Care Home: Homecroft

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What the care home does well People are very happy in the home - they were smiling all day on our visit. Their needs are met, they decide what they do each day and said that they have nothing to complain about - staff and the manager respond to any requests. Relatives and professionals also speak highly of the home and that they are kept closely informed of any changes: "...x...is always happy ..."; "people have very good care, and health advice is followed"; "medical support is good and I`m kept informed"; "overall the home provides a safe and pleasant environment..."; "Homecroft is...second to none...". People have good relationships with staff and managers. Staff know a lot about each person and their detailed care plans. Respectful and dignified care is provided with daily consent, the way people want. Support is flexible, maximises independence and there is good access to healthcare. People at Homecroft have diverse needs and some decisions are made in their best interests with relatives and multi-professional teams. The home encourages suggestions in a number of ways so that the service can act, continue to learn and develop. There have been no complaints, adult protection concerns or outbreaks of contagious infection since the last inspection. Staff have good inductions, qualifications and additional training so that they understand health conditions and associated risks. People experience good outcomes in most regards. Facilities are spacious and promote privacy. The home is welcoming, well maintained and clean and best practice is used for infection control and food safety. There are management audits and clear development plans for the service and staff. We complimented staff practice and management, and excellent food on our visit. What has improved since the last inspection? There is now a website about the home. Since the last inspection care planning is more person-centred and there are more craft activities. Staff had equality and diversity training so that they treat each person as unique. Facilities for sensory needs improved. People at risk of falls are now referred to a clinic for specialist advice. Staff are trained to use the Walsall Pressure Sore Tool for prevention. Handovers share changes about people`s needs, and the updating of care plans has improved. The homely remedies medication policy was changed. Some staff had training about end of life care and malnutrition screening. Catering staff undertook NVQ 2 qualifications for more knowledge about dietary needs, cultural choice, and healthy eating. The manager had training in new mental capacity laws about people`s rights and the home`s duties. Directors and managers attended a leadership and management course. A deputy manager was appointed three months ago who has care qualifications, experience and skills in health promotion and activities. The home`s Investors in People Award has been renewed. This means that an external body has determined that management train and support their staff well. A new quality assurance system is based upon the AQAA, and the home are using it more frequentlyto get the views and suggestions of people living in the home and visitors for development. The home was redecorated. New garden furniture and shrubs were purchased. What the care home could do better: During and after our visit appropriate action was taken to concerns we raised about medication and hot water temperatures in showers. Risk assessments about existing staff were undertaken satisfactorily pending more rigorous vetting checks so that people are safe. Further improvements are needed to staff selection, supervision, appraisal of staff performance and training so that staff and managers are clear on all their responsibilities, people benefit from best practice and their rights are fully promoted. Records must be available in the home for those responsible in the manager`s absence and for inspection, in accordance with the Commission`s guidance. Timely risk management, a health and safety culture and training in safe working practices must ensure that avoidable errors are prevented. The medication system must protect people`s health. Policies and procedures have not been reviewed for sometime so people are not fully benefitting from national learning, research, and new laws. The home needs to work with statutory agencies and have policies that interlink to take safeguarding seriously for people in the home and wider community. People need to be able to report a concern outside of the home if they want to, and not everyone currently knows how to do so. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Homecroft 446 Lichfield Road Four Oaks Sutton Coldfield West Midlands B74 4BL     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: Tina Smith     Date: 0 4 0 8 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 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 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 Older People Page 2 of 34 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 Older People Page 3 of 34 Information about the care home Name of care home: Address: Homecroft 446 Lichfield Road Four Oaks Sutton Coldfield West Midlands B74 4BL 01213086367 01213088294 suemeakin@homecroft-ltd.co.uk 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 Marjorie Joan Murch,Mr Godfrey Murch care home 23 Number of places (if applicable): Under 65 Over 65 0 23 dementia old age, not falling within any other category Additional conditions: 4 0 The maximum number of service users who can be accommodated is: 23 The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 23 Dementia (DE) 4 Date of last inspection Brief description of the care home Homecroft provides care and accommodation for 23 older people, some with dementia. It is located in Sutton Coldfield with public transport nearby to Birmingham, Lichfield and Burton. There is off road car parking and ramped access for wheelchairs at the front of the home. There are modern facilities of a high standard. All bedrooms have ensuite toilets and wash hand basins, and some bedrooms also have showers. There is a lift to the first floor bedrooms and an assisted bathroom with a hoist. An assisted shower room is on the ground floor. Communal rooms are on the ground floor - a Care Homes for Older People Page 4 of 34 Brief description of