Care Home: Primrose Croft

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What the care home does well We received many positive comments about Primrose Croft including: `I like coming to Primrose Croft for respite and am always sad when I leave as everyone is so friendly`; `we understand the difficulties management and staff deal with on an everyday basis. In our opinion they do an excellent job`; `they manage the care of these severely senile residents with a quiet, calm atmosphere, in a caring way`; ` praise is due to management and staff for their fortitude, standard of meals, entertainment and genuine care for those in care`. Both relatives and residents praised staff for their patience in particular.Family members told us that the home met the needs of their relatives well and that they were kept up to date with important issues affecting their relative. Activities are afforded a high profile in this home, giving residents regular social contact, stimulation and entertainment. What has improved since the last inspection? Fencing has been erected around the front garden and entranceway so that residents can walk around safely, and a gate has been put across the driveway to stop cars using it as a turning circle and disturbing residents. The use of agency staff has reduced considerably, ensuring that residents now receive their care from familiar staff that know their needs well. The home has employed a specific member of staff to launder residents` clothes since the last inspection. As a result, the number of complaints we received about missing and poorly laundered clothes has reduced considerably. CARE HOMES FOR OLDER PEOPLE Primrose Croft Victoria Road Cambridge CB4 3EH Lead Inspector Janie Buchanan Unannounced Inspection 27th August 2008 08:20 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Primrose Croft DS0000015237.V370597.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Primrose Croft DS0000015237.V370597.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Primrose Croft Address Victoria Road Cambridge CB4 3EH 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) 01223 354773 01223 566549 Primrose Healthcare Ltd Ruby Davis Care Home 38 Category(ies) of Dementia - over 65 years of age (20), Old age, registration, with number not falling within any other category (38) of places Primrose Croft DS0000015237.V370597.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th September 2007 Brief Description of the Service: Primrose Croft offers accommodation and personal care to 38 older people, some of whom have dementia. It is situated in a residential area north of the river Cam. It is within walking distance of all local amenities round Mitcham’s Corner and is a short drive away from Cambridge town centre. The home has undergone a refurbishment programme that included internal reconstruction to create eight new bedrooms with en-suite facilities and the creation of a unit for older people with dementia occupying the whole of the first floor. The home offers thirty-eight single bedrooms and there are a variety of communal rooms for residents to use. Pleasant gardens surround the home. Fees vary between £361 and £445 per week. A copy of the most recent inspection report is available in the hallway of home for visitors and relatives to read. Primrose Croft DS0000015237.V370597.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. For this key inspection we (CSCI) looked at all the information that we have received, or asked for, since the last key inspection. This included: • The annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. Surveys returned to us by people using the service, from staff and from other people with an interest in the home: we received 29 surveys from residents, staff and visitors to the home. This is an excellent response and shows that the home actively seeks the views of people who use its services prior to an inspection. What the service has told us about things that have happened in the home, these are called ‘notifications’ and are a legal requirement. • • We also visited the home and talked with people living there and members of staff. We toured the premsies and viewed a range of documents and policies. An ‘expert by experience’ (ex by ex) was part of our inspection: an ex by ex is someone who has experience of using social care services. During this inspection the ex by ex looked at activties, staff’s interaction with residents and mealtimes. Her feedback is included in this report. What the service does well: We received many positive comments about Primrose Croft including: ‘I like coming to Primrose Croft for respite and am always sad when I leave as everyone is so friendly’; ‘we understand the difficulties management and staff deal with on an everyday basis. In our opinion they do an excellent job’; ‘they manage the care of these severely senile residents with a quiet, calm atmosphere, in a caring way’; ‘ praise is due to management and staff for their fortitude, standard of meals, entertainment and genuine care for those in care’. Both relatives and residents praised staff for their patience in particular. Primrose Croft DS0000015237.V370597.R01.S.doc Version 5.2 Page 6 Family members told us that the home met the needs of their relatives well and that they were kept up to date with important issues affecting their relative. Activities are afforded a high profile in this home, giving residents regular social contact, stimulation and entertainment. What has improved since the last inspection? What they could do better: Food and fluid charts must be much more detailed so there is a clear record of what residents have eaten and drunk. Medication recording must improve so there is a clear and accurate record of what medications residents have received. Some areas of the home smelled strongly of stale urine and more must be done to eradicate this so that residents live in a pleasant environment. The home employs a large number of overseas workers whose English language is at best variable. One relative told us; ‘the staff are generally foreign ands their English is not good enough to communicate that well’. We struggled to understand and be understood by some of these so it is likely that residents also find this difficult. It is also of concern that these staff may not always understand the training given to them. The home must ensure that it only employs staff with sufficient language skills to communicate effectively with residents. All staff should receive formal supervision at least six times a year so their working practices can be discussed and their training needs identified. Please contact the provider for advice of actions taken in response to this Primrose Croft DS0000015237.V370597.R01.S.doc Version 5.2 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Primrose Croft DS0000015237.V370597.