Care Home: Croft House Nursing and Residential Home

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What the care home does well The manager is committed to ensuring the `service in the home is what the people living in the home want`. New admissions to the home are only made following a thorough assessment of the persons needs. The Manager does not admit people to the home if their needs cannot be met. Care plans are written in the standard Bupa home format and provide comprehensive details of individual needs, and the actions required to meet them. Routines in the home are flexible and varied according to individual needs and wishes i.e. there are no restrictions on when residents get up, or go to bed etc. One resident said "I am happy with the care provided, and pleased that I cando what I wish to, it was a concern of mine that this might not be the case when I agreed to move in". A range of activities is provided within the home to suit individual needs, and preferences. The home is well decorated, clean and odour free. A maintenance programme is in place to ensure the home remains at a good standard. What has improved since the last inspection? A new manager, who has experience in the care of the elderly and also substantial management experience, is now providing clear direction to staff working in the home. Changes are being made in the home that residents and relatives have requested i.e. increased staffing levels and changes to the food offered. Complaints are now investigated and responded to within the set times with every effort being made to resolve, and provide successful outcomes for residents. What the care home could do better: Staffing levels need to be kept under review to ensure consistency of staffing; particularly at peak times, when complaints have previously been made about the time residents need to wait for the support they need. The Manager must seek the views of all residents with regard to the quality of food served. Consistency of quality must be recorded and maintained so that this can be kept under review. CARE HOMES FOR OLDER PEOPLE Croft House Nursing and Residential Home Braintree Road Great Dunmow Essex CM6 1HR Lead Inspector June Humphreys Unannounced Inspection 10th & 23 June 2008 11:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Croft House Nursing and Residential Home DS0000015400.V367487.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. Croft House Nursing and Residential Home DS0000015400.V367487.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Croft House Nursing and Residential Home Address Braintree Road Great Dunmow Essex CM6 1HR 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) 01371 872135 01371 874727 www.bupa.com BUPA Care Homes (BNH) Ltd Care Home 38 Category(ies) of Old age, not falling within any other category registration, with number (7), Physical disability (2), Physical disability of places over 65 years of age (31) Croft House Nursing and Residential Home DS0000015400.V367487.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. A person of either sex, aged 55 years and over, who requires nursing care by reason of a physical disability (not to exceed 2 persons) Persons of either sex, aged 65 years and over, who require nursing care by reason of a physical disability (not to exceed 31 persons) Persons of either sex, aged 65 years and over, only falling within the category of old age (not to exceed 7 persons) No more than 2 persons may attend the home on a daily basis in addition to those 38 accommodated The total number of service users accommodated must not exceed 38 persons 23rd May 2007 Date of last inspection Brief Description of the Service: Croft House is a large established care home providing nursing and personal care for up to 38 residents over the age of 65 years, which includes up to 2 residents over the age of 55 years. The home can also provide day care for up to 2 people. Croft House is in a purpose built two-storey building. The home has 32 single and three double rooms. All rooms have en-suite facilities. The home is on two floors and a passenger lift is available. There is a sitting room on each floor and a large dining room on the ground floor. The home has attractive gardens and a paved area with seating. The home is located five minutes from Dunmow town centre and there is a bus stop outside the home. The current range of fees is £566 to £950 per week and there are additional charges for private telephone lines, hairdressing, chiropody and newspapers. Croft House Nursing and Residential Home DS0000015400.V367487.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 3 stars. This means that people who use this service experience excellent quality outcomes. This was a routine unannounced inspection, which included a visit to Croft house on the 10th and 23rd June 2008. One inspector undertook the site visit, and all of the key national minimum standards were inspected. Opportunity was taken to speak with residents, relatives and staff, and both the Manager and her deputy. The Manager completed and returned the Annual Quality Assurance Assessment to the Commission, which is a self-assessment of how the service is doing. Information from the document has been included in the report. Records and documents were looked at in detail, including a sample of care plans, four staff files and supervision records, the staff rota, complaints, medication and accident records. As part of the inspection 15 staff surveys, and 16 residents/relatives surveys were returned. Comments from the surveys have been included in the report. Many of the Service users spoken to expressed a high level of satisfaction with the home, and the service provided. However evidence gathered during the inspection suggests that there is some inconsistency in the care provided especially for residents who require a higher level of assistance, and cannot always request the help they need. What the service does well: The manager is committed to ensuring the ‘service in the home is what the people living in the home want’. New admissions to the home are only made following a thorough assessment of the persons needs. The Manager does not admit people to the home if their needs cannot be met. Care plans are written in the standard Bupa home format and provide comprehensive details of individual needs, and the actions required to meet them. Routines in the home are flexible and varied according to individual needs and wishes i.e. there are no restrictions on when residents get up, or go to bed etc. One resident said “I am happy with the care provided, and pleased that I can Croft House Nursing and Residential Home DS0000015400.V367487.R01.S.doc Version 5.2 Page 6 do what I wish to, it was a concern of mine that this might not be the case when I agreed to move in”. A range of activities is provided within the home to suit individual needs, and preferences. The home is well decorated, clean and odour free. A maintenance programme is in place to ensure the home remains at a good standard. 