the care home lounge, library, dining room and conservatory. Also on the ground floor are the kitchen, laundry and office. There is an enclosed landscaped garden. The homes service user guide provides terms and conditions about services included in the fee. A fee range is not published but is individually provided before admission. Some people funded by councils may also need an arrangement to pay a top up fee. People can make their own arrangements or extra charges apply for toiletries, hairdressing, newspapers, magazines, and private health care such as chiropody, eyeglasses. Care Homes for Older People Page 5 of 34 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: The last key inspection was carried out on 09/06/07 when no requirements were made. Prior to our visit the home supplied information to us each year from their Annual Quality Assurance Assessment (AQAA). The AQAA provides information about what has improved and is planned for the future, and current information about running the home. The AQAA arrived on time, had all the information we asked for, and the self assessment quality was generally good. Information from this and from other sources was also used when forming judgments on the quality of the service. The home sends us legally required notifications about events, and we receive reports from other sources. We received 21 out of 34 surveys sent to people, relatives and staff. One inspector visited the home over one day, 10:15 am to 20:25 pm. The inspection Care Homes for Older People Page 6 of 34 took longer than expected because the registered manager was on leave and information was not readily available. They were not informed that we would be visiting. We looked around the home with a Director, spoke privately with two people, a visiting relative and health professional and shared dinner with three people and observed others. The medication system was inspected with two Directors, and we spoke with various staff. Records about people were seen along with records about the running of the home: three staff files; medication and communication records and incident logs; staff training records; contractor certificates and management audits; policies and procedures about complaints, adult protection, medication; staff meeting minutes and the homes surveys. We also saw the master service user guide, statement of purpose and the homes certificates about registration and insurance. A Director was present all day. The deputy manager and another Director were present for part of the day and we discussed our findings with them and a third Director responsible for the service. As a result of our visit, one immediate requirement was made to ensure people were safe. We agreed additional information to be sent and action that was confirmed as taken to our satisfaction within 48 hours. A list of requirements and recommendations are at the end of this report. What the care home does well: What has improved since the last inspection? There is now a website about the home. Since the last inspection care planning is more person-centred and there are more craft activities. Staff had equality and diversity training so that they treat each person as unique. Facilities for sensory needs improved. People at risk of falls are now referred to a clinic for specialist advice. Staff are trained to use the Walsall Pressure Sore Tool for prevention. Handovers share changes about peoples needs, and the updating of care plans has improved. The homely remedies medication policy was changed. Some staff had training about end of life care and malnutrition screening. Catering staff undertook NVQ 2 qualifications for more knowledge about dietary needs, cultural choice, and healthy eating. The manager had training in new mental capacity laws about peoples rights and the homes duties. Directors and managers attended a leadership and management course. A deputy manager was appointed three months ago who has care qualifications, experience and skills in health promotion and activities. The homes Investors in People Award has been renewed. This means that an external body has determined that management train and support their staff well. A new quality assurance system is based upon the AQAA, and the home are using it more frequently Care Homes for Older People Page 8 of 34 to get the views and suggestions of people living in the home and visitors for development. The home was redecorated. New garden furniture and shrubs were purchased. 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 Older People Page 9 of 34 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 10 of 34 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is an accurate assessment by trained staff and people can be confident that their needs are met. There are ways to visit and try the home, and there is helpful information about the service in the home and on their website. Evidence: On our visit there were 22 people at Homecroft, and another person is expected shortly. The home does not offer intermediate care services. Everyone has a thorough pre-admission assessment by trained staff so they can be sure that their needs and preferences can be met. The AQAA said that assessment takes place for up to six hours without family present so that the home can be sure people are making an informed choice. This is followed by a months trial period and a formal review. Two people told us that their relatives chose the home after visiting as they were in hospital, and they were assessed during their first week in the home. A relative told us about someone who came every day for breakfast while waiting to be admitted. Care Homes for Older People Page 11 of 34 Evidence: One relative said: Homecroft provides the homeliness, support and care to...x...which we as a family feel is second to none...the caring understanding of all staff has helped her settle in and she now feels that Homecroft is her home...We are absolutely delighted at every aspect of care provided...and facilities.... The people still settling in were very happy with their relatives choice, as was someone in the home for several years. They felt very welcome and said that their needs are well met. Two people told us how their health has improved since coming to stay. There are specific surveys for new people every six months so that managers can follow their experience and how it affects them. They want to make use of any