Care Home: Littlecroft Residential Home

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What the care home does well Generally the home was found clean, warm and well lit. The atmosphere of the home was noted to be relaxed; individuals living in the home looked well cared for in their homely environment. Staff were interacting with service users in an informal, respectful, personalised and dignified manner. Prospective service users have detailed needs assessment using different tools before admission to the Home to ensure that the home is able to meet the individual’s need. Individuals and their relatives are informed on admission about the onemonth trial period to enable them to make a decision whether to stay. In order to ensure adequate nutrition for residents, good meals are provided and are not hurried. One service user told the inspector at lunchtime that the food is very good Evidence from the visitor’s book shows that families, friends, relatives and other visitors are encouraged to visit the home to ensure that regular contact is maintained. One relative we spoke with stated that they were satisfied withLittlecroft Residential HomeDS0000061093.V374896.R01.S.docVersion 5.2the care provided for the service users, staff are kind and that relatives are able to visit the home at any time without restrictions. The home has a well-established team of care staff and generally a stable work force that treat the service users with respect. To help us make judgements about the services provided at the home we spoke with relatives of people who use the service, staff working at the home as well as people who are living in the home. Their comments are written below: “I am very happy here” “The home is the best thing that ever happened to me. The home is very good staff are very good” “Staff are very caring and thoughtful”. “This is a good place to work. We work as a team so residents can receive good care. We care very much about the residents and are excellent at giving individual attention”. “I am happy and satisfied with the care given to my aunt she is very happy.” “Staff are dedicated and committed to providing the highest standards of personal care”. “Communication is very good here if there is a problem they inform you straight away and also sort it out”. “We are very happy with care given to our dad”. What has improved since the last inspection? The home stated in the Annual Quality Assurance Assessment (AQAA) that staff have attended awareness course on Mental Capacity Act and ongoing training in various areas to ensure that staff are updated about anything that affects their job. For example National Vocational Qualification (NVQ) at Level 4 for more experienced staff, 2 fully qualified Manual Handling Trainers, and the deputy manager is currently doing NVQ 4 in Care. The manager holds a Community Mental Health Certificate. There is ongoing redecoration and refurbishment. The home had just completed an extension which provides three extra rooms and a court yard. This also increased the communal area.Littlecroft Residential HomeDS0000061093.V374896.R01.S.docVersion 5.2 What the care home could do better: The home must ensure that risk assessments and consent forms are completed for residents who are self medicating to prevent drug error or overdose. The home must ensure that all handwritten medication on the Medication Administration Record Sheet (MARS) must be signed and dated to prevent drug errors to the residents. To ensure adequate protection to the residents all life limited medications must have a date of opening and be discarded after 28 days as instructed on the drug label and a specific medication stored in the fridge as stated. It would be better to record controlled drugs in a ‘Controlled Drug Book’ rather than loose sheets to ensure that vital information is not lost. Ref: The Administration and Control of Medicines in Care Homes and Children’s Services. Section 9.4 “Records for Controlled Drugs”. This is a Royal Pharmaceutical Society of Great Britain publication June 2003. The home informed us that a controlled drug book had been ordered and would be in the home in a few days. We noted that the home has undertaken generic risk assessment of some areas of the home it could be better if it includes the lounges, dining areas bedrooms and other areas that the residents have access to. The home told us before this report was completed that risk assessment of the identified areas including the kitchen has been put in place. To ensure that the residents’ needs are adequately met it could be better if care plans are comprehensive and individualised. To provide security to residents’ money the home must ensure that the present system of storage is reviewed. The home must ensure that the laundry is kept clean to uphold infection control principles. Regular staff supervision must be in place to enable staff to express any concerns in relation to residents care needs. Key inspection report CARE HOMES FOR OLDER PEOPLE Littlecroft Residential Home 44 Barry Road Oldland Common South Glos BS30 6QY Lead Inspector Grace Agu Unannounced Inspection 09:30 22nd April 2009 DS0000061093.V374896.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Littlecroft Residential Home DS0000061093.V374896.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Littlecroft Residential Home DS0000061093.V374896.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Littlecroft Residential Home Address 44 Barry Road Oldland Common South Glos BS30 6QY Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0117 9324204 Quality Care Homes Ltd Mr Mark Anthony Hewlett Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Littlecroft Residential Home DS0000061093.V374896.