Staff appeared to have a good relationship with those under their care and were polite and courteous at all times. Staff were seen to knock on bedroom doors before entering. There was no screening in shared bedrooms. It was noted that this has been ordered and that new structures have been put on the ceiling to hold curtain screening. DS0000072994.V374587.R01.S.doc Version 5.2 Page 16 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): 12, 13, 14 and 15 Quality in this outcome area is good People who use the service find the lifestyle experience matches their expectations and preferences, they are helped to make choices and have control over their lives. Open visiting arrangements encourage regular contact with relatives and friends. People benefit from a varied, tasty and nutritious choice of food. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A discussion was held with the manager, staff, people who use the service and visitors to the Home regarding recreational activities on offer. Observation during the day of inspection showed that people were at ease in their surroundings, three communal lounges are available and people were free to wander into any communal area as they wished. A list of the activities suggested for the week are recorded on an activity sheet, which is on display on the notice board in the lounge. Care staff are responsible for completing activities, they inform the people on a daily basis what the planned activity is but offer alternatives and ask people individually if DS0000072994.V374587.R01.S.doc Version 5.2 Page 17 there is anything that they would like to do. We saw that the people who use the service were enjoying singing and dancing on the morning of the inspection. Throughout the day some were seen watching television, chatting amongst each other or walking around the Home. Seven people were spoken to throughout this inspection, two commented that there was not a lot to do in the day apart from sit, one said that she likes to keep busy, she said she had always been a busy lady and now sometimes gets bored. She said that she would like to do some knitting to keep her hands busy. Other people spoken to were either unable to comment or expressed no concerns regarding the activities available. An activity log is kept in each care file this records the activities undertaken by people morning and afternoon. Entries were recorded every day, activities such as watching television, talking to residents, talking to staff, fizzical fun, playing soft ball, help to clean and lay tables, help put clothes away, listen to old music and exercise were recorded. The activity records for the people being case tracked record activities such as bingo, watching TV, family visits, sing a long, manicure/nail care and chatting to people. Records show that a varied range of activities is available to people on a regular basis. During the morning of the inspection two people asked staff if they could go out for a walk as the sun was out, staff took one lady in a wheelchair and the other lady walked. Both were heard saying how much they had enjoyed their walk in the fresh air. During the inspection the deputy and manager were seen holding in depth conversations with people about their past life, where they had lived, cars they had driven and places they had visited. People involved in this conversation appeared to enjoy the chats and had a good relationship with these staff. The manager confirmed that the vicar from the local church visits every three weeks to provide a service and a holy communion takes place each Wednesday morning. One visitor spoken to confirmed that they were aware that the vicar attends the Home and confirmed that they had taken their friend out of the Home to go to the church that she had previously attended. Choice, independence and individual preferences were discussed with the manager, staff and people who use the service. It was noted that the Home provides both bathing and showering facilities and residents are able to choose which they prefer. Currently there are no male care staff, there is one male person using the service and all others are female. The manager confirmed that male staff would be employed if/when there are more male persons to care for. Individuals would then be given a choice of having personal care provided by male or female staff and this would be recorded on their care plan. DS0000072994.V374587.R01.S.doc Version 5.2 Page 18 People were seen wandering freely around the Home and appeared at ease in their surroundings. One person spoken to said “I come and go as I please and go to bed when I fancy”, “I can do as I please here”. Care plans contain information about preferences, fears, likes and dislikes and staff spoken to were aware of these. Lists of food/drink likes and dislikes were on display in the kitchen. Records show that a choice of two main meals are available each day, residents are able to have cereal, a cooked breakfast or toast each morning and a choice of sandwiches or a hot snack for the evening meal. The choice of lunchtime meal on the day of inspection was salmon vegetables and potatoes or liver and onion, vegetables and mashed potatoes. All seven people spoken to praised the food saying how nice it was. They all said that there was plenty of food and that it tasted good. Comments made by people regarding the meals at the Home are detailed below: “the food is really good, I had sandwiches for tea, its all good and there is plenty of food” “the food is good, I can’t remember what I had but it is always nice”, “the food is excellent” “everything is good, I can’t fault the food” There are three lounge/dining rooms in the Home and residents are able to eat their meals in any of these rooms. Food is carried on trays by staff from the kitchen to