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. Croft House Nursing and Residential Home DS0000015400.V367487.R01.S.doc Version 5.2 Page 7 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 Croft House Nursing and Residential Home DS0000015400.V367487.R01.S.doc Version 5.2 Page 8 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): 1,2 and 3 (standard 6 does not apply) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People moving into Croft House can be confident that their needs will be fully assessed, and that they will not be offered a place, unless the service can meet their needs. EVIDENCE: The service has a statement of purpose and a service user’s guide, which is regularly reviewed and updated to ensure it provides precise information about the service on offer. Each resident has a statement of the terms and conditions of occupancy and a contract detailing the accommodation to be provided, the care the person will receive and any other services available i.e. hairdressing and chiropody. New admissions to the home are only made following a thorough assessment of the persons needs. Croft House Nursing and Residential Home DS0000015400.V367487.R01.S.doc Version 5.2 Page 9 The manager stated in the Annual quality assurance assessment that “all prospective residents undergo a pre-admission assessment to ensure the home can meet any identified needs and that the placement will be appropriate”. Three assessments were looked at on the second day of the inspection. All sections of the assessment forms had been completed, and were found to contain sufficient detail, to form the basis of the initial care plan. The home does not provide intermediate care. Croft House Nursing and Residential Home DS0000015400.V367487.R01.S.doc Version 5.2 Page 10 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. This judgement has been made using available evidence including a visit to this service. Staff practices promote good healthcare within the home, and medication practices protect residents. The current ethos promotes the privacy and dignity of residents. EVIDENCE: Six care plans were looked at as part of this inspection. Those seen were written in the standard Bupa home format and provided comprehensive details of individual needs and the actions needed to meet them. Good personal details were included which provided a picture of the person being cared for, such as personal preferences etc. Individual progress was tracked on the daily record, and all six files had adequate information. However a resident raised concern that they had requested to see their G.P and that this had not happened. On tracking the daily records only limited information had been recorded, and it would seem that the G.P had been telephoned, and had said that they did not need to visit Croft House Nursing and Residential Home DS0000015400.V367487.R01.S.doc Version 5.2 Page 11 and to make certain changes to the persons medication. Despite this the resident still requested to see their G.P and it was only when this was picked up as part of the inspection that this was acted on immediately by the Manager. Staff must act on residents’ requests, and record subsequent responses and actions. The annual quality assurance assessment stated that “continuous update of documentation” would improve a quicker response and the Manager has now put in place a care plan and daily records monitoring form, which will help in the consistency and accuracy of recording. Each resident is registered with a GP, and the Manager stated (Annual quality assurance assessment 2008). “there are company specialist both regionally and nationally who can be consulted for advise and support, “ i.e. specialists in dementia care. Service users spoken to said that staff monitored their daily condition and felt confident that outside help would be summoned as necessary. One person said “the staff are very good at helping when you’re unwell. They give you that little bit of extra attention”. Another resident said “ I always receive the help I request, staff are very good. Observation of the care staff at work showed that interaction with residents was positive, appropriate and in keeping with their needs. Residents looked well cared for, were well presented physically with tidy hair and fingernails etc. and were dressed in their own clothes. Personal care was delivered discreetly and those service users spoken with who were able to express a view said that they were well-treated by the staff and felt that their privacy was respected - this was seen to be the case in several instances seen during the inspection. The Medication policy used in the home has been updated since the last inspection. There is also a new medication administration procedure with most medication now administered from blister packs. This was introduced shortly after the first day of inspection. The staff spoke positively of the new procedures and felt that the system was less time consuming. Medication administration records (MAR) were viewed and were well maintained. The breakfast medication procedures were observed, residents could eat their breakfast either downstairs in the dinning room, or in their bedroom. Medication was offered before, with their food or after they had eaten. Croft House Nursing and Residential Home DS0000015400.V367487.R01.S.doc Version 5.2 Page 12 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. This judgement has