suggestions about improvements. There are innovative ways to learn more about the home, including a website. When families first visit they are provided with the master copy of the service user guide and statement of purpose, in a large font so that they can be easily read. This provides mainly up to date information about the service people can expect, staff and management, terms and conditions, inspection reports and services available from the local council. The service user guide has compliment letters and comments people have made, such as Ive been looking for a cobweb every since I came here. Everyone has the same terms and conditions, but fees are individually determined. Eleven surveys told us that people and families had enough information to make a decision about the home. Services included in the fee are clear, as well as those available locally families can arrange themselves or through the home, such as newspapers, hairdressing and private chiropody. We were told that any revisions to these costs are posted on the noticeboard in reception. There are interesting savings passed onto people through, for instance bulk purchases. People also run their own tuck shop where they can for example buy toiletries, and they decide as a group how any profits are to be used. Two people did not recall having a contract when they moved in. The contract could be written using Plain English so that it is user friendly. We advised that people in the home may want to contribute to any changes, which would also remind people. Care Homes for Older People Page 12 of 34 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. People participate in reviews, are treated with respect, and can be sure that their needs will be met in the way they prefer and with dignity. People cannot be fully confident in the homes medication administration system to ensure their health needs are fully met. Evidence: Thorough assessments have a person-centred approach so that needs are met the way individuals want to be supported, maximising their independence. Abilities to participate in self care are assessed and choices are offered, such as how often to bathe or shower. We saw three records to confirm this, spoke to five people and one relative and observed other people. There are currently two men in residence but no male staff available should they prefer male carers. On our visit everyone was appropriately dressed for the warm weather, and personal hygiene was good. The home liaises with health professionals including hospital discharges. People admitted from hospital said that their health has improved and wounds healed. Staff Care Homes for Older People Page 13 of 34 Evidence: know people well and individuals told us they have good relationships with staff, who are available when needed. We saw discreet personal care and prompting of continence that maintains dignity and self-confidence. Staff knocked and waited before entering peoples rooms and asked permission to clean or whether midmorning drinks and snacks were wanted. People who have been longer in the home have their needs met when there are changes, and health specialists are sought when necessary. A district nurse had high praise for staff and managers, and said their professional advice is always followed. There have been no outbreaks of contagious infection or illness, and we saw good infection control measures. Care records, risk assessments and monthly reviews are up to date and securely stored for confidentiality. Staff handovers discuss changes in health, wellbeing or preferences so there is speedy action or monitoring. People and representatives take part in care planning and reviews where the plan is evaluated. Care plans are signed or record best interest decisions, signed by managers. This shows us that rights are respected and there are good outcomes for people able to make their own decisions, and people who have incapacity. There are daily records, regular weight and body mass index measurements so that risk of malnutrition can be spotted early, minimized or involve specialists. Staff are knowledgeable about peoples food intake and nutrition. The cook said that food is routinely fortified with butter and cream; she is told about peoples likes, dislikes, food allergies and dietary needs. There are people on prescribed nutritional supplements and who have diabetes. One person recovering from illness has temporary swallowing difficulty so food liquidized and is now progressing back to health with finger food. On our visit it was very warm and we queried why extra drinks were not provided. We were told that people often have tea and coffee, but these have dehydrating effects. Heat wave advice displayed in the office was not being used. The AQAA told us that a new nutritional system puchased has not yet been introduced but some staff have had training. Care plans and monitoring measures recognise the importance of helping people to remain mobile as long as possible and to have good nutrition and hydration to avoid pressure sores. There is screening of skin integrity and the district nurse was treating pressure sores that are healing. Overall we found confident nutritional best practice and dietary needs met, but fluid intake may need more oversight especially for people at risk of pressure sores developing. People have annual health checks and regularly see the optician, dentist chiropodist and have care plans about eye, oral and foot care. Either family or staff take people to health appointments and there is ready access to GPs. Mobility and personal safety is assessed and planned for. There is screening about risk of falls that ensures people Care Homes for Older People Page 14 of 34 Evidence: have appropriate foot wear, aids and staff assistance for prevention. We saw staff assisting people to mobilize safely with a variety of aids. Some people needed two staff who were patient and worked together, for instance using a handling belt or alongside a walking frame. Four people had falls resulting in fractures since the last inspection. We saw that people at risk are referred to a falls clinic. The clinic have not always been able to help if cognitive impairment prevents specialist advice being followed. Regarding rehabilitation, one person recovering from a stroke should have access to stroke recovery services, such as a speech and language therapy as they are starting to regain skills and