Care Home: Croft Meadow

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What the care home does well Staff are described as "courteous and helpful and cheerful". There are good arrangements in place to ensure medication is being safely administered. People tell us that there are "very good meals - well cooked and presented, varied". It is described as a "friendly, well run home with a good atmosphere". What has improved since the last inspection? This is the first inspection of the service. What the care home could do better: No requirements or recommendations were made at this visit. Key inspection report Care homes for older people Name: Address: Croft Meadow Croft Meadow Tanyard Lane Steyning West Sussex BN44 3JR     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Edward McLeod     Date: 1 1 1 1 2 0 0 9 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 27 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. 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 Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Croft Meadow Croft Meadow Tanyard Lane Steyning West Sussex BN44 3JR 0000 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Shaw Healthcare Ltd Name of registered manager (if applicable) Ms Rebecca Dacosta Type of registration: Number of places registered: care home 60 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: 1. The registered person may provide the following category/ies of service only: Care home with nursing (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Old age, not falling within any other category (OP) 2. The maximum number of service users to be accommodated is 60 Date of last inspection Brief description of the care home Croft Meadow is a care home which can accomodate up to 60 people in the categories of old age and dementia. The registered provider is Shaw Healthcare Ltd, and the responsible individual is Mr Peter John Jeremy Nixey. The registered manager for the service is Ms Rebecca Dacosta. Care Homes for Older People Page 4 of 27 Over 65 0 60 60 0 Brief description of the care home Croft Meadow is a purpose built care home with accomodation on ground, first and second floors. All bedrooms have en suite toilet and shower facilities. Lifts are operated in the home. The home is close to local bus links, shopping and leisure facilities in the village of Steyning. The fees range from 420.44 to 781 pounds per week. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This is a new service, and the inspection was arranged to assess the homes compliance with the key national minimum standards for care homes for older people. The visit took place on the 11th November 2009 and lasted from 10.50 a.m. to 5.15 p.m. In preparing for this visit we looked at all the information that we had received or asked for since the last key inspection and this included:the annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. The AQAA was received by the due date and included the information we asked for Care Homes for Older People Page 6 of 27 the fourteen Care Quality Commission (CQC) surveys we received from people living in the home. We also received six CQC surveys completed by members of staff. What the service has told us about things that have happened in the service What other people have told us about the service and relevant information from other organisations. Some of the information received has been included in this report. During our visit we spoke with five people living in the home, five members of staff and the manager. We also spoke with one visitor. Records and policies and procedures we sampled during our visit included the pre admission assessments for three people living in the home the care plans for five people living in the home recruitment, training and supervision records for four permanent staff and four temporary staff working in the home records relating to money held on behalf of people living in the home, activities records, the record of complaints, and records relating to health and safety and the administration of medication. We observed interactions between staff and people living in the home, including during the serving of lunch. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details 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. Care Homes for Older People Page 8 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are confident the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. Evidence: The AQAA tells us that residents have said that by visiting the home prior to admission they feel more comfortable on the day of admission. We sampled the pre-admission assessments for five people living in the home and found that the persons needs were being assessed before admission was agreed. Care Homes for Older People Page 10 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. Peoples right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. Evidence: We sampled the care plans for five people living in the home. We found that care plans are being regularly updated, and that risk assessments are put in place. People living in the home who responded to our Care Quality Commission (CQC) questionnaire survey told us that they are receiving the care and support that they need, and that staff listen to them and act on what they say. Care Homes for Older People Page 11 of 27 Evidence: Interactions observed between staff and people living in the home indicated that people are being treated with respect and that care is provided which takes into account the persons wishes and choices. One person told us in their survey form that staff are courteous and helpful and cheerful. We sampled the food and fluid charts and turning records for two people who are bedbound, which indicated that arrangements were in place to provide this assistance. Arrangements for district nurses to regularly monitor their care were also in place. The AQAA tells us that residents are escorted to the surgery with a member of staff if they are able to do so, promoting independence. We observed duirng our visit that staff help people maintain their dignity and privacy when care is being provided - for example, while giving assistance with eating or cutting food. People living in the home told us in their surveys that they were receiving the medical support that they needed. This