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Old age, not falling within any other category (Code OP) The maximum number of service users who can be accommodated is 20. 10th May 2007 Date of last inspection Brief Description of the Service: Little Croft is one of three care homes owned and managed by Quality Care Homes Ltd. It is a converted property located at Oldland Common providing accommodation for up to 20 older people. There are 20 single rooms, 13 of which have en-suite facilities. There is a lounge, a dining room and a small seating area adjoining the dining room, used mainly for residents and their families and other visitors. Residents accommodation is on the ground and first floors with lift access. There is an extensive garden, with level access, to the rear of the property. Aims of the home include to ensure quality of life for residents, by providing first class care in a friendly, relaxed yet stimulating environment and we aim to ensure that living in a residential setting is a positive experience (taken from the homes Statement of Purpose). Fee £413-550 depending on assessed need. Littlecroft Residential Home DS0000061093.V374896.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience Good quality outcomes. This was an unannounced inspection which took place over eight hours and was undertaken to review the requirements made at the last inspection and to review the care practice to ensure that it is in line with the legislation and that best practice is followed at the home. At the last visit no requirements and recommendations were made The residents were noted relaxed and staff were noted interacting with the residents in a dignified and respectful manner. We met with the new manager and another manager from one of the sister homes. We were told that the new manager was undergoing a trial period having previously completed her induction period. Whilst touring the building, we spoke with 12 residents, two staff members and 3 relatives. A number of records were viewed. What the service does well: Generally the home was found clean, warm and well lit. The atmosphere of the home was noted to be relaxed; individuals living in the home looked well cared for in their homely environment. Staff were interacting with service users in an informal, respectful, personalised and dignified manner. Prospective service users have detailed needs assessment using different tools before admission to the Home to ensure that the home is able to meet the individual’s need. Individuals and their relatives are informed on admission about the onemonth trial period to enable them to make a decision whether to stay. In order to ensure adequate nutrition for residents, good meals are provided and are not hurried. One service user told the inspector at lunchtime that the food is very good Evidence from the visitor’s book shows that families, friends, relatives and other visitors are encouraged to visit the home to ensure that regular contact is maintained. One relative we spoke with stated that they were satisfied with Littlecroft Residential Home DS0000061093.V374896.R01.S.doc Version 5.2 Page 6 the care provided for the service users, staff are kind and that relatives are able to visit the home at any time without restrictions. The home has a well-established team of care staff and generally a stable work force that treat the service users with respect. To help us make judgements about the services provided at the home we spoke with relatives of people who use the service, staff working at the home as well as people who are living in the home. Their comments are written below: “I am very happy here” “The home is the best thing that ever happened to me. The home is very good staff are very good” “Staff are very caring and thoughtful”. “This is a good place to work. We work as a team so residents can receive good care. We care very much about the residents and are excellent at giving individual attention”. “I am happy and satisfied with the care given to my aunt she is very happy.” “Staff are dedicated and committed to providing the highest standards of personal care”. “Communication is very good here if there is a problem they inform you straight away and also sort it out”. “We are very happy with care given to our dad”. What has improved since the last inspection? The home stated in the Annual Quality Assurance Assessment (AQAA) that staff have attended awareness course on Mental Capacity Act and ongoing training in various areas to ensure that staff are updated about anything that affects their job. For example National Vocational Qualification (NVQ) at Level 4 for more experienced staff, 2 fully qualified Manual Handling Trainers, and the deputy manager is currently doing NVQ 4 in Care. The manager holds a Community Mental Health Certificate. There is ongoing redecoration and refurbishment. The home had just completed an extension which provides three extra rooms and a court yard. This also increased the communal area. Littlecroft Residential Home DS0000061093.V374896.R01.S.doc Version 5.2 Page 7 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Littlecroft Residential Home DS0000061093.V374896.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Littlecroft Residential Home DS0000061093.V374896.