abilities. We discussed this with management, as it has not been proactively sought. Emotional wellbeing is also maintained or improved. We spoke to one person recently bereaved, a relative, staff and checked medication records and care plan reviews to confirm this. People are being treated for depression and dementia, and health specialists review their medication. The homely remedies policy was changed and now only prescribed medication is stored by the home. People managing their own, such as paracetemol need to check with their doctor that it is suitable with any prescribed medication. Risk is appropriately assessed for their own and others wellbeing and safety. Some people administer their own inhalers, which the home stores. Controlled drugs are well managed, using an appropriate register and cabinet. The communication book shows that timely action was taken when the lock was sticking, and there is a temporary lock in place while a part is on order. We saw strict key security. Regular medication audits in the home have found some recurrent errors in dose administered, tablets not accounted for and administration recording gaps. On our visit medication we checked was accounted for except one prescribed medication from hospital that was administered but did not appear in records. There were no gaps in records. We discussed a number of concerns with management based on our findings about the system of ordering, receipt and disposal of medication, safekeeping and storage. Discontinued medication was in the trolley and was not noted on the medication administration record (MAR). Hospital discharge letters kept elsewhere needed to be checked to identify this. Medication stocks were not used in date order, and some supplies are due to run out before the end of the month. A lot of medication is being ordered and stored in advance to prevent this. We queried out of date medication in the fridge and left on an office cabinet. Daily temperatures are taken for some but not all storage facilities, and we had concerns that one room was too warm for medication to remain stable for peoples health. The home monitored this after the inspection at Care Homes for Older People Page 15 of 34 Evidence: our request and confirmed new storage was identified. From discussion we learned that the monthly audit of medication does not address the entire medication system and stock control, and all of the homes medication policies and procedures so these concerns were not picked up by management. Audits and records about people and staff had no mention of errors or recorded actions taken about audit findings. Management could not confirm that timely action ensured people had essential medication or medical advice if an error was made, or to account for missing medication. The homes policy is clear about this, but confusing on other matters as older versions are alongside undated newer sections. Management confirmed after the inspection that there are no observations or appraisals of staff medication competence after accredited training. Audits should have a link to the homes human resource processes so that people are fully protected and staff performance is sustained. We did not have concerns about anyones health on our visit, so improvement is needed for effective risk management and staff development. Action was taken and planned by directors who include a qualified nurse, to concerns we raised during and after our visit. We have confidence that this will be addressed in a timely way. There are external audits by the homes pharmacist, and action was taken during our visit to improve pharmaceutical labeling so that the shelf life of medication is clear. Action is planned with doctors to re-synchronize ordering a full months supply of medications through the homes monitored dose system. This will improve the availability of medication, make ordering easier and make it more likely that receipt of medication into the home is clearly recorded so that all medication can be accounted for. Care Homes for Older People Page 16 of 34 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are flexible routines and people can follow their lifestyle and worship as they choose. There are activities and outings and good relationships are maintained with families and friends. Food is excellent and dietary needs are catered for and met. Evidence: Everyone was smiling when they had staff assistance on our visit. There are flexible routines so people live the lifestyle they choose. One family told us: As I get confused I rely on family for help with all aspects; As she is confused, she is better with a routine. Daily life is in accordance with individual needs. Interests and hobbies are maintained. One person really enjoyed an outing to a plant nursery as they love flowers. Another person still attends a social club after coming to the home. One person brought their own embroideries to display on the wall of their room. Staff helped someone learn to use the remote control for a new TV their family provided. There is meaningful activity that keeps people in touch with the community and making decisions. We were told for example about the tuck shop. People used profits for arts and craft materials, making and selling items at Easter to raise money for charity. The range of activities and outings increased in response to surveys. We were Care Homes for Older People Page 17 of 34 Evidence: told that on the day of an outing people often do not want to go out, but clearly people who go benefit from the homes continued efforts. Some people occupy themselves, reading or listening to music and TV and told us they do not want to join in activities. Others particularly like the fortnightly exercise sessions. On our visit there was bingo in the afternoon. An activity chart in reception is somewhat hidden, but it shows that there is regular hairdressing, handicrafts, singing, games and physiotherapy. A relative said, The staff try to provide good care under difficult circumstances due to the diverse nature of the residents needs.... There are people with cognitive impairment from strokes and dementia, some with poor short term memory and others in recovery. A few suggestions were made to us about expanding the range of activities and support, including one to one support for daily orientation and reminiscence activities for people with dementia, and more intellectual pursuits requested