Care Home: Carr Croft Care Home

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What the care home does well What has improved since the last inspection? What the care home could do better: Some assessment information would benefit from more detail, especially for those people admitted to the home on an emergency basis. This would make sure that staff had enough information on people`s needs and nothing was overlooked. Staff said that information in emergency circumstances was passed on through word of mouth and by asking the person what they needed. The manager agreed to make sure more detail on care needs was provided in the pre-admission assessment information in future. A referral to health care professionals should be made to make sure the need for any specialist seating is explored. This will make sure that people who are at risk from poor posture are given the opportunity to sit more comfortably. Handwritten entries on MAR (Medication Administration Records) sheets should be checked and countersigned by a second person to make sure the information is correct and people receive the right medication. The upstairs bathroom in the home is in need of repair or replacement. The enamel base is chipped and rusting. This could be a health and safety risk if someone caught themselves on it. The provider and manager agreed this must be repaired.Carr Croft Care HomeDS0000066259.V377079.R01.S.doc Version 5.2 Risk assessments must be carried out on working practices in the environment. This will make sure work practices are safe for staff and people who live at the home. Key inspection report CARE HOMES FOR OLDER PEOPLE Carr Croft Care Home Stainbeck Lane Leeds West Yorkshire LS7 2PS Lead Inspector Dawn Navesey Key Unannounced Inspection 09:00 14th August 2009 DS0000066259.V377079.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Carr Croft Care Home DS0000066259.V377079.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Carr Croft Care Home DS0000066259.V377079.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Carr Croft Care Home Address Stainbeck Lane Leeds West Yorkshire LS7 2PS 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) 0113 2782220 F/P 0113 2782220 Carrcroft Care Home Limited Lesley Jane Abbott Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35) of places Carr Croft Care Home DS0000066259.V377079.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 category: Old Age, not falling within any other category, Code OP - maximum number of places 35 The maximum number of service users who can be accommodated is: 35 19th August 2008 2. Date of last inspection Brief Description of the Service: Carr Croft is a large converted Victorian house, providing personal care for up to 35 older people. Nursing care is not provided and the community nursing service gives support for any nursing needs that can be managed at the home. The garden area to the front has had some landscaping following completion of the extension. People have access to this area. Accommodation is provided in single and shared rooms. Some of the shared rooms have en-suite facilities, as do the new bedrooms in the extension. Communal areas are on the ground floor, with a large lounge/dining area, a smokers’ lounge and other seating areas. The home is situated close to the local amenities of Meanwood. Charges are reviewed twice a year in April and October. The home should be contacted directly for up to date information about fees. Additional charges are made for chiropody, hairdressing, daily papers, toiletries, some activities and transport. Escorts to accompany people for hospital appointments are charged at £7.50 per hour. Information about the services is provided by the home in the form of a Statement of Purpose and Service User Guide. Carr Croft Care Home DS0000066259.V377079.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is two star good. This means the people who use this service experience good quality outcomes. The Care Quality Commission (CQC) inspects homes at a frequency determined by how the home has been risk assessed. The inspection process has now become a cycle of activity rather than a series of one-off events. Information is gathered from a variety of sources, one being a site visit. More information about the inspection process can be found on our website www.cqc.org.uk This visit was unannounced and was carried out by one inspector who was at the home from 9:00am- 3:50 pm on the 14 August 2009. The purpose of the inspection was to make sure the home was operating and being managed for the benefit and well being of the people who use the service. And also to monitor progress on the requirements and recommendations made at the last inspection. Before the inspection evidence about the home was reviewed. This included looking at any reported incidents, accidents and complaints. This information was used to plan the visit. An AQAA (Annual Quality Assurance Assessment) was completed by the home manager before the visit to provide additional information. Survey forms were sent out to people using the service, staff and health care professionals. None of these have been returned in time for the preparation of this report. During the visit a number of documents and records were looked at and some areas of the home used by the people living at the home were visited. Some time was spent with the people who use the service, talking to them and interacting with them. Time was also spent talking to staff, the manager and provider. Feedback at the end of the visit was given to the manager and provider. What the service does well: People said they liked the home. Comments included: • • It’s all very, very good. Everything’s perfect. DS0000066259.V377079.R01.S.doc Version 5.2 Page 6 Carr Croft Care Home The atmosphere in the home is calm and relaxed and life seems to go at the pace of people who use the service. People who live at the home and their relatives said they were very happy with the care they receive. Their comments included: • • • • • You can have a bath or shower whenever you want one. They always answer the buzzers when you call. Look after everyone really well. Thank you for all the care given to mum. She is very