the dining rooms. This method of transporting food may be time consuming. The manager should monitor to ensure that meals are not cold by the time they are available to eat. Tables were nicely laid out with tablecloths and serviettes. A new kitchen has been built since the last inspection. This was clean and hygienic. All equipment was in good working order. DS0000072994.V374587.R01.S.doc Version 5.2 Page 19 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): 16 and 18 Quality in this outcome area is good. People living in the home can be confident that their concerns will be listened to and acted upon. Processes are in place to help protect the vulnerable people who use this service from harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two complaints have been received by us regarding Butts Croft House. Both were referred to and investigated by the Home manager. Neither complaint was substantiated. One complaint referred to low staffing levels, the manager confirmed that staffing levels have increased since the new registration as a dementia care home and have not fallen below these levels. No concerns were raised regarding staffing levels on the day of inspection, staff spoken to said that there were sufficient staff on duty to be able to do their job and people using the service confirmed that staff were always available and attentive to their needs. People spoken to were aware of how to make a complaint and confirmed that they would speak to the manager or staff if they had any problems. People using the service commented as follows regarding complaints “I would let them know if I had any problems at all”, “I have no worries, I haven’t had any since I moved in here, everything is OK”, “I am feeling well and everything is DS0000072994.V374587.R01.S.doc Version 5.2 Page 20 going well, nothing to complain about, I just do what needs to be done and everything is OK”. A copy of the complaint procedure is on display in the Home, although the print size has been slightly increased this was not sufficiently large to assist those with sight difficulties. The manager confirmed that the procedure was available on her computer and would be printed off in a larger format and put on display. A monthly complaint audit is undertaken, this is used to identify the number of complaints received, whether the complaint was verbal or written and the issues identified in the complaint i.e. care, staff, food etc. Only one complaint has been received at the Home recently. A copy of the letter of complaint was seen and the manager discussed the action taken to address the issue. Satisfactory action was taken to address concerns. One adult protection issue has been raised. An investigation was undertaken, the manager was aware of her responsibilities for reporting suspected abuse and reported concerns to the appropriate authorities. Satisfactory action was taken to address issues identified. All staff have undertaken protection of vulnerable adults training within the last twelve months. The manager confirmed that it is her intention to ensure that all staff undertake this training every year. DS0000072994.V374587.R01.S.doc Version 5.2 Page 21 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): 19 and 26 Quality in this outcome area is good People living in the home are provided with clean, homely and comfortable surroundings to live in. Recent improvements within the home benefit those who live there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at different parts of the premises which included looking at all communal areas, the laundry, kitchen, bathrooms, the bedrooms of the three people being case tracked plus three others. Since the last inspection the Home has re-registered to be able to provide care for people with dementia. An extension has been built and a further six bedrooms registered. The Home now has three lounge/dining areas, two with televisions and one quiet lounge, the laundry has been moved and the kitchen DS0000072994.V374587.R01.S.doc Version 5.2 Page 22 moved and rebuilt. Officers from the Environmental Health Agency visited the Home to provide advice and guidance regarding kitchen facilities whilst the building work took place. One of the lounges was being used by the hairdresser during the inspection. People were sitting watching television whilst having their hair done. The quiet lounge was used by some people to sit and chat together or to rest alone. The large main lounge was being used by the majority of people who sat and chatted amongst each other or watched television. The Home was pleasantly decorated throughout and fixtures and fittings were in a good state of repair. Notices on doors with words and pictures show people where they are. Bathrooms and toilets also had signs on doors to help people find their way around. Bedrooms seen were clean and had been personalised with pictures and ornaments, some had more items than others but staff confirmed that this is the choice of individuals. A slight odour was noted in one bedroom. Due to changes in layout there was no flooring laid in the small area leading to the en-suite. The staff member confirmed that this is available and will be put in place shortly. Ceiling curtain poles have been put up in shared bedrooms, curtain screening was not yet available but was due to arrive shortly. This is used to promote the privacy and dignity of the people that share bedrooms. The newly built and registered bedrooms seen were sufficiently large, pleasantly decorated, call bells were in place and in good working order and furnishings and fittings were in a good state of repair. There are two assisted bathrooms on the ground floor and one bathroom and a separate shower room on the first floor of the Home. Five toilets are available on the ground floor and