by others, such as poetry to maintain mental agility and interests. We saw similar home survey results which have not yet been acted upon and discussed this with management. Arrangements are made for religious worship in accordance with preferences and there is monthly communion in the home. Families are actively involved, take people out and told us they feel welcome when they visit. One person is looking forward to a family wedding. A relative said good with medical help and keeping us up to date. Visiting arrangements are flexible outside of mealtimes, because the home wants to provide an environment conducive to people eating well, without distraction but also socializing together. This is best practice, but notices in reception and the service user guide could explain why. People eat when they want to, choosing to eat some meals together and we saw that meals are a social event. During breakfast choices are made for dinner and tea. Everyone finds the food excellent and we complimented the cook on our visit. The cook and manager plan a healthy balanced diet. There is a rotational menu discussed at resident meetings and new things are tried. Tablecloths and napkins are in use, with condiments at each table. On our visit everyones dietary needs were catered for and there were sufficient staff at dinner time. Some people needed prompting or food cut up, provided sensitively, but then ate independently. No one needed feeding. One person was assisted to change clothing after an accidental spill. Care Homes for Older People Page 18 of 34 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. Complaints will be taken seriously and acted upon. Rights are promoted and protected. Adult protection procedures need updating with links to the local council protocol so that people can also report concerns outside of the home, and so that the home works with statutory agencies to safeguard when necessary. Evidence: Homecroft actively encourages comments and complaints and there are forms by the visitors signing in book in reception. The service user guide includes the complaints policy. People told us that they feel safe and would report a concern to relatives, keyworkers or the manager. One said, ...I do not know what alternative action I could take. The policy needs up to date contact details for the Commission, and could include the local council and advocacy organizations. This could be discussed with people and families so they are clear about support and options. There have been no complaints or adult protection concerns in the past four years, but people can have confidence that this would be taken seriously and acted upon within ten days, which exceeds the minimum standards. Everyone we spoke to said that they have nothing to complain about. From the information available to us, the homes approach to safeguarding is under-developed and we were not satisfied with managements response during feedback. The Commissions guidance is on the office noticeboard, but it has not been used to review Homecrofts systems and policies. Care Homes for Older People Page 19 of 34 Evidence: The induction of new staff includes a purchased video and test about recognising abuse / neglect and how to respond. The training matrix shows that some staff have not yet had abuse and adult protection training and that it is not considered applicable to certain staff and managers. This needs review as everyone working in the home must be clear on their role, the homes policy on involving the police and working with other statutory agencies. The adult protection policy has no link to the council multiagency protocol. Management were uncertain where the council protocol is kept, and the protocol in the office is not up to date. Staff supervision notes include reporting abuse to social services however management confirmed that no one in the home has attended council training to understand the multi-agency process and wider issues. Staff trained in 2006 now need refresher training, and we are told this is planned. Links are needed between the homes code of conduct for staff, policies about adult protection, whistleblowing, restraint, mental capacity, staff selection, disciplinaries and reporting to the Independent Safeguarding Authority. These are required to safeguard adults, their rights and their financial interests and prevent abuse affecting people in the home, care industry and wider community - the home must work with statutory agencies and in accordance with mental capacity law codes of practice. A legal duty of care differs for people able to make informed choices, and those determined to have mental incapacity about their own and others personal safety. The home may also support people who experienced abuse at other times in their lives. A home particularly registered to provide dementia care should be clear on their approach. Managers attended council training on Deprivation of Liberty Safeguards, which is a new legal duty. We understand that a policy was formed and managers are about to train staff about peoples legal rights. End of life care planning policy could be developed so that staff know how to support people who make advance decisions. There were no inventories in peoples records about possessions they bring to the home, and peoples interests could be better protected if something goes missing. There are insurance arrangements about personal possessions in the service user guide, along with details about how to vote in local elections. Peoples financial interests are well protected through bulk purchase savings passed on, securing money and valuables on request, and supporting people with personal allowances and account statements. Care Homes for Older People Page 20 of 34 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. Homecroft is comfortable, clean, well maintained and provides a good, homely environment for people. Facilities support privacy. The homes health and safety culture could improve to prevent accidents. Evidence: Homecroft is located in a residential area on a main road, with access to public transport. It is an extended ordinary house with wheelchair access at the front. The standard of decoration and furnishing is high. A survey said, overall the home provides a safe and pleasant environment.... It is comfortable, with a variety of communal areas. Chairs could be arranged so that conversation is more likely. Facilities for