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 Primrose Croft DS0000015237.V370597.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,5 Quality in this outcome area is good. Information about the home is detailed, ensuring prospective residents can make a fully informed choice about whether or not the home is suitable for them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a statement of purpose and service user guide, both of which give good information about the services and facilities on offer. These are available in large print for visually impaired residents. Prospective residents and their relatives are encouraged to visit the home to assess its facilities and family members who completed our surveys told us they had done this. Every resident is issued with a contract that clearly states the terms and conditions of their stay at the home, and the fees payable by them. We viewed the files for three recently admitted residents and each contained appropriate pre-admission assessments of their needs completed by a senior member of staff at the home. Primrose Croft DS0000015237.V370597.R01.S.doc Version 5.2 Page 10 Primrose Croft DS0000015237.V370597.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10, Quality in this outcome area is good. Residents’ needs are clearly recorded in the care plans, and their health is monitored closely. EVIDENCE: We viewed the care plans for three residents. The information they contained was generally detailed and residents’ needs in a number of areas including washing, dressing, continence, mobility and communication were clearly documented. There was good evidence that the plans were meaningfully reviewed: one resident had recently been diagnosed with MRSA (methicillin resistant staphylococcus aureus) and all aspects of her care plan had been updated to take this into account. However, in two plans residents’ food and fluid charts were not in enough details to show how much they were actually receiving. Residents’ weights, nutrition, falls risk and dependency levels are assessed regularly and the home had built up good relations with local health care professionals. A local clinical psychologist and community psychiatric nurse visit the home very 6 weeks to discuss the needs of specific residents and offer guidance and support to staff. Primrose Croft DS0000015237.V370597.R01.S.doc Version 5.2 Page 12 We checked the medication storage and a sample of medication administration records. The following shortfalls were noted: • • • • For one resident the number of tablets in the blister packs did not always correspond with the number recorded as having been administered Hand written additions to the MAR sheets had not been signed or dated The date on which liquid bottles of medication had been opened had not been recorded One resident had two packs of frusemide tablets. It was not clear why this was, and staff were taking tablets from both packs Primrose Croft DS0000015237.V370597.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15 Quality in this outcome area is good. Activities are well managed, frequent and provide daily interest for many residents at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is much for residents to do at this home including outings to tea dances, pub meals, the theatre and regular manicures, clothing sales, coffee mornings, music for health sessions and visiting musicians. Some staff are being trained in cognitive stimulation therapy to be better able to offer appropriate activities to people with dementia. One relative told us: ‘mum gets very involved in the activities organised’. A resident told us she particularly enjoys the church services. Our ex by ex spent some time observing an activity, she reports: ‘The Activities Co-ordinator came in and I watched her trying to persuade the residents to join in the activities. A number of them would not leave the lounge but some did. Those that did had a pleasant hour sticking shapes on paper. The residents in the lounge did not get left, she went back in and tried to work independently with some of them’. Primrose Croft DS0000015237.V370597.R01.S.doc Version 5.2 Page 14 Visitors told us that the home helps their friend or relative keep in touch with them and stated: ‘When I phone the home, they are always happy to take the phone to my mother’. Lunch on the day we visited was a choice between beef curry or meat salad. Residents told us they enjoyed to the food however one commented that the staff always fill her cups of tea too full. This is of particular importance to her as she is blind, and has to feel for her cup in order to drink. Our ex by ex sat and watched residents as they had their lunch. She comments: I observed first the Dementia Unit’s lunch procedure. I was not too happy here. Two tables in the dining room, 4 people fed in the lounges. One table of ladies had meat and salad plus potatoes, they made no attempt to help themselves and a member of the staff had to be told to go and help them, which she did. She served them did not explain what was in the jugs and tried to serve meat to a lady that did not eat meat. At the other table the residents were served their food, nothing was put into the middle of the table but I felt that some of them could have done with a spoon not a fork. Two staff were trying to feed two of the residents food on a one to one basis, it was time consuming but they were doing a good job. In the other lounge the residents were eating their lunches with a member of staff supposedly helping and watching but she was reading a magazine that she put down when I entered. Somehow I think the lunchtime on this Unit needs careful supervision but the Unit Manager is handing out the food not observing’. Primrose Croft DS0000015237.V370597.