view is supported by the care records we sampled. We looked at the arrangements for the administration of medication in the home, which included sampling recent medication records for three people. We found that arrangements are in place to ensure medication is administered safely, is safely and securely stored, and properly recorded. Training in the safe adminstration of medicines is being provided regularly for staff who administer medication. There are good arrangements in place to monitor medication arrangements and check medication records. Care Homes for Older People Page 12 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. Evidence: The AQAA tells us that residents have shown an interest in more outings being arranged and for a weekly church service in addition to the monthly service, and that these possibilities are being looked into. There is a weekly activities plan in the home which is posted in each of the units, and includes games, singing, drawing and painting, indoor gardening, and yoga. On the day of our visit an activity co-ordinator was spending time on different units Care Homes for Older People Page 13 of 27 Evidence: encouraging people to sing along. The activity co-ordinator said that 27 people had taken part in the singing during that morning. Photographs of recent events displayed on the walls included a Halloween party and Remembrance Day. The home has also been developing a pick a wish scheme and this has included one resident having a flight in a small aeroplane. We talked to the relative of someone living in the home and they told us they were welcomed when they visited and were usually kept in touch with what was happening. A member of staff we spoke to told us that one of the responsibilities of the key worker is to maintain contact with and talk to the persons next of kin. People who live in the home told us they enjoy the meals provided in the home, and their comments included very good meals - well cooked and presented, varied, and the cooking is excellent. At our visit we were advised by the manager Ms Dacosta that breakfasts are served from 8.45 am and noted that one person was being provided with breakfast at 11.45 having got up late. We observed the arrangements for lunch, and found that people were being offered a choice of meals, and that people who required specialist diets such as a soft food diet were receiving this. Lunch on each floor was unhurried and relaxed, and people who needed assistance with cutting their food or eating were receiving this. Care Homes for Older People Page 14 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. Evidence: Twelve of the fourteen people living in the home who completed our CQC survey told us that they felt there was someone they could talk to if they had concerns. Nine of them said they knew how they make a formal complaint. During our visit we sampled the records for three complaints the home had received, and the records indicated that the complainants concerns had been investigated, appropriate action taken, and feedback had been given to the complainant on the outcome of the complaint. Information on contacting an advocate with Age Concern is displayed in the home. During our visit we learned that 10 staff are booked to do training in the deprivation of liberty safeguards. The AQAA tells us that staff receive training in the safeguarding of vulnerable adults Care Homes for Older People Page 15 of 27 Evidence: and whistle blowing during induction and at yearly statutory training updates. We looked at safeguarding referrals in the home and their outcomes. It was our assessment that the home has been making appropriate referrals and taking appropriate action to ensure that people living in the home are being protected from harm. Care Homes for Older People Page 16 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. Their room feels like their own, it is comfortable and they feel safe when they use it. Evidence: The premises are new and purpose built. We found that the building, gardens and grounds are being well maintained and the building is kept in good decorative order. Arrangements are in place for maintenance issues to be attended to in a timely manner. There were records in place which indicated that the safety of the premises are being regularly monitored. Each of the ten bedded units in the home has a sitting area, and on the first floor there are an additional two sitting rooms which are used by people when they receive visitors. There is is a sitting room on the second floor used for showing films and as a quiet room. Care Homes for Older People Page 17 of 27 Evidence: We visited seven bedrooms and found that people had been assisted by relatives to personalise their bedrooms with pictures, belongings and sometimes their own furtniture which all helps to make the bedroom feel like their own. All bedrooms have en suite facilities including a shower, and on each floor there is a bathroom for people who prefer a bath. The fourteen people living in the home who responded to our CQC survey told us that the home is usually or always fresh and clean. All areas of the home we visited were found to be clean and free from odours. We visited the laundry room and found that suitable arrangements were in place for the proper cleaning of laundry and to ensure that clothes are returned to the right person after they have been cleaned. Care Homes for Older People Page 18 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. Evidence: On the day of our visit fifty two people were being accomodated. Of the fourteen people living in the home who responded to our CQC survey, seven told us that staff were always available when needed, six said staff were usually available when needed, and one person told us that staff are sometimes available when needed. Of the six members of staff who responded to our CQC survey, one told us there were always enough staff to meet peoples needs, three said there were usually enough staff, and two said there were sometimes enough staff. One person living in the home tells us in their survey form but that permanent staff are courteous and helpful and cheerful but that at weekends agency staff have lack Care Homes for Older People Page 19 of 27 Evidence: of knowledge of the home and poor English skills. The manager