three on the first floor. This is in addition to en-suite facilities in some bedrooms for the individuals who stay in those rooms to use. There are sufficient number of bathrooms for the people that live at Butts Croft House and these were clean and pleasantly decorated. There are two sluice rooms on the ground floor that are used on a daily basis. A new fire alarm system has been fitted throughout the Home, new dining room and lounge furniture has been purchased. Some areas of the Home have been re-carpeted and new televisions bought for the lounge. Two washing machines and two tumble dryers have recently been purchased and were in good working order. Washing machines have a “sanitization cycle” which the manager confirmed is the same as a sluice cycle, which is used to clean soiled laundry to satisfactory standards to prevent the spread of infection. The laundry sacks used to transport items to the laundry were seen, as were disposable gloves. However, there was no supply of disposable aprons in the laundry. A member of staff confirmed that anyone working in the laundry would already be wearing an apron. However, a supply of aprons DS0000072994.V374587.R01.S.doc Version 5.2 Page 23 should be available in case a new apron is needed whilst working in the laundry. Infection control practices in the laundry were satisfactory and the laundry was clean and hygienic. DS0000072994.V374587.R01.S.doc Version 5.2 Page 24 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): 27, 28, 29 and 30 Quality in this outcome area is good There are sufficient, competent staff on duty to meet the needs of people living in the home. Procedures for employment, induction of new staff and ongoing training ensure that people who use this service are protected and safe. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The number of staff on duty was discussed with the manager, a copy of the duty rota was also taken for review. The number of staff on duty on the day of inspection was as recorded on the duty rota and this appeared to be sufficient to meet the needs of those that live at the Home. Three care staff work between the hours of 7.30am - 7.30pm, as well as a team leader. The manager and deputy work alongside each other Monday to Friday, the manager also works on a Saturday and the deputy on a Sunday. Night duty is 7.30pm – 7.30am and this is covered by two care assistants. Staff spoken to felt that a sufficient number of staff are on duty to be able to undertake their daily duties. People who use the service said that staff are kind and friendly and come quickly to give help when it is needed. The Home do not use agency staff to cover times of staff sickness or annual leave, the manager confirmed that existing staff including the deputy and the manager will take it in turns to work DS0000072994.V374587.R01.S.doc Version 5.2 Page 25 additional shifts as needed to cover any vacancies. Staff confirmed this and said that they were happy to help each other out and swap shifts if necessary. Staff said that they work well as a team and thought that they are all very hard working. Fourteen care staff are employed at Butts Croft House, twelve of these have undertaken a national vocational qualification in care at level two. Ensuring that staff receive ongoing training helps to ensure that they have sufficient knowledge to meet the needs of those under their care. Two new staff have been employed recently, their personnel files were reviewed to evidence the recruitment procedures at the Home. Both files contained appropriate information, including safety checks and written references before a decision was made to employ. The annual quality assurance assessment document completed by Butts Croft House records that all staff have undertaken induction training as required when they started their employment. A training plan has been devised and training is organised for each month from January to October 2009. Staff spoken to felt that they received sufficient training to enable them to do their job properly, they recalled having training recently regarding dementia, equality and diversity and health and safety. Certificates of training undertaken were on file for both mandatory and service user focussed training, records show that staff receive regular and varied training. A discussion was held with a member of staff regarding suspected abuse. This member of staff was aware of the action to take but was unsure of the correct reporting procedure if continued abuse is suspected. The staff member confirmed that she had undertaken training regarding protection of vulnerable adults and was aware of the Home’s whistle blowing procedure. The manager should ensure that all staff are aware of the procedure to follow for blowing the whistle on poor practices or suspected abuse. DS0000072994.V374587.R01.S.doc Version 5.2 Page 26 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): 31, 33, 35, 36 and 38 Quality in this outcome area is good The manager has organisational support to ensure the service is run in the best interests of people living in the home. The safety and well being of the people who use this service, visitors and staff are promoted and protected This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has been employed at the Home for approximately two years and has completed the National Vocational Qualification at level four and the Registered Manager’s Award. A new deputy has recently been employed and the manager feels that they work well together. Systems and practices are considered to be good and ongoing improvements are being made. Improvements have been made to care planning, medication, quality DS0000072994.V374587.R01.S.doc Version 5.2 Page 27 assurance and ongoing training. Lines of accountability and on call arrangements were