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 People using the 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 process of admission is well planned with clear information to enable the resident or their representatives to make decisions about the services provided at the Home. EVIDENCE: The Home’s Statement of Purpose and Service User’s Guide remains in place and provides information to prospective residents in relation to services provided to enable them to make a decision about the Home. The manager stated that both documents are to be reviewed. We expect the updated copies to be forwarded to the Commission. Inspection of the care record of one recent admission to the home showed that there was a Care Management assessment from the Social Services which was Littlecroft Residential Home DS0000061093.V374896.R01.S.doc Version 5.2 Page 10 given to the home on contact to enable the home to deternime it’s ability to meet the residents needs. Relatives stated at a conversation that their person was assessed before admission to the home; they were offered a trial visit and also given a contract detailing the fees to be paid and what service users can expect from the home. Staff demonstrated that they had a good understanding of the needs of the older people. Littlecroft Residential Home DS0000061093.V374896.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 People using the 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 offers support to service users throughout their lives and towards the end, it also protects them by reviewing their health needs, however, there are shortfalls falls in relation to comprehensive care planning and medication administration practices. EVIDENCE: We looked at four care files and noted that all showed evidence of detailed preadmission assessment of the needs of the individuals. The manager we met who was covering for the registered manager due to sickness stated that pre-admission assessment is very important as it enables the home to determine if they are able to meet the individuals’ needs. The resident is reassessed on admission before care plans are provided detailing how the assessed needs are to be met. We agreed that the current care plans need to be comprehensive and specify how the assessed needs Littlecroft Residential Home DS0000061093.V374896.R01.S.doc Version 5.2 Page 12 were to be met. We noted that there were monthly reviews of all care plans and intervention as needs change. There was evidence of individual risk assessments in some of the care files to enable staff to support the residents in order to minimise accidents. The care files contained evidence that all of the residents living at the home are registered with a General Practitioner to ensure that healthcare requirements are met, this was confirmed with the information that we received when we spoke with residents. Furthermore information seen in care records made us believe that service users living at the home are also supported by domiciliary services to the home such as district nursing services and chiropody. Service users are supported in other healthcare areas that affect them in their life such as continence and sensory impairments. There are no residents living at the home who require support with pressure area care. The Care Quality Commission received a Regulation 37 Notification for incidents that have required residents to be admitted to hospital through ‘accident and emergency’. Records of these occurrences were reviewed through looking at the records which the home had in place, we were satisfied that individuals were supported appropriately on a health and emotional level. Two individuals spoken with stated that “I am very happy here, staff are very good and very kind, and this is the best thing that happened to me”. Another person confirmed that staff respect her and always ensure that her privacy is maintained. A group of residents, met in the lounge, told us that they like living at Little Croft and that the staff are very good. They also told us that they have a choice of when they get up and when they retire. Care staff were seen knocking at the doors and waiting to be allowed in before going into the resident bedrooms to assist them with personal care. Some residents had private telephones installed in their rooms to enable them to have private conversation with their families, relatives and representatives whenever they wished. All of the care documentation and other information we looked at showed that good care based on dignity and respect is practiced at the home. One relative stated on the day of the visit “I am happy with the care given to my relative. The home is very good and the communication is excellent. They always inform me when there is a problem”. Littlecroft Residential Home DS0000061093.V374896.R01.S.doc Version 5.2 Page 13 We looked at medication practices at the home and we noted that arrangements have been made for all residents to be registered with a local doctor’s practice, with the aim of improving care for the individuals living in the home. All medication is reviewed routinely and when necessary as part of this process. We saw the medicines being administered at lunchtime. The medicines administration record sheet was signed when the medicines had been administered. The pharmacy provides a printed medicines administration record sheet each month. Nomad packs of medicines indicated that medicines had been given as recorded on the medicines administration record sheet. However one record was seen indicating that medicines had been hand written but were not signed and or dated to make sure that it was authorised by the residents’ doctor or the dispensing pharmacist. We also noted that one resident’s drugs that required extra security were stored correctly however there was no clear specific guidance on the label (labelled as directed) on how staff were to administer the medication to correspond with what was written on the Medication Administration Record Sheets. Furthermore we noted that there was one Controlled drug with two separate strengths but were to be given together. These were written together on loose sheets of paper. It was agreed that the Controlled drugs with their strengths must be written and accounted for separately to avoid confusion. We also agreed that it would be