tells us in the AQAA that to reduce the impact on residents of using agency staff we use the same agencies and request staff who have worked in the home before in order to provide consistency until the home is fully recruited. We discussed staffing issues with the manager Ms Dacosta. She advised us that since the opening of the home there had been a decrease of more than 50 per cent of agency staff being used, and that to recruit more full time staff interviews were being held two or three times a week. Ms Dacosta said that where agency staff were found to be lacking in skills including communication skills, that they were no longer employed in the home. One member of staff told us in their survey form that staff are working towards the same goal and are a happy, dedicated working team. The AQAA tells us that no new member of staff commences employment until we have received the CRB and at least two satisfactory references and that all new staff receive a 4 day induction training. The six members of staff who responded to our CQC survey told us that their induction training covered everything they needed to know for starting work in the home. We sampled the recruitment records for four members of staff, and found that staff references and checks were being obtained before staff started work in the home. The AQAA tells us that more half the members of permanent staff have obtained the National Vocational Qualification (NVQ) in care at least at level 2. We sampled the records obtained for four members of agency staff who were working at the home during the week of our visit. We found that the home was obtaining confirmation of references and checks and training records for agency staff who were working in the home. Staff we spoke to told us that agency staff were being included in the training provided in the home. We are told in the AQAA that a training matrix identifies when a member of staff is due to do statutory training. Care Homes for Older People Page 20 of 27 Evidence: We looked at the training recods for four members of staff and the training matrix that tells us when staff have most recently completed each required training. We found that most staff were up to date with required training. Staff told us in their CQC survey forms that they felt they were receiving training which was relevant to their role, helped them understand peoples needs, kept them up to date with new ways or working and gives them enough knowledge about health care and medication. We learned during our visit that supporting people with dementia is part of the induction training, and that in January 2010 10 members of staff will be doing a more in-depth training in supporting people with dementia. Care Homes for Older People Page 21 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. Evidence: The manager Ms Dacosta advises us that she has achieved the NVQ in care at level 4 and is undertaking the leadership and management award. At our visit we learned that she is continuing to update her training and skills. Ms Dacosta told us that there is a skilled team of team leaders in place in the home. Care Homes for Older People Page 22 of 27 Evidence: People we talked to during our visit said there was relaxed and friendly atmosphere, and we found that staff have a caring attitude towards people living in the home. One member of staff told us in their survey form that it was a friendly, well run home with a good atmosphere. Arrangements are in place for residents and other people to give their views on the service. During our visit people told us that views and suggestions are listened to. For example, relatives had suggested that the names of the members of staff working on the unit for that shift be displayed, and this is now done. We understand that residents said they would be interested in having a cat around the home, and that a kitten has recently been brought in and is very popular. The AQAA tells us that quarterly audits are undertaken to measure the homes performance. During our visit we looked at the arrangements in place for holding money on behalf of people living in the home. We sampled the records for two people, and talked with staff about how the system works. We found that appropriate arrangements were in place for handling peoples money. The AQAA tells us that residents accounts are audited regularly. We are told in the AQAA that staff are supervised bi-monthly and have named supervisors. We found that arrangements are in place for staff to receive one to one supervision which supports the work they are doing. We sampled some staff supervision records, which indicated that regular staff supervision is beginning to be provided. There are not yet arrangements in place for agency staff to receive one to one supervision, although a team leader told us that team leaders give feedback to agency staff on their performance and agency staff have the opportunity to talk issues through with the team leader on the unit they are working. We discussed this after the visit with the manager Ms Dacosta who advised that where issues had been discussed with agencies supplying a worker this had been recorded, but that general feedback to agency staff had not been recorded. Ms Dacosta told us Care Homes for Older People Page 23 of 27 Evidence: subsequent to our visit arrangements had been put in place for staff from agencies working in the home to receive one to one supervision. No requirement concerning staff supervision was made, as the inspector understands that this standard is now being met. Training records we sampled indicated that staff are receiving training in health and safety topics such as infection control, food hygiene and lifting and handling. We found that weekly fire system tests and regular fire drills were being completed. We sampled other health and safety records, such as daily and weekly environment checks and hot water temperature checks. Records sampled indicated that appropirate arrangements for health and safety in the home are in place. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@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). 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. Care Homes for Older People Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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