people with sensory impairments include large screen TVs and talking books. The home is painted one colour throughout, which does not help people with poor memories find their way around however communal rooms are labelled and bedrooms are numbered. Upstairs there are window restrictors to prevent falls. There is open access in the dining room to a level patio which people told us they liked. The landscaped garden is steeply sloped and inaccessible for most people. Bedrooms are spacious, with sufficient storage for essential equipment, aids and personal possessions. Each room is different and the home will provide help for people to make changes to their rooms, for example to hang pictures. All bedrooms are for Care Homes for Older People Page 21 of 34 Evidence: single occupants and are ensuite, some with showers or wetrooms with no step. There are lockable facilities for valuables and door locks; people can request a key. There are also assisted bathing and toilet facilities on both floors, with hoists, slings and door locks. These facilities promote privacy. The home is modern and generally well designed for people living there, but there is an outward opening toilet door on the ground floor that can cause an accident if opened too quickly. We discussed this as there is no warning sign on either side of this door. We also advised that a better place is found to charge the hoist battery than an upstairs hallway floor, which had not been noticed and removed. Hallways need to be kept free from hazards to prevent falls. Maintenance and contractor checks we saw were up to date, including emergency lighting, hoists, fire extinguishers and smoke detectors. Fire drills are held. Repairs are timely. There is no written risk assessment or scheme about preventing bacteria entering the water supply. Directors had clearly thought this through, and said that the home has a sealed system with no pockets for water to pool. There are regular checks of hot water to prevent scalds, but the safe temperature range was exceeded in showers. The home confirmed this was adjusted after our visit. We had one sink tested as the last check showed an excessively high temperature and no further action was documented. We were told that the testing device needed re-setting and the test we saw confirmed the water tmperature was safe. The home is very clean with good measures to control infection, such as anti-bacterial gel in reception, paper towels and liquid soap, separation of clean and soiled laundry. Gloves and aprons are used in peoples rooms for cleaning and personal care. We were told that slings are washed after use. The kitchen is hygienic, and temperatures of fridges and freezers are in the safe range. The food probe is regularly tested and recalibrated. Food probing to ensure meat is safe is regularly done by the cook, but records could improve on weekends when this task is undertaken by managers. There has not been an environmental health inspection in at least three years. A Director attended the council Safer Food Better Business course, and we were told that the charts in use were further enhanced by the home. These charts rather than the diary should form the homes permanent record of food probing and we recommended spot checks by directors. Care Homes for Older People Page 22 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall people have appropriate levels of support by qualified staff. However people are not fully protected by the homes recruitment procedures and process. Evidence: Rotas were examined over a four week period. There are four or five care staff during day shifts, and two staff at night. People had timely attention to their needs on our visit and told us that this was usual. Temporary staff have not been necessary to cover for sickness and holidays, so staffing is consistent. On each shift there are staff trained in first aid, kept up to date so that they can save lives in an emergency. We were told that staff roles are interchangeable - staff and managers clean, handle food and provide care. One carer tests temperatures in the kitchen and for medication. The managers and cook prepare food. A director does the shopping and acts as the caretaker. All staff are currently supervised by the manager with an on-call staff support system day and night. We wanted to see legally required information about staff so that we could check on improvements since our last inspection however records lacked clarity and three staff files were disorganized. The AQAA led us to expect to see police and government list checks for new employees. We could not confirm that existing or new staff were determined to be safe and fit to work in the home because there was insufficient Care Homes for Older People Page 23 of 34 Evidence: recruitment information kept in accordance with our published guidance. There were no UK checks in two staff records, as at the last inspection. Management said that there is a checklist for staff files that was not being used. Fitness assessments were introduced about staff working at night. There is only one health declaration question on job application forms, which lacks depth. We queried a blank detailed health assessment in a new staff record where the persons role included working weekends and were told that they will be working such shifts after training, but only then will their health be assessed in depth. This means that the home is not determining fitness for the full intended job role when recruiting staff. A training chart was not up to date and the staff development plan, supervision and appraisal of staff performance was not clear in the managers absence. We agreed additional time for management to search for electronic records. After our visit we established with management that supervision records are often undated so no one can confirm whether there is sufficient supervision. Staff performance is annually assessed for pay awards, but this does not include all staff roles and continued fitness, so the appraisal process is under-developed to ensure that people are in safe hands at all times. We were assured this will be improved with oversight by a accountable director registered with the Commission. There is an induction about care and safe working practices for new staff. Skills For Care competencies are confirmed by the manager after tests, discussion and observation. Regular observation needs to take place