been made using available evidence including a visit to this service. People living at Croft House are supported to live their lives according to their personal and individual preferences. EVIDENCE: Observation during the inspection showed that the routines in the home are flexible and are varied according to individual needs and wishes. There are no restrictions or routines that residents need to follow i.e. on when to get up, or go to bed. Breakfast can be ordered from the kitchen even when the main breakfast time has finished. There was plenty of activity in the home on both days of the inspection. There is a structured activities programme, which offers a range of different activities to suit individual needs and preferences i.e. quizzes, painting, sewing/craft activities etc. A number of residents have personal televisions in their bedrooms and prefer not to join in. One person said, “I join in sometimes, but prefer to be left on my own.” Another person said, “I like the activities, especially the entertainers that come in, they’re very good”. Croft House Nursing and Residential Home DS0000015400.V367487.R01.S.doc Version 5.2 Page 13 The home has received a number of complaints with regard to the food on offer in the home. This has ranged from the type of food on offer to the quality, and taste of food served. The manager has reviewed the menu offered to residents with the assistance of the regional catering manger. The manager stated in the annual quality assurance assessment that “the home uses the Bupa menu master which helps to ensure the menu meets the nutritional needs of the residents”. There is a four-week menu which residents are consulted on prior to it being agreed. This is usually undertaken by the chef talking to residents’ individually about their likes and dislikes. The menu seen offered a range of different wellbalanced nutritious foods. On the day of inspection 6 people were interviewed personally, and every table in the dining room was approached to make comment on the food. There was a choice of two main meals, one meat based, and the other fish. One person who had previously expressed concern about the food requested plaice instead of baked cod, and this was provided. Many residents said they liked the food provided and praised the general standard, however several said that they considered it ‘bland and rather dull’ in taste. Ranges of condiments are available at each meal to try to offer extra taste to those resident who prefer more salt, or pepper on the food served. On the second day of inspection both breakfast and lunch was sampled as part of the inspection. The food for both meals was well presented, hot and of an acceptable standard. Two alternative meals were served to those not suited by the main choice. The Manager advised that she had listened to residents and understood how important the quality of food was to residents. An advertisement has been placed for a new senior chef to be employed to try to resolve any concerns. It must be acknowledged that it is very hard to satisfy everybody in mass catering situations but in the light of these comments a requirement has been made to ensure residents likes and dislikes are clearly recorded. Several people needed help to eat their meals and once again the staff assisted discreetly and appropriately, giving their full attention to the resident. Croft House Nursing and Residential Home DS0000015400.V367487.R01.S.doc Version 5.2 Page 14 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 excellent. This judgement has been made using available evidence including a visit to this service. Residents can be assured that the appropriate practices and procedures in place within the home will protect them from possible abuse, and that any complaints will be acted on. EVIDENCE: A robust complaints procedure is in place that contains the required elements to meet the standard. There is a copy of the complaints procedure on display in several communal areas of the building. Most residents asked, said they knew how to go about making a complaint and expressed confidence that the senior staff and manager would listen and react promptly to resolve the matter if possible. The current manager is an experienced, but relatively new into post at Croft house, and has been dealing with several complaints, which appear to have been on going since September 2007. Every effort has been made to try to resolve these issues in accordance with the procedure. Staff had an awareness of the whistle blowing procedure and knew how to report any concerns about residents’ welfare. Staff spoken to confirmed that training relating to safeguarding had been provided. Complaints records were viewed on the day of inspection. They are corporate documents, which clearly record the complaint made; and subsequent information relating to the investigation. Five complaints had been received since the last inspections all-relating to the same areas, namely staffing levels Croft House Nursing and Residential Home DS0000015400.V367487.R01.S.doc Version 5.2 Page 15 and food. The Manager has met with relatives, and responded in writing detailing the action taken. A number of changes have been implemented in the home in response to the complaints made. Residents were confident that the Manager would follow through any complaints. It is to be noted that the staff and manager has also received a number of compliments with regard to the quality of care, and the commitment to looking after residents. Croft House Nursing and Residential Home DS0000015400.V367487.R01.S.doc Version 5.2 Page 16 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. This judgement has been made using available evidence including a visit to this service. Croft House is a purpose built care home providing both residential and nursing care. Every effort has been made to try to provide a homely atmosphere for the residents who live there. EVIDENCE: The building has two floors, with 32 single and three double rooms. All rooms have en-suite facilities. Wide corridors with handrails are ideal for the mobility of residents and the use of wheelchairs. The home has a passenger lift, which was fully operational on the day of inspection. There is a sitting