Care Home: Cromarty House

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What the care home does well A warm and comfortable environment is provided at Cromarty House with wellmaintained accommodation to include en suite bathrooms. The registered provider Manages the home on a day to day basis and provides clear leadership and direction. The atmosphere within the home was relaxed and friendly and this was evident in the residents interactions. Staff were positive about the home and the care provided. The home has its own transport so the residents have good opportunities to visit a wide range of places in Cornwall. Photos are displayed in the home of some of the visits. What has improved since the last inspection? The training and knowledge base of staff has improved in the area of adult protection and safeguarding. Staff training has improved as evidenced by the high level of NVQ qualifications currently held and the number of regular training courses on offer. What the care home could do better: No specific recommendations or statutory requirements are made as a result of this inspection. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Cromarty House 11 Priory Road Bodmin Cornwall PL31 2AF     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Michael Dennis     Date: 3 0 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 25 Information about the care home Name of care home: Address: Cromarty House 11 Priory Road Bodmin Cornwall PL31 2AF 0120878607 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Debra Tarrant,Mr Roger Tarrant care home 6 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 6 Service users to include up to 6 adults with a learning disability (LD) aged 18 to 65 years. Date of last inspection Brief description of the care home Cromarty House is a detached property set in its own grounds with private parking at the rear of the house. The home is within easy walking distance of Bodmin town and shopping area. Cromarty House provides care and accommodation for up to six younger people with a learning disability, some of who may present with challenging behaviour. The home provides six ensuite single bedrooms and well furnished communal areas. The accommodation is on two floors, three ground floor bedrooms and three first floor bedrooms. There is a bathroom on the first floor and an additional toilet on the ground floor. Externally there is a garden area for the use and enjoyment of the service users. The accommodation would not be suited to anyone who was reliant on wheelchair for mobility although a person with limited walking ability could probably manage in a ground floor room. Care Homes for Adults (18-65 years) Page 4 of 25 Brief description of the care home Fees range from approximately 678 to 1218 pounds per week. Fees are calculated based on the assessed needs of the individual. Care Homes for Adults (18-65 years) Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The key inspection took place on the 30th.June 2009 and was unannounced. The inspection lasted for approximately four hours. We spoke with residents, staff, and the registered provider. We walked around the home, observed practices and examined documentation. Care Homes for Adults (18-65 years) Page 6 of 25 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.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 Adults (18-65 years) Page 7 of 25 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents are properly assessed prior to admission. Evidence: There is a Statement of Purpose and service user guide, both in standard and pictorial forms. This information is given to all prospective residents, their family and advocates. Copies are also found in each persons bedroom. No new admissions have taken place since the last inspection. The admission process includes a full needs assessment undertaken by senior staff members. Appropriate paper work is in place to record and collate this information. Further information is obtained from placement authorities. Prospective residents are given the opportunity to visit the home prior to making decisions about permanent residency. Contracts of care and statements of terms and conditions are issued to each resident. Care Homes for Adults (18-65 years) Page 9 of 25 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents care needs and capabilities are clearly understood. Residents are involved in their care and assisted to make informed choices and to take risks responsibly. Evidence: Discussion with staff and examination of care documentation confirms that residents are included and involved in developing their own plan of care. Care plans are regularly reviewed and include comprehensive risk-assessments. The care plan also includes any restrictions on choice and freedom, and staff provide the residents with the information they need in order to make informed decisions. Residents also complete a my life, my plan section. The care plans include financial managements and the residents capabilities are recognised and encouraged where possible in this respect. There are relevant and appropriate procedures in place. The staff can access the care plans as required and during the course of the inspection the staff presented as having a very good understanding of the needs of the residents. Care Homes for Adults (18-65 years) Page 10 of 25 Care Homes for Adults (18-65 years) Page 11 of 25 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are given appropriate information and assistance in order to live a fulfilling life, which includes friends and family. Residents enjoy a health, varied diet. Evidence: The daily records detail the activities that people are offered. These can include attendance at day centres, exercise sessions, trips out, visits to favourite local places, work placements, and time away with families. Residents help with the shopping for the home, and with general household chores and activities. Each resident completes a personal diary in which his or her activities and interests are included. When at home people like to watch television, listen to music of their choice or generally relax. Visitors tend to ring prior to visiting, not as a restriction, but more to ensure that the residents plans for the day are not disrupted, which could be upsetting for some Care Homes for Adults (18-65 years) Page 12 of 25 Evidence: residents. There are regular recorded collective house meetings, and also meetings with individual residents. Residents are involved in deciding what is on the menu. As some of the residents attend day care facilities, the main meal of the day is taken in the evenings. Some of the residents have complicated care needs around meals and special diets have to be catered for. All the staff have responsibility for meal preparation and have received basic food hygiene certificate training. A healthy eating programme is encouraged with no biscuits or cakes being offered during the course of the day. Care Homes for Adults (18-65 years) Page 13 of 25 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Health care needs are evidenced as being met in care planning and medication administration