in addition to medication audits to sustain good medication practice following accredited and witness training. Staff knowledge about medication and best practice also needs updating because it often changes. Records did not show us that this takes place. We were told that almost all staff have NVQ care qualifications and additional training so that staff understand peoples conditions and encourage independence, which is good practice but the training chart doesnt reflect this. It also shows us that some but not all staff had mandatory training, and some staff did not have at least 3 days training in 2008. A director confirmed there is no refresher policy. Hands-on manual handling training is refreshed by an external trainer. Management said that after mandatory training in other areas, updates are undertaken in supervision but record keeping did not enable us to confirm that all mandatory training is refreshed about health and safety. The home has accredited trainers who can provide certification in future. Staff and managers need adult protection training or refreshers in light of changes in the law and about their roles in relation to the local protocol. The training chart shows that this training has not been seen as necessary for managers and certain staff, which does not promote safeguarding or take adult protection seriously. Care Homes for Older People Page 24 of 34 Care Homes for Older People Page 25 of 34 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. The home is well run to benefit people and protect their rights, including their finances. People influence service development. The environment is safe but improvements are needed to risk management, human resource processes, and to update policies and procedures for health, safety and working with statutory agencies. Evidence: The manager is experienced and is registered by the Commission. They have an NVQ4 qualification, the Registered Managers Award and recently attended leadership training. We are told that the manager developed a new policy and will be running inhouse training for staff about legal duties for Deprivation of Liberty authorisations and peoples rights. A person-centred approach has been led by the manager. This shows us that the manager keeps up to date and ensures new ways of working are used. The manager is held in high regard and is seen as approachable by everyone we spoke to. Thhe manager will soon have more support in running the home. A deputy Care Homes for Older People Page 26 of 34 Evidence: manager and director are on site and will have training including medication so that roles, systems and supervision of staff can be reviewed. An audit was conducted by a manager prior to their own medication training, but other roles have been held in obeyance. Some essential records could not be located in the managers absence, which needs resolution so that management roles can be effectively shared. The AQAA was returned on time and the quality was generally good but we queried accuracy of the dataset about recruitment checks, and action taken to two recommendations since the last inspection. Appropriate certificates were on display about registration and insurance. There are staff recruitment and retention strategies. The service user guide has a statement about the current lack of male staff and how this affects choice for men. We were told that the home previously had male staff. Homecroft is choosy about staff selected and seek experienced staff in the UK and abroad. Recruitment abroad is now more restricted by government. We shared some comments made to us for the home to act upon, that some staff are not always understood by people in the home. Since the last inspection Homecrofts existing Investors in People (IPP) Award was reconfirmed, showing how highly staff are valued. Food is provided free to staff on shift. Homecroft are aiming for all staff to achieve NVQ 3 qualifications. Through Narrick we were told that international qualifications were equated to those in the UK, although we did not see this in staff files or on the homes training chart. Rotas are arranged so that staff can pursue other qualifications they arrange themselves or through an agency abroad. Work permits show no restrictions on hours for staff entering the UK to study, and this was not queried. The homes process of recruitment checks, supervision, training and appraisal has positive merits, however it is too lax to ensure that people are safe and staff performance is sustained. We advised management to audit staff files to meet an immediate requirement about existing staff. Action was taken to our satisfaction, more is planned, but changes are needed to ensure sufficient vetting before staff are confirmed in post. The staff development plan needs to be informed by an up to date training chart so that essential training can be prioritised and checked as progressed. People, relatives, professionals and staff influence the running of the home in a variety of ways. A new quality assurance framework was introduced during the past year so that the home can compare views gathered over time, evidence changes in response to views, and improve outcomes for people at all stages of their stay in the home. A director intends to analyse and publish the results from two sets of surveys we saw. The homes surveys matched those of our own and discussions on our visit. High satisfaction has been maintained with praise from all sources. We discussed positive Care Homes for Older People Page 27 of 34 Evidence: achievements, as well as suggestions from people not yet acted upon: the range of activities, access to stroke recovery services, and help to personalize a room. Some relatives manage peoples money and receive regular statements as well as an annual statement of account. This is good practice. We checked and confirmed that accounts and receipts tallied where people are supported with personal allowances. The home does not act as anyones agent. Staff encourage people to make their own decisions about money, and this is spent in accordance with their assessed needs when best interest decisions are made. Homecrofts policies and procedures have not all been regularly reviewed; some date back to 2001 whereas the law and best practice has changed. The homes medication policies need clarity as sections written in 2003 are alongside newer undated versions. Other policies and procedures