better to record controlled drugs in a ‘Controlled Drug Book’ rather that loose sheets to ensure that vital information is not lost. The home informed us that a controlled drug book had been ordered and would be in the home in a few days. We also noted that life limited medications did not have a date of opening to enable staff to discard them after 28 days as instructed on the drug label and a specific medication was not stored in the fridge as stated. The identified medicines were discarded immediately and new ones commenced and stored in the fridge as instructed. Some records were seen in the residents’ care plans relating to medication. Unwanted medicines returned to the pharmacy are recorded in a disposal book. Action has been taken to provide training about medicines for staff, and this is good practice to help staff administer medicines safely. However, where individuals are assessed as being able to self-medicate there must be a risk Littlecroft Residential Home DS0000061093.V374896.R01.S.doc Version 5.2 Page 14 assessment, reviewed on a regular basis or in the event there is concern as to their ability to continue managing their own medication. Residents’ wishes in the event of death was noted in the care files reviewed. Littlecroft Residential Home DS0000061093.V374896.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home enables service users to maintain contact with families, friends, advocates and the community. It also provides them with meaningful activities and some choice in respect of meals. EVIDENCE: During this visit visitors were seen at the home with their relatives. A resident told us that visitors are made welcome by the home and that their families remain an active part of their lives. We viewed the home’s visitors’ book, which records that there are a number of visitors who visit on a regular basis. In care records we saw how staff support the residents to maintain relationships with family and friends. We also saw within the home’s Statement of Purpose it states that visitors are welcome and that visiting times are open. The home told us in the Annual Quality Assurance Assessment (AQAA) that it encourages involvement with residents’ families and friends. Littlecroft Residential Home DS0000061093.V374896.R01.S.doc Version 5.2 Page 16 During the inspection staff were observed asking residents for their views and opinions and residents were encouraged to make choices on aspects that affect their life. Residents’ rooms contained many of their personal possessions such as small items of furniture, ornaments, pictures, soft furnishings and photographs. The home was able to demonstrate that daily living routines and activities provided are flexible and varied to suit the residents’ preferences and capacities. People spoken with informed us that they are encouraged to choose their own preferred routines as part of daily living in the home. Individuals living in the home told us that they woke and retired when they wished, that they enjoyed participating in activities of daily living such as enjoying the garden when the weather is good. We saw in the AQAA, the Statement of Purpose and the activities that the home provided clear information on what regular activities were taking place within the home; individuals living in the home stated that these activities take place on a regular daily basis. These include making cards, gentle exercises, reminiscing, ball games, and bingo, memory quiz, outside entertainment, dancing, instrument playing, and sing along. The visiting manager told us that residents who decide not to join in the planned activities have a key worker time on a one to one basis. We noted that lunch was not hurried and the dining areas were a relaxed area in which service users eat. We saw that the residents who required assistance were supported in a discreet sensitive way, without undermining their independence. Individuals told us that they enjoyed meals that meals are flexible and that alternatives are available if required. One resident met in their room told us on the day, “sometimes I don’t like the meal, but they can give me something else”. We saw that hot and cold drinks were freely available to the residents. The kitchen was seen to be clean and in a hygienic condition. The home was inspected in September 2008 by the South Gloucestershire Council Environmental Services and was given a five star rating on food safety. Littlecroft Residential Home DS0000061093.V374896.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are able to complain and are confident that the home is able to protect them from abuse. EVIDENCE: There is a complaint policy and procedure displayed at the home also in the Statement of Purpose and the Service User’s Guide. It contained information about the Commission to enable service users and their relatives to contact the Commission if not satisfied with the outcome of a complaint made to the organisation. The complaint procedure contained details of how complaints would be dealt with and time-scale. Service users spoken with stated that they are able to complain to the manager or the providers if they were not satisfied with any area of the service because the providers are here regularly. There were no recorded complaints at the home and the Care Quality Commission had not received a complaint since the last inspection. Individuals living in the home told us at a discussion that they have no complaints. Littlecroft Residential Home DS0000061093.V374896.R01.S.doc Version 5.2 Page 18 The home has a robust policy and procedure for prevention of abuse of vulnerable adults. There is also South Gloucestershire guidance based on the ‘No Secrets’ policy for dealing with suspected abuse. Staff are aware of the Whistle Blowing policy and would report any bad practices to the Manager without fear of reprisal. There is evidence of staff training in relation to Protection of Vulnerable Adults from Abuse. Newly employed staff members had Criminal Record Bureau checks and two suitable references before commencing employment. The home must ensure that adequate provision is made in relation to storage of residents’ money at the home in order to prevent theft or financial abuse. Littlecroft Residential Home DS0000061093.V374896.