discussed and found to be satisfactory. The manager has ideas for areas of improvement and is constantly seeking the views of the people that live at Butts Croft House to ensure that the service meets their needs and expectations. Quality assurance systems were reviewed, it was noted that quality assurance questionnaires are sent to five people (staff, professional visitors, residents/relatives randomly chosen) each month. A different topic is chosen and the results of the questionnaires are kept in a quality assurance file, which was seen on the day of inspection. Regular meetings for realatives and people who use the service were held during 2008, minutes were available on the quality assurance file for review and are put on display in the Home. The manager has developed a monthly newsletter, this is put on display, this newsletter informs people of any activities or changes taking place and reminds people that they are able to contact the manager regarding any issues which they may wish to discuss. Regular audits are undertaken as part of the quality assurance systems in place, audits of care plans, medication, accidents, complaints are completed and documented. The manager confirms that whenever she is on duty she takes some time to observe staff working practices and any issues noted would be discussed immediately and also discussed during staff supervision. Records seen show that regular staff supervision takes place. Quality assurance systems in place are robust and incorporate the views of the people that live at the Home. Records for people’s money held by the Home were reviewed. All monies are stored appropriately, records held are audited by the manager and deputy on a regular basis. An individual named wallet is kept for each person who has funds. The wallet contains the money and any receipts showing expenditure. Records are held to record any income and expenditure, the records and monies for three residents were reviewed. Funds held balanced with records. Some hairdressing receipts were not available. The hairdresser was in the Home on the day of inspection, her receipt book was checked and it was confirmed that hairdressing was undertaken on the days recorded. Staff spoken to confirmed that they receive regular supervision, they were aware of the list on the wall in the office that records the date that their supervision is planned. They stated that during supervision they are able to talk about any problems, worries or concerns that they may have. Staff said that they would be able to talk to the manager about anything, they said that the she is very supportive. DS0000072994.V374587.R01.S.doc Version 5.2 Page 28 Records were reviewed to identify whether the health and safety of staff and people using the service is maintained. The manager confirmed that new emergency lighting has been put in place and the fire system has been changed throughout the building when the new extension was built. Records demonstrate that a weekly test is undertaken on the fire alarm system, the last test recorded was 27 February 2009. Emergency lighting is serviced on a six monthly basis. An Officer from the West Midlands Fire Service visited the Home following completion of the building work. A new fire risk assessment has been completed which now includes the new rooms built. Hot water temperature records were available, one water outlet is checked each week and the temperature recorded. All water outlets accessible to residents have thermostatic mixing valves in place with the temperature set to a maximum of 420C. Health and safety meetings are held, these meetings discuss accidents, incidents, risks are identified and any furniture that needs replacing or items that need repairing are discussed. This helps to ensure that health and safety issues are identified and acted upon. DS0000072994.V374587.R01.S.doc Version 5.2 Page 29 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 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 3 X 3 3 X 3 DS0000072994.V374587.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13 Requirement Storage of controlled medication should be in a suitably fixed and constructed cabinet in line with the Misuse of Drugs (Safe Custody) Regulations. This is to make sure that people who use the service are not placed at risk. Timescale for action 10/05/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP7 OP7 Good Practice Recommendations Care plans should be updated to include current information regarding care needs and equipment in use. Documentary evidence should be available to demonstrate that residents or their representatives are involved in the care planning process. All standardised documentation in care files should be completed where the information is available. 3 OP7 DS0000072994.V374587.R01.S.doc Version 5.2 Page 31 4 OP7 Documentary evidence to demonstrate that mental capacity has been ascertained should be available before relatives/representatives are asked to sign documentation on behalf of residents, for example “do not resuscitate” Risk assessments should be reviewed and updated on a monthly basis or sooner if needed. Documentary evidence should be available to demonstrate that people receive a medication review upon admission to the Home and on a regular basis thereafter. Screening should be available in shared bedrooms to preserve the privacy and dignity of those that stay in the room. Disposable aprons should be available for use in the laundry to help maintain infection control and prevent the spread of infection. 5 6 7 OP8 OP9 OP10 8 OP26 DS0000072994.V374587.R01.S.doc Version 5.2 Page 32 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 DS0000072994.V374587.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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