happy and healthy. Without your care I don’t think I would have had my mother back to full strength. Staff are familiar with peoples needs and can talk confidently about the support they give. Staff are able to describe peoples preferred routines with regard to their personal care and what works well for people. Staff have a good knowledge of peoples individual needs. People who live at the home were positive about what they do at the home. Their comments included: • • We have lovely church services and birthday parties. I like my own company but they always ask me if I want to do the activities. People who live at the home were very happy with the food. Their comments included: • • • • • The food is very good and plenty of drinks in-between. Always plenty of choice, chef listens to what we want. Very good food. Always good food. Special day Friday, fish and chips, it is always very good. People who live at the home and their relatives spoke highly of the staff. Their comments included: • • • • • They are lovely, all of them. The carers are all brilliant. There are enough of them, bit rushed at busy times but always come to you. All staff are helpful. Staff very polite and great with the residents. DS0000066259.V377079.R01.S.doc Version 5.2 Page 7 Carr Croft Care Home • The staff are wonderful. Staff spoke highly of the management and leadership in the home. They said: • • • • We get really good support, whatever you tell her she listens and helps you with. She works alongside us to see how we are doing. She tells you if you are doing a good job. She works with us, tells or shows us what needs doing. What has improved since the last inspection? The manager has worked hard to make improvements to the home since our last visit. The home’s records are now well organised and regular meetings take place to make sure communication in the home is good. We looked at care plan and risk assessment records for some people who live at the home. The manager has introduced a new format for care planning and made sure that staff are trained in care planning and carrying out risk assessments. We found the care plans to be person centred and individual to each person. They had clear and detailed instruction on how the needs of people who use the service are to be met. They gave information on how people are supported to maintain their independence, how people like their care to be given and what their individual routines are. This is good person centred practice. And makes sure people get the care and support they want. The manager has now developed a training plan for staff so that training can be planned and managed better. The manager has a number of years experience in working in the home. She is now registered with the CQC as the registered manager. She is currently working towards her NVQ 4 in leadership and management which will mean she has a qualification to run the home. When asked how the service had improved in the last 12 months, the provider’s comments included: • New style of management has been developed to help maintain high standards of care. • The quality of life of the residents has been enhanced due to the variety of daily activities now offered. Carr Croft Care Home DS0000066259.V377079.R01.S.doc Version 5.2 Page 8 • • • • • New links have been developed with the local community: community constables, Meanwood elders club, local Sikh temple, district nurses, CPN nurses, Age Concern etc. Supervisions are carried out regularly. Staff continue to feel empowered and supported. Results of annual quality survey have been analysed. Handrails have been installed at the front steps leading to the front entrance and a new fence had been installed around the patio area. The homes safeguarding adults policy now contains the contact numbers to enable staff to report concerns outside of the home if they needed to. In the AQAA, the provider said they had made improvements to activity available in the home. She said the following: • • • • Weekly activities programme has been reviewed in light of feedback from the residents/families. Outings are organised on a regular basis. Newsletter is produced by staff/relatives for the service users. Fundraising activities have been enjoyed by all. What they could do better: Some assessment information would benefit from more detail, especially for those people admitted to the home on an emergency basis. This would make sure that staff had enough information on people’s needs and nothing was overlooked. Staff said that information in emergency circumstances was passed on through word of mouth and by asking the person what they needed. The manager agreed to make sure more detail on care needs was provided in the pre-admission assessment information in future. A referral to health care professionals should be made to make sure the need for any specialist seating is explored. This will make sure that people who are at risk from poor posture are given the opportunity to sit more comfortably. Handwritten entries on MAR (Medication Administration Records) sheets should be checked and countersigned by a second person to make sure the information is correct and people receive the right medication. The upstairs bathroom in the home is in need of repair or replacement. The enamel base is chipped and rusting. This could be a health and safety risk if someone caught themselves on it. The provider and manager agreed this must be repaired. Carr Croft Care Home DS0000066259.V377079.R01.S.doc Version 5.2 Page 9 Risk assessments must be carried out on working practices in the environment. This will make sure work practices are safe for staff and people who live at the home. 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Carr Croft Care Home DS0000066259.V377079.R01.S.doc Version 5.2 Page 10 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 Carr Croft Care Home DS0000066259.V377079.R01.S.doc Version 5.2 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3 People using the service experience good quality outcomes in this area. In the main, people who use the service can be sure that the home will meet their needs following assessment. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: People said they liked the home. Comments included: • It’s all very, very good. DS0000066259.V377079.R01.S.doc Version 5.2 Page 12 Carr Croft Care Home • Everything’s perfect. In the AQAA, the provider said, ‘A detailed pre-assessment form is completed before each admission ensuring we are able to meet the prospective client’s needs’. She also said that the pre-assessment documentation had been reviewed. We looked at the assessments for the most recently admitted people to the home. Referrals had been made from care managers and the manager had made sure an up to date care management assessment of peoples needs was obtained. The manager said this information was then used as part of their assessment in making sure they were able to meet peoples needs. The home also carries out their own pre-admission assessment to make sure they can meet peoples needs properly. The manager completes these assessments for people. The manager said they can carry out the assessments in peoples own homes or if people are in hospital. She also said that people thinking of moving in to the home can visit with their families as much as they like before making any decisions about moving in. Some assessment information would benefit from more detail, especially for those people admitted to the home on an emergency basis. This would make sure that staff had enough information on people’s needs and nothing was overlooked. Staff said that information in emergency circumstances was passed on through word of mouth and by asking the person what they needed. The manager agreed to make sure more detail on care needs was provided in the pre-admission assessment information in future. Carr Croft Care Home DS0000066259.V377079.R01.S.doc Version 5.2 Page 13 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 People using the service experience good quality outcomes in this area. Overall, the health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: People look well cared for clean, tidy and well groomed. Attention had been paid to detail. People had clean glasses, women had their nails painted if they wanted and people had their hair styled as they wished. Staff were patient, gentle and kind when interacting with people. They were discreet and Carr Croft Care Home DS0000066259.V377079.R01.S.doc Version 5.2 Page 14 respectful of peoples dignity when attending to any personal care needs. They gave reassurance and explanations for any tasks that they needed to support people with. In the AQAA, the provider said, ‘All personal care is based on individuals needs. Excellent person centred care plans inform care workers on how to provide good quality of care according to needs of each resident.’ She said they had made improvements to the service. These included, • • • • New care planning documentation in place. Mobility care plans and risk assessments have been reviewed and are more detailed. Daily communication sheets have been revised and improved. Daily communications are much more descriptive and thorough. She also said they are planning to improve the service by having end of life care plans for people. We looked at care plan and risk assessment records for some people who live at the home. The manager has introduced a new format for care planning and made sure that staff are trained in care planning and carrying out risk assessments. We found the care plans to be person centred and individual to each person. They had clear and detailed instruction on how the needs of people who use the service are to be met. They gave information on how people are supported to maintain their independence, how people like their care to be given and what their individual routines are. This is good person centred practice. People’s social needs are also considered and information had been gained on people’s life history. Staff said this enabled them to get to know people better. Staff were familiar with peoples needs and could talk confidently about the support they give. Staff were able to describe peoples preferred routines with regard to their personal care and what works well for people. Staff have a good knowledge of peoples individual needs. The manager checks on the standard of the care plans and daily communication sheets on a regular basis. She does this in order to make sure that people are getting the care and support they need. People who live at the home and their relatives said they were very happy with the care they receive. Their comments included: • • • • You can have a bath or shower whenever you want one. They always answer the buzzers when you call. Look after everyone really well. Thank you for all the care given to mum. She is very happy and healthy. DS0000066259.V377079.R01.S.doc Version 5.2 Page 15 Carr Croft Care Home • Without your care I don’t think I would have had my mother back to full strength. Help and advice is sought from health care professionals to make sure that people get the special help they need to maintain their health. People are escorted to appointments or health care professionals such as district nurses, attend the home as required. Records are kept of any visits to or from health care professionals. Records are also kept of people’s weights to make sure noone is nutritionally at risk. One record we looked at showed someone to have lost a significant amount of weight during one month. We spoke to the manager about this and what had been done about it. She gave assurances that this had been recorded wrongly and the person was not losing weight. She said she would make sure the person was weighed again and the records updated. We also noticed that one person living at the home seemed to be uncomfortable in the chair they were sat in. The manager said they would make a referral to see if they could get any specialist seating to support this person better. Staff have been trained to meet the specific health needs of people who use the service. Training has been carried out on mental health issues, dementia, first aid and infection control. The manager said that staff would be trained in any individual health care needs that came up and that she had established good relationships with health care practitioners who could provide training for them. The