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a safe, clean, well-maintained hygienic environment, comfortable bedrooms and specialist equipment suitable for service users needs. EVIDENCE: Little Croft is one of three care homes owned and managed by Quality Care Homes Ltd. It is a converted property located at Oldland Common providing accommodation for up to 20 older people. There are 20 single rooms, 13 of which have en-suite facilities. There is a lounge, a dining room and a small seating area adjoining the dining room, used mainly for residents and their families and other visitors. Residents accommodation is on the ground and first floors with lift access. Littlecroft Residential Home DS0000061093.V374896.R01.S.doc Version 5.2 Page 20 Little Croft provides an environment which is equipped with adaptations such as grab rails, raised toilet seats, rails to meet the needs of residents who have a physical disability and require such aids to enable them to maintain independence. Generally, the home was found tidy, clean well lit, warm, comfortable and suitable for its stated purpose. It was well maintained with on going refurbishment. Residents were noted sitting in the lounge relaxed and enjoying each other’s company. Staff were wearing disposable aprons when serving and assisting service users with meals. Residents interviewed stated that they felt comfortable at the home. The home has an ongoing refurbishment programme, it was noted whilst touring the building the home had recently completed an extension which provides three extra rooms and a court yard area. This recent development has increased the communal area. The laundry was noted to be unclean and untidy. This does not demonstrate that infection control and principles of hygiene are being followed at the home. We have issued a requirement for the laundry to be kept clean at all times in order to prevent spread of infection. The home stated in their AQAA that it has a maintenance team to keep up the standards of repairs and maintenance at the home. The maintenance book was up to date clearly stating jobs/tasks to be carried out, date completed and any relevant comment in relation to outstanding jobs. Littlecroft Residential Home DS0000061093.V374896.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents enjoy a good, warm relationship with competent staff. The home’s recruitment procedure offers protection to residents and there are adequate numbers of staff to meet the needs of the residents. EVIDENCE: Staff records were examined and evidenced good practice in the recruitment of staff. References are sought, medical declarations are given and CRB checks have been requested. As part of the induction process staff are given copies of the GSCC code of practice and staff handbook. The visiting manager stated at a discussion that there is a well-established staff team at Little Croft. During the inspection staff were able to demonstrate a clear understanding and knowledge of the individuals who use the service, and of their role in the home. It was evident from interactions between staff and residents during the inspection that staff have developed positive relationships with the residents. Evidence from the rotas showed that there were three care staff in the morning between 8am and 1pm, two managers between 8am and 4pm, house -keeping staff to include, two kitchen staff. The manager on the day stated Littlecroft Residential Home DS0000061093.V374896.R01.S.doc Version 5.2 Page 22 that the general assistant for the laundry was off sick and that one care staff had to cover the duties for the day. We believe that if this practice is continued it will affect the numbers of care staff to meet the needs of the residents. Whilst we have not made any requirements we would be monitoring it at the next inspection. Staff rota evidenced that there are adequate numbers of staff in the evening and at night. From evidence gathered during the inspection, the inspector concludes that staff members employed at Little Croft have a range of skills and experience, which enables them to adequately meet the needs of the residents. For example five staff members have undertaken National Vocational Qualification (NVQ) at level 2, four staff at level 3, four staff at level 4 and 11 staff members are either currently undertaking an NVQ at level 2 or are waiting to start after their probationary period. All staff have completed core training, which includes moving and handling, fire awareness, health and safety, first aid, control of substances hazardous to health (COSSH) and medication training. All staff with the exception of three new staff have attended training on the protection of vulnerable adults from abuse. Other training attended included palliative care, mental health, bereavement, diabetes, pressure area care, Dementia awareness, mental capacity awareness, catheter and bowel care, communication and vision and hearing impairment training. Littlecroft Residential Home DS0000061093.V374896.