was found to be satisfactory on the day of the inspection. Evidence: Health care needs are identified in care planning and daily records evidence that these are being met. Staff understand the key principles of giving personal support and are responsive to the varied and individual requirements of the residents. It is recognised that the delivery of personal care is highly individual and must be flexible, consistent and reliable. Attention is given to ensuring privacy and dignity when delivering personal care and staff are sensitive to changing needs of residents. Where possible residents are supported and helped to be independent and responsible for their own personal hygiene and personal care. Residents have access to health and remedial services, staff make sure that those residents who are fit and well enough are encouraged to be independent, have regular appointments and visit local health care services. Medication is stored securely. Staff have undertaken accredited training. The Care Homes for Adults (18-65 years) Page 14 of 25 Evidence: medication policy and procedure was inspected, as was the storage of the medication and the medication administration records. These were found to be in order on the day of the inspection. Care Homes for Adults (18-65 years) Page 15 of 25 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaint information is available, and staff recognise that some of the residents may need help to access and understand the complaints procedure. All residents have access to external agencies and appropriate contacts. Residents are protected by an appropriate adult protection procedure. Evidence: The Care Quality Commission has not received any complaints since the last inspection. There is a relevant complaints procedure in operation and this is included in the Service User Guide. Some of the residents may need help to access and understand the complaints procedure. Residents are protected by their access to other agencies and professionals, and the contact details for useful agencies, such as advocacy services, are clearly displayed in the home. There is an adult protection procedure in operation, and training certificates were on display. All new staff receive in house adult protection training as part of their initial induction training. Within eight weeks they also attend formal external training. Three of the staff have completed Safeguarding training at management level. This marks an improvement on the previous inspection findings. Care Homes for Adults (18-65 years) Page 16 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have comfortable accommodation that is well maintained and meets their needs. The home is a pleasant, clean and safe place to live. Evidence: Cromarty House is decorated and maintained to a good standard with residents being encouraged to personalise their own rooms, which are all en suite. Two residents gave the inspector permission to view their rooms. Bedrooms are available on the ground and first floor of the home. There is no stair lift facility to access the upstairs bedrooms. Thermostatic valves are fitted to hot water outlets. The communal space to include a spacious lounge and dining kitchen is comfortable and homely. The grounds were noted to be tidy and pleasant providing sufficient communal space in more clement weather. Parking for visitors to the home is generally on the road. The home was seen to be clean throughout. General hygiene and infection control practices are thought to be satisfactory. Care Homes for Adults (18-65 years) Page 17 of 25 Care Homes for Adults (18-65 years) Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported and protected by a competent staff team that have been properly recruited and trained. Evidence: The duty rota was seen to be current and accurate. There is always a minimum of two staff on duty for 6 residents, and this will increase according to needs and activities. At night there are two sleep-in staff, one upstairs and one downstairs. On the day of inspection two additional staff members were on duty as one resident needed support and transportation to a hospital appointment Observed interactions between staff and residents show that the latter clearly have confidence in the staff that cares for them. The staff confirmed that they have access to ongoing relevant training that is targeted and focussed on improving outcomes for residents. Staff also confirmed that they enjoy their work and that morale in the home is high. There are 9 care staff, of which 5 have achieved NVQ Level 3, three have achieved NVQ level 2 and the other staff member has nearly completed the NVQ level 2. One staff member has also obtained the Registered Managers award. Various external training agencies are employed to facilitate some fifteen regular training Care Homes for Adults (18-65 years) Page 19 of 25 Evidence: courses aimed at keeping staff up to date The personnel records show that the home adheres to a robust recruitment procedure. Records and comments from staff also confirm that there is regular and frequent supervision happening. Care Homes for Adults (18-65 years) Page 20 of 25 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered provider ensures that the home is run in the interests of the residents, and that they have the opportunity to express their views. Resident safety and welfare is protected. Evidence: Comments from staff, observations of residents, and documentation show that there is good morale and clear leadership, with the residents having confidence in the staff. The Registered Provider, Mrs. Tarrant, is in day to day control of the management function of the home. She holds an NVQ level 4, the Registered Managers Award and is currently undertaking a Business Administration Course. There are regular house meetings. Staff were observed to knock before entering residents rooms. Quality assurance is measured in a number of ways. Mr. Tarrant undertakes a monthly inspection of the home and makes a relevant report. Areas covered will include environmental considerations, upkeep of the premises, office management, records, policies and procedures. A three monthly cycle of events completes the gathering of Care Homes for Adults (18-65 years) Page 21 of 25 Evidence: residents views. Month one residents complete questionnaires, month two all attend a house meeting and month three will see the individual involved in their care planning. The service has sound policies and procedures, which are regularly reviewed. The home was seen to be well-maintained and there is relevant maintenance documentation to support this. There is a variety of health and safety information available and on display. On-call duties are shared between the manager elect and a senior carer. A strong ethos of being open and transparent in all areas of running of the home was evident. Care Homes for Adults (18-65 years) Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 23 of 25 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 Adults (18-65 years) Page 24 of 25 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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