home uses a monitored dosage pre-packed system for medicines. There are good ordering and checking systems in place. The manager makes sure that prescriptions come back to the home before going to the pharmacy for medication to be dispensed. This means they can be checked and any errors avoided. We checked some medication administration records (MAR) sheets. These were found to be in good order. We did however notice that some entries on the MAR sheets had been handwritten. It is good practice to make sure these entries are checked and countersigned by a second person to make sure the information is correct and people receive the right medication. The community pharmacy dispenser was at the home on the day of the visit. She spoke highly of the organisation of medication in the home and that they had good systems in place to make sure the system ran smoothly. Staff are trained in medication awareness and confirmed they would not be responsible for medication without first having the training. Carr Croft Care Home DS0000066259.V377079.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 People using the service experience good quality outcomes in this area. People who use the service are able to make choices about their lifestyle. Social, cultural and recreational activities meet people’s expectations. They also benefit from a good, healthy and varied diet. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: In the AQAA, the provider said they had made improvements to activity available in the home. She said the following: Carr Croft Care Home DS0000066259.V377079.R01.S.doc Version 5.2 Page 17 • • • • Weekly activities programme has been reviewed in light of feedback from the residents/families. Outings are organised on a regular basis. Newsletter is produced by staff/relatives for the service users. Fundraising activities have been enjoyed by all. We saw that activity was provided in small groups or for one to one activity with people. People were enjoying manicures, reading the paper, playing board games or doing chair exercises as a group. One person told us how the staff had helped them celebrate their birthday, providing a cake and a party. People who live at the home were positive about what they do at the home. Their comments included: • • We have lovely church services and birthday parties. I like my own company but they always ask me if I want to do the activities. The activity plan has been developed, based on people’s interests and social care plans. Activity on offer includes, pamper sessions, motivational exercise classes, 1-1 meditation, movie afternoons and sing-a-longs. There are additional special activities organised each month. During August it was planned for a trip to Bridlington, a Summer Fair and a prize bingo evening. Staff said they felt they had enough staff to provide people with a decent amount of activity and said they didnt feel people were bored at the home. The atmosphere in the home is calm and relaxed and life seems to go at the pace of people who use the service. People are free to move about the home as they wish and are able to have their things around them. Everyone we spoke to said it felt like home. People were sat in small social groups to encourage conversation and interaction. People who live at the home were encouraged to make choices throughout the day. Staff said they always ask people what they want to do, what to wear and make sure people can get up and go to bed when they want. Staff said there are no rigid routines for people. This is good person centred practice. A visitor to the home said, “The staff and residents are always very happy and efficient and happy to see us” and “Very friendly and polite atmosphere”. People who live at the home were very positive about the food. Their comments included: • • • The food is very good and plenty of drinks in-between. Always plenty of choice, chef listens to what we want. Very good food. DS0000066259.V377079.R01.S.doc Version 5.2 Page 18 Carr Croft Care Home • • Always good food. Special day Friday, fish and chips, it is always very good. A health professional said, “Food and assistance with feeding very good”. Menus are arranged based on likes and dislikes of people. This information is gained from people at the home, their relatives and staff. There is plenty of choice for people. If people refuse food, alternatives can be prepared quickly for them. Meals can be served in peoples bedrooms, sitting rooms or in the dining areas. Staff are sensitive to the needs of people who find it difficult to eat and need help and encouragement with this. Staff sit with people helping them feel comfortable and unhurried which helps people relax and respond in time. Food looked appetizing and people were offered as many choices as required to encourage them to eat. Carr Croft Care Home DS0000066259.V377079.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 People using the service experience good quality outcomes in this area. People who use the service are able to express their concerns and are protected from abuse. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: In the AQAA, the provider said, ‘All complaints are documented’ and ‘Listen informally to little “niggles” and take appropriate action. People we spoke to said they knew what to do if they were unhappy about anything and knew how to complain. People all said they had “Nothing to complain about though”. It was clear from staffs interactions with people that the people who live at the home seemed confident to raise their wishes or concerns. Any complaints received by the home have been dealt with properly and show they have listened to people and responded well to issues raised. Carr Croft Care Home DS0000066259.V377079.R01.S.doc Version 5.2 Page 20 The provider also told us in the AQAA, that the manager and staff have attended training in safeguarding and updated their knowledge. Staff have received training in safeguarding adults. They were able to say what action they would take if they suspected abuse or had an allegation of abuse made to them. They were also able to describe the different types of abuse. All staff were clear on their responsibility to report abuse or allegations of abuse. They were familiar with the whistle blowing procedure and said they would have no hesitation in using it if they thought they needed to raise concerns outside of the home or organisation. The homes safeguarding adults policy now contains the contact numbers to enable staff to do this. The manager and senior staff are familiar with the local authority safeguarding referral system. This means people are properly protected. There have been three safeguarding adults matters addressed since the last inspection of the home. These have been managed properly and investigated thoroughly. Carr Croft Care Home DS0000066259.V377079.