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,37,38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Home benefits from good leadership and management, its practices have offered protection to the health and safety of residents. EVIDENCE: Mr Mark Hewlett has been the registered manager of Little Croft Care Home since it was taken over by Quality Care Homes Ltd. He has NVQ 4 in Care Management and the City and Guild Foundation level Management of Care qualification. Whilst Mr Hewitt was not on duty on the day of the visit due to ill health the home was covered by a visiting manager from one of the homes owned by Quality Care Homes Ltd. There was also a new manager for the home who had Littlecroft Residential Home DS0000061093.V374896.R01.S.doc Version 5.2 Page 24 only been in post for a day undertaking induction. The individual told us that they would submit an application for registration to the Care Quality Commission in due course Staff we spoke with told us that the manager is fair and would listen to what staff have to say in terms of providing quality care for the people living in the home. Residents’ meetings are held every two to three months. Minutes showed residents had made comments and suggestions about the food provided outings and clothing going into wrong rooms. Staff meeting minutes showed that the issue of residents’ laundry had been raised; this had previously been discussed at a residents meeting. All statutory and other records seen were well ordered, clearly written and up to date. These records included Policies and procedure file, minutes of staff and residents meetings and care plans. These records were securely locked away. There was evidence that the home ensures so far as is reasonably practicable. the health and safety of residents’ staff and visitors. The home has robust policies and procedures in relation to aspects of health and safety. Records relating to health and safety were clearly written and accessible to staff. There was evidence that the home takes the health and safety of residents, staff and visitors seriously whilst maximising residents’ independence. For example the home had completed a fire risk assessment. While we noted that the home has undertaken generic risk assessment of some areas of the home it could be better if it includes the lounges, dining areas, bedrooms and other areas that the residents have access to. The home told us before this report was completed that risk assessment of the identified areas, including the kitchen, has been put in place The system of monitoring the quality of care in the home shows that, the views of the residents are being listened and are being acted upon. There is evidence of regular care plan reviews questionnaires sent to residents, families and friends which are collated and all areas of concern addressed. Other tools used include resident and staff meetings, feedback from doctors and other health professionals. The fire logbook was viewed and was well maintained. The home was completing the appropriate checks on the fire equipments and recording of training and testing of equipment was satisfactory. Staff have attended fire drills to ensure that they have clear knowledge of action to be taken in the event of fire emergency. Littlecroft Residential Home DS0000061093.V374896.R01.S.doc Version 5.2 Page 25 There is a service record of the lifts, hoists, Nurse Call system, fire alarm service and portable appliance tests (PAT) of all electrical appliances, five year electrical and annual gas inspection. Accident reports were clearly recorded and reviewed on each occasion. It was agreed that that the home need to audit the accidents/falls regularly in order to establish if there a pattern and ensure that appropriate risk assessment is in place or seek support from the ‘falls clinic’. The home has policies and procedures to include, complaints, confidentiality death of a resident and protection of vulnerable adults from abuse. There was no documentary evidence, that staff at the home were receiving formal supervision however the visiting manager told us that the home undertakes group discussions and that this is used as supervision. The individual told us that staff receive annual appraisals. We believe that regular staff supervision plays a key role in ensuring that staff perform their duties effectively. The home sent us a confirmation in writing that formal regular supervision will be put in place for all staff working at the home. Individual residents’ records were securely locked away at the Home along with other service users’ information. Storage of residents’ monies had been previously discussed under Standard 18. Littlecroft Residential Home DS0000061093.V374896.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 2 3 3 Littlecroft Residential Home DS0000061093.V374896.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 13 Requirement Ensure that risk assessments and consent form are completed for residents who are self medicating to prevent drug error or overdose. Ensure that all handwritten medication on the Medication Administration Record Sheet (MARS) must be signed and dated to prevent drug errors to the residents. Record controlled drugs in a ‘Controlled Drug Book’ rather than loose sheets to ensure that vital information is not lost. Ensure that the present system of storage of resident’s money is reviewed to prevent theft/financial abuse. The home must ensure that the laundry is kept clean to promote infection control principles. Ensure that staff receive regular supervision to enable staff to express any concerns in relation to residents care needs Timescale for action 22/05/09 2 OP9 13 22/05/09 3 OP9 13 22/05/09 4 OP18 16 22/06/09 5 OP26 23 22/05/09 6 OP36 18 22/06/09 Littlecroft Residential Home DS0000061093.V374896.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Littlecroft Residential Home DS0000061093.V374896.R01.S.doc Version 5.2 Page 29 Care Quality Commission South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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