room on each floor and a large dining room on the ground floor; all have been decorated with domestic style fixtures and fittings. The home has attractive gardens; the manager has increased the maintance work undertaken in the garden areas since the last inspection to ensure residents can fully enjoy, the view from the patio area in the Summer months. Croft House Nursing and Residential Home DS0000015400.V367487.R01.S.doc Version 5.2 Page 17 Bedrooms were seen to be personalised, reflecting individual interests, and of a good size. Overall the home was seen to be clean, tidy and odour free. In some cases this is a difficult task has at times service users require a high level of nursing care, and associated equipment is located in their own personal space i.e. bedroom. However out of 6 relatives interviewed during the inspection, two raised concern about the cleanness of their relative’s bedroom. One person said, “this room could be cleaner, and the tap in the bathroom has not worked properly for sometime.” Another person said “They don’t always clean the toilet when I make a mess, I really don’t like that! This was discussed with the manager and she advised that a housekeeping manager, and a further full time member of staff had been employed since the last inspection. By the second day of the inspection an auditing sheet had been devised to ensure that residents were satisfied with the quality of housekeeping services. A maintenance programme is in place and refurbishment is therefore on going. One relative has requested that the resident’s room not be decorated, as she is concerned that this would be very disruptive. This was agreed, as long as there are no concerns with regard to health and safety, or the possible risk of infection. Staff spoken to as part of the inspection appeared to have good knowledge of infection control; they were aware of the companies policies and procedures and new how to report any concerns i.e. “ I would write it in the maintance book, or report it to the head housekeeper, and then check that it has been followed up on the next shift”. The manger stated as part of the annual quality assurance assessment that staff have had training on infection control, but also under’ what we could do better’ it states “further training is to be offered.” This was discussed with the Manager and I was advised that this is seen as a priority and whilst a number of staff has received training, all staff will undertake training within the next 12 months. Croft House Nursing and Residential Home DS0000015400.V367487.R01.S.doc Version 5.2 Page 18 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 adequate. This judgement has been made using available evidence including a visit to this service. Adequate numbers of staff need to be available at all times to ensure residents receive consistency in the care provided. EVIDENCE: On both days of the inspection, there was adequate staff on duty to meet the assessed care needs of current residents. The staff rota for the day was accurate and few changes had been made. Staff on duty had a good understanding of residents assessed care needs. Staff were informative and very helpful. All wore a recognised uniform. A complaint has been received by the C.S.C.I since the last inspection, from several relatives about the number of staff on duty, and the number of agency staff working in the home. The new Manager has responded to the concerns and has actively started to address these. There are 8 members of staff on duty in the morning, and 5 staff in the evening. The evening shift has been increased by one extra member of staff. The manager is currently trying to recruitment new carers. Once this is completed the morning shift can then also be increased, to nine members of staff. An extra carer has also been added to the night shift. The layout of the building does not always make it easy to respond immediately to resident’s requests. In the evening if there are 5 staff Croft House Nursing and Residential Home DS0000015400.V367487.R01.S.doc Version 5.2 Page 19 on duty, this allows for 2 staff on each floor, and one person (senior) managing the shift. Whilst this staffing level can be seen to be adequate some residents require two staff in relation to manual handling tasks. Also at 5pm in the evening a larger number of residents choose to eat their meal in their bedroom. One relative stated “Residents can wait sometime for a member of staff to feed them, there’s just not sufficient staffing.” The Manager advised that she is trying to introduce a twilight shift that will cover this time of day, and hopefully improve the numbers of staff available. As part of the inspection 15 staff surveys were returned and 16 residents/relatives surveys. Evidence from the surveys suggests that whilst the new Manager has actively worked hard to improve recruitment and staffing ratios, time is required for this to filter through to improve the morale of staff, which ultimately will improve outcomes for residents. All 15 surveys received from staff commented on staffing levels and current wages. Examples from survey such, as “The home is not the greatest at the weekends”. Another person said, “To improve the care we need more staff, and improved wages may help staff stay longer!” Bupa is a large company with homes located in different areas; salaries are often set on where the home is located. The new Manager has offered a range of incentives to try to improve this. Staff are now paid for breaks. Each month a buffet is provided to show that staff efforts are appreciated. Unqualified staff are offered N.V.Q 2 training after 6 months of employment. Resident/relatives surveys provided a more varied response with some residents concern but others complimentary. 