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 People using the service experience good quality outcomes in this area. Overall, the environment is homely, comfortable and safe for people who live at the home. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: In the AQAA, the provider said, ‘All rooms are safe, homely, spacious, comfortably decorated, furnished and upholstered to a high standard. The home is odourless, clean and pleasant. A key to the front door is available where this has been agreed in the individual care plan.’ Carr Croft Care Home DS0000066259.V377079.R01.S.doc Version 5.2 Page 22 She also said that improvements had been made to the outside. She said handrails had been installed at the front steps leading to the front entrance and a new fence had been installed around the patio area. A tour of the building was carried out. Communal areas, bathrooms and bedrooms were visited. The home was clean, tidy and homely. Some bedrooms are for single use and a number are shared. Privacy screening is provided in the shared rooms. The people who share a room have made the decision to do so after being offered the choice of a single room or double. Some rooms have en-suite facilities. Staff work hard to make sure the home is kept clean. There are no malodours in the home. The manager has made sure there are good cleaning routines in place to make sure the home is clean and fresh smelling. A visitor to the home commented, “General décor and cleanliness is very good”. People who live at the home were pleased with their bedrooms and had personalised them with their own things such furniture and pictures. One person said, “It’s a real home from home my room”. The upstairs bathroom in the home is in need of repair or replacement. The enamel base is chipped and rusting. This could be a health and safety risk if someone caught themselves on it. The provider and manager agreed this must be repaired. The environmental health department visited the home in October 2008. The home were awarded three out of a possible five stars from this visit. They are now addressing the recommendations made in that seals have been replaced around the kitchen work surfaces. The kitchen is clean and functional but looking a bit tired and worn in its décor and fittings. The provider is aware of this and said would be considering a refurbishment in the future. Clinical waste is properly managed. Staff have received training in infection control as part of their induction and were able to say what other infection control measures are in place. Staff said they have been trained to always make sure toilets were clean before and after use for people who live at the home, not only to prevent the spread of infection but to also promote people’s dignity. Hand washing and hand drying facilities were available in all areas of the home. Liquid soap or paper towels were available. This ensures good hygiene practice. Carr Croft Care Home DS0000066259.V377079.R01.S.doc Version 5.2 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 People using the service experience good quality outcomes in this area. Staff in the home are trained, skilled and in sufficient numbers to support people who use the service and to support the smooth running of the home. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: People who live at the home and their relatives spoke highly of the staff. Their comments included: • • • • • They are lovely, all of them. The carers are all brilliant. There are enough of them, bit rushed at busy times but always come to you. All staff are helpful. Staff very polite and great with the residents. DS0000066259.V377079.R01.S.doc Version 5.2 Page 24 Carr Croft Care Home • The staff are wonderful. In the AQAA, the provider said, ‘Rotas are prepared to ensure we have a good mix of skills, age, ethnicity and experience on the floor at all times’. We looked at rotas and these showed there were sufficient staff to meet people’s needs at the moment. On the day of our visit there were nineteen people living at the home. There were three care staff on each shift through the day with support from an assistant chef, kitchen assistant, domestic and laundry assistant. Staff said they felt they had enough staff, that they never felt rushed and could meet peoples needs well. The manager said that as more people move into the home, staffing levels will be increased. Staffs interactions with people who live at the home were very respectful, caring and gentle. They showed they had respect for peoples individual needs and dignity. We looked at the recruitment process for people working at the home. The files had the relevant information to confirm these recruitment processes were properly managed. This included application forms, references and CRB (criminal records bureau) checks. The manager has now developed a training plan for staff so that training can be planned and managed better. These records showed that staff’s training was mainly up to date and any updates needed were planned for. Training topics included, induction training which is based on the skills for care common induction standards, diversity and cultural awareness, care planning and risk assessment, health and safety, moving and handling, dementia, Parkinson’s disease and diabetes. Staff said they received good training and felt well prepared for their job. Comments included: • • • Very happy with my training. Induction covered everything I needed. Feel very happy to ask about any training we might need. Over half of the staff team have achieved or are working towards an NVQ (National Vocational Qualification) in care at level 2 or above. This is good practice and means the home keeps staff who are qualified to carry out their job. Some staff told us they were now going on to do level 3. Staff also said how much they enjoyed working at the home. One said, “It’s a really happy place to work”. Carr Croft Care Home DS0000066259.V377079.R01.S.doc Version 5.2 Page 25 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,37,38 People using the service experience good quality outcomes in this area. The home is well managed. The interests of people who use the service are seen as important to the manager and staff and are safeguarded and respected. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Carr Croft Care Home DS0000066259.V377079.R01.S.doc Version 5.2 Page 26 In the AQAA, the provider said, ‘The directors and manager are very approachable and friendly. New management structure includes two deputies. The management team are caring and very approachable maintaining good relationships with the residents and resident’s families’. When asked how the service had improved in the last 12 months, the provider’s comments included: • New style of management has been developed to help maintain high standards of care. • The quality of life of the residents has been enhanced due to the variety of daily activities now offered. • New links have been developed with the local community: community constables, Meanwood elders club, local Sikh temple, district nurses, CPN nurses, Age Concern etc. • Supervisions are carried out regularly. • Staff continue to feel empowered and supported. • Results of annual quality survey have been analysed. The manager has a number of years experience in working in the home. She is now registered with the CQC as the registered manager. She is currently working towards her NVQ 4 in leadership and management which will mean she has a qualification to run the home. Staff spoke highly of the management and leadership in the home. They said: • • • • We get really good support, whatever you tell her she listens and helps you with. She works alongside us to see how we are doing. She tells you if you are doing a good job. She works with us, tells or shows us what needs doing. Staff said they regularly had discussions with the manager to discuss their roles and see how they were working. Records showed that these meetings are recorded and show how the manager is directing the staff to constantly be improving their skills. Visitors to the home said: • • A beautifully run home. Management have a structured and organised system in place. The manager has worked hard to make improvements to the home since our last visit. The home’s records are now well organised and regular meetings take place to make sure communication in the home is good. The manager Carr Croft Care Home DS0000066259.V377079.R01.S.doc Version 5.2 Page 27 said she receives good support from the provider and feels this is key to the improvements made. The provider is at the home most days. Arrangements are in place to make sure of safe working practices. The home has a range of health and safety policies and procedures in place. In the AQAA, the provider said that all equipment used in the home has been serviced or tested as recommended by the manufacturer or other regulatory body. For example, the hoist and electrical wiring. Regular checks are carried out in the home to see if there are any hazards or health and safety issues. However, environmental risk assessments have not yet been carried out to make sure work practices are safe for staff and people who live at the home. The manager said she would ensure these were done. Accident or incident reports are completed and kept in the home. These are sent promptly to CQC, if necessary and the manager looks at these every month to see if there are any patterns or trends or if there is anything that can be put in place to minimise the risk of accidents. We recommend that the manager records this analysis. The provider conducts monthly provider reports with requirements for improvement. They also sometimes use outside consultants to do this. They also send out annual questionnaires to people who use the service and their families or carers and health professionals. This makes sure they are always looking at ways the service can be improved. The manager and staff have recently completed training on the Mental Capacity Act and Deprivation of Liberty. This means they are in a better position to protect people’s interests if needed. Carr Croft Care Home DS0000066259.V377079.R01.S.doc Version 5.2 Page 28 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 2 X X x 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 3 2 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 3 3 X 3 3 3 2 Carr Croft Care Home DS0000066259.V377079.R01.S.doc Version 5.2 Page 29 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 OP19 Regulation 16 Requirement The chipped and rusted enamel bath must be repaired or replaced to make sure it is safe for people to use. Risk assessments must be carried out on working practices in the environment. This will make sure work practices are safe for staff and people who live at the home Timescale for action 30/10/09 2 OP38 13 30/10/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP3 Good Practice Recommendations Assessment information would benefit from more detail, especially for those people admitted to the home on an emergency basis. This would make sure that staff had enough information on people’s needs and nothing was overlooked. A referral to health care professionals should be made to make sure the need for any specialist seating is explored. This will make sure that people who are at risk from poor DS0000066259.V377079.R01.S.doc Version 5.2 Page 30 2 OP8 Carr Croft Care Home posture are given the opportunity to sit more comfortably. Carr Croft Care Home DS0000066259.V377079.R01.S.doc Version 5.2 Page 31 Care Quality Commission Yorkshire & Humberside Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.yorkshirehumberside@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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