need updating and cross-referencing for effective safeguarding and to meet legal duties. For example human resource policy must include reporting to the Independent Safeguarding Authority about barring should the need arise. The code of conduct must ensure staff do not benefit from wills. There are good systems for recording incidents and accidents, and we were told these are analysed to act on any patterns. We confirmed that the home notifies the Commission in accordance with our guidance. There are fire, health and safety risk assessments but the culture needs further development and leadership so that there is proactive prevention of accidents and hazards and timely response to medication errors for peoples protection. Directors keep up to date about health and safety, but they are not always checking regulator guidance and national safety alerts. These need to be reflected in the homes risk assessment, policy and procedure updates. There are no Regulation 26 reports or unannounced spot checks because a director is in the home daily. There are regular audits, but these do not include all the homes systems and we advised more oversight by individuals registered by the Commission. Care records are accurate, but those about staff are not always dated. Audits need to evidence the action taken and date progressed. In many ways the home has continued to improve and provides people with innovative options. With the additional management support and oversight planned, we have confidence that this report will be acted upon so that performance in all areas is improved and sustained. Care Homes for Older People Page 28 of 34 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 29 of 34 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 1 9 18 Reg 18(1)(a): Staff involved in the medication system must be regularly assessed to be knowledgeable and confirmed as competent. This is to ensure that peoples health is protected by safe practice. 04/11/2009 2 9 13 Reg 13(2): Registered persons must ensure that regular audits and spot checks confirm safety of the medication system and timely action taken for peoples health, and about staff performance. This is so that people have stable medication as their doctor intends, and the potential for error is minimized. 14/09/2009 3 9 13 Reg 13(2): All prescribed 14/09/2009 medication in use must be entered on the medication administration record (MAR). Care Homes for Older People Page 30 of 34 This is to ensure medication introduced mid month is administered as the doctor intends. 4 9 13 Reg 13(2): Medication must be secured at all times including medication awaiting disposal. This is for peoples safety, and to prevent medication going missing. 5 18 13 Reg 13(6): The homes adult 04/10/2009 protection policy and procedure must be linked to the local council protocol and reporting to the Independent Safeguarding Authority. The home must work in partnership with other agencies to safeguard adults. 6 29 19 Reg 19, Schedule 2: New 04/09/2009 workers should not be confirmed in post until there are full satisfactory recruitment and fitness checks. Documents specified in Schedule 2 must be evident in staff records on the premises, and in accordance with the Commissions guidance. This is to ensure that people are in safe hands at all times. 7 36 13 Reg 13(6): Everyone regularly working in the home needs training in 04/11/2009 04/09/2009 Care Homes for Older People Page 31 of 34 accordance with their role to recognise abuse and use adult protection procedures and the law, periodically refreshed. Staff and managers must keep up to date about abuse / neglect and how to respond. 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 1 8 Fluid intake needs more oversight, especially in hot weather and for people at risk of pressure sores so that dehydration is avoided. It should be clear on the MAR when medication is received into the home and used. Medication carried forward should only be entered once and added to any further stocks in the home so that all medication is accounted for and is auditable. Daily temperature checks should be made wherever medication is stored in so that its stability is maintained in accordance with its product licence for peoples health. Staff should report gaps in medication records to managers as they arise so that timely action can be taken to protect peoples health, in accordance with the homes policy and procedure. The medication system needs improved stock control, so that medication is used in the order in which it is received into the home, over-ordering is avoided, and only currently prescribed medication is kept in storage facilities for safe administration. Any ambiguity in pharmacist labeling should be queried so that the shelf life of medication can be determined. There is website guidance on dementia care and reminiscence activities that would benefit people in the home, such as www.scie.org.uk. Personal possessions would be better protected if there are inventories. Page 32 of 34 2 9 3 9 4 9 5 9 6 12 7 17 Care Homes for Older People 8 19 Health and safety audits and the homes risk assessment need to be critical so that hazards and risks are avoided / spotted early and acted upon to prevent accidents. The homes risk assessment should be reviewed after consulting environmental health guidance so that the risk of legionella and bacteria entering the water supply is minimised. Policies and procedures need regular review so that they reflect changes in law, regulator and national best practice guidance and safety alerts so that people have the benefit of lessons learned and research. The training matrix should be kept up to date so that the staff development plan can be prioritised and progress checked. The home needs a policy about refreshing mandatory training, and staff records need to evidence how and when this takes place for each staff member. Staff must have formal supervision a minimum of 6 times per year. Supervision records should be dated and signed. Registered persons should ensure that audits include all the homes systems and action is progressed for health, safety and welfare. Records about the running of the home must be readily available to those in charge in the managers absence. 9 25 10 33 11 36 12 36 13 14 36 38 Care Homes for Older People Page 33 of 34 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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