7 surveys stated that there is “not always enough staff on duty, particularly at weekends”. “Sometimes when you sound the buzzer help is a long time coming, it’s not the carers fault, it’s the lack of staff. The other nine surveys were however complimentary about the staff that work in the home, ”always so nice, and do their best to help”. Another person said, “On the whole it’s good here, most of the staff are very helpful.” Staff on duty should be commended for the effort they make. Evidence suggests that numbers of staff need to be reviewed and a requirement has been made in relation to this. Recruitment files were looked at as part of the inspection process. Four files were sampled and information seen was well documented, staff files being well organised, and in an easily readable format. Appropriate CRB checks, references and recording of information relating to the employment of staff was in place. New staff files were looked at and evidence of induction was in place. The new Manager has agreed that staff are not included in the numbers of staff on duty until that have had an opportunity to experience working on shift in the home. Staff is also supported/coached by senior staff to help them feel confident to do the job. In the annual quality assurance assessment the Manager stated that the number of N.V.Q 2 staff has increased “to 42 from 21 ”. The Manager is Croft House Nursing and Residential Home DS0000015400.V367487.R01.S.doc Version 5.2 Page 20 also “encouraging more staff to commence N.V.Q” as a target for next year. “There is a training matrix specific to the home that identifies the training requirements of staff”. This was seen at the inspection, and training appeared to be well organised covering all mandatory areas such as fire safety, manual handling, safeguarding etc. Croft House Nursing and Residential Home DS0000015400.V367487.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home is well managed, and residents’ benefit from the knowledge, ethos and experience of the new manager, who is committed to ensuring the home, is run in the best interests of residents. EVIDENCE: The new manager had been in post three months at the time of this inspection. She has a strong commitment to raise and sustain standards and the numerous improvements noted in the operation of the home since she came into post provided evidence of her effectiveness. Staff spoken with said that she was approachable, although firm in providing guidance, especially in matters of care practice. Residents and relatives spoke highly of the new manager of the home, and felt there was good communication. The manager demonstrated a good awareness Croft House Nursing and Residential Home DS0000015400.V367487.R01.S.doc Version 5.2 Page 22 of the needs of older people, and a positive approach to promoting independence and fulfilment for the people living in the home. Since the last inspection, and from information provided by the nine residents spoken to, the issues and concerns raised in relation to staffing and food have been on going for sometime. The amount of time is significant has it makes it more difficult for residents and staff to see/appreciate the changes, and subsequent improvements that the manager has implemented. The manager communicates a clear sense of direction and has identified a number of areas for improvement in the home including the issues relating to staffing and food, which should benefit residents. Prior to the current manager being in post supervision of staff was inconsistent with no evidence available i.e. notes to suggest these have happened. This has now improved and is essential to support and improve staff morale. Team meetings have been increased, and the Manager is looking at ensuring all staff are able to attend. The manager is keen to ensure relatives are aware of the changes and improvements that are happening. A newsletter has been introduced, and will be sent out every 3 Months. The number of social gatherings organised within the home has been increased. A cheese and wine evening had been planned for relatives to attend at the time of inspection. All of the records required by regulation are kept correctly. The home had a clear health and safety policy statement, and additional information and guidance on various aspects of health and safety. Staff interviewed was aware of policies and procedures and felt confident that the manager would update them when necessary. The home’s training summary record showed that the majority of staff had current moving and handling and fire safety training, and that staff had attended other relevant health and safety training (e.g. COSHH, food hygiene, first aid, health and safety). New staff had dates scheduled for training. Records looked at showed that appropriate servicing and checks were carried out on facilities and equipment. This undertaken by the maintance officer employed in the home. The fire logbook provided evidence that regular fire alarm checks, extinguisher checks and emergency lighting checks took place. The manager reported that fire drills were under taken on a 3 monthly basis. The inspection was undertaken over 2 days and the evidence gathered within this period suggests that the home is a safe place for residents to live in, with staff and Managers following health and safety working practices. Croft House Nursing and Residential Home DS0000015400.V367487.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 4 3 X X X X X X 3 STAFFING Standard No Score 27 2 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 X X 3 Croft House Nursing and Residential Home DS0000015400.V367487.R01.S.doc Version 5.2 Page 24 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 OP27 Regulation 18 Requirement The registered person(s) must ensure that having regard to the size of the home, the statement of purpose, and the number and needs of residents that at all times suitable qualified, competent and experienced persons are working in the home. This will ensure that there are adequate staff to meet the changing/ increased needs of the people who live in the home. Food must be served hot. It must be tasty, edible and of good quality. This must be audited at each meal and steps taken to ensure consistency of quality of the food served to residents. Timescale for action 01/09/08 2. OP15 16 (2) 01/08/08 Croft House Nursing and Residential Home DS0000015400.V367487.R01.S.doc Version 5.2 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Croft House Nursing and Residential Home DS0000015400.V367487.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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. 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