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. Residents are able to express their concerns and know that they will be taken seriously. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents who completed our survey stated that they knew how to make a complaint a one told us: ‘I tell a carer, and it gets dealt with’. There is also a visitor communication book in the entranceway to the home so that people can leave comments should they wish. We also viewed posters details how to complain in some of the residents’ bedrooms. We checked the home’s complaints log and read the details of two complaints concerning a residents going home with a sore bottom and another from a family member about staffing levels and cleanliness. Both these had been recorded well, thoroughly investigated and responded to comprehensively. Staff we spoke to confirmed they had received training in protecting vulnerable adults and their training records further evidenced this. Local protecting vulnerable adults guidelines are available in the entranceway to the home so that residents and visitors can easily access them. Primrose Croft DS0000015237.V370597.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,25,26 Quality in this outcome area is good. Residents live in a comfortable and wellmaintained environment, however strong smells of urine in some areas make it very unpleasant. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There are a variety of communal spaces for residents to use within the home including three lounges, three dining areas, and a small area where residents can sit comfortably in the corridor overlooking the front of the home. A quiet room can also be made available for residents who want to entertain guests. There are pleasant gardens surrounding the home that are accessible to the residents. Our ex by ex commented: ‘Access was good and car parking great. As I approached the Home I observed lots of tables and chairs outside for people to sit at and this felt right. It meant families could sit outside and chat to relatives in a very pleasant atmosphere’. Residents’ bedrooms meet all the minimum size requirements and ten of the bedrooms have ensuite facilities. There are a number of aids and adaptations Primrose Croft DS0000015237.V370597.R01.S.doc Version 5.2 Page 17 throughout the home to assist residents including grab rails, raised toilet seats and moving and handling equipment. The dementia care unit has pictorial signage to aid orientation, and a keypad entry system and a stair gate to ensure residents’ safety. However, this unit is also on the first floor of the home, thereby making it very difficult for residents to access the garden area for fresh air and natural light when they want. One relative told us; ‘I arrive unannounced and have always found the atmosphere to be quiet, calm and friendly’. However another commented:’ The fire alarm system is faulty and for the past few months has driven the staff, residents and visitors mad with its constant high pitch sounds- why can’t it be mended we all ask’? We did ask the manager and were assured it had now been fixed, but only after a period of about 3 months. This is an unacceptably long time. Other relatives reported: ‘Primrose Croft is a well run unit, however upstairs does always smell of urine’ and ‘there is a strong smell of urine throughout the home which is very unpleasant’. We noted strong smells of urine on the ground floor outside rooms 2,5 and 16 and also in some parts of the dementia care unit. The environmental health officer visited the home in February 2008 and awarded it 4-stars (very good). Primrose Croft DS0000015237.V370597.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. Staffing levels are adequate to meet residents’ needs, however the high use of overseas workers employed means that communicating with them can be difficult. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There are six members of staff and one team leader on between 8am and 2pm, and five members of staff and a team leader on between 2pm and 8pm to support 38 residents. There are three waking night staff. Residents told us they only occasionally waited a long time for help and we saw staff answering calls bells promptly during our visit. We received many positive comments about the staff at Primrose Croft including: ‘I find them kind, efficient and exceptionally pleasant to all. They carry out a very difficult job with great patience’. Staff have encouraged my mother to eat more that she has in a long time and I think that is a real achievement in the few days she has been there’. However we also received many concerns about staff’s ability to speak and understand English; ‘The staff, I find at times, are a little bewildered by our language’ and ‘the only difficulty is with language as their English is rather limited and heavily accented’. Of the four staff we interviewed, we struggled to understand and be understood by three of them. In fact it was not possible for us to ascertain their knowledge of important issues such as dementia care and adult protection as they did not have the ability to communicate their answers and failed to comprehend what we asked them. One member of staff told us that he didn’t always understand the training given to him. Primrose Croft DS0000015237.V370597.R01.S.doc Version 5.2 Page 19 Four hold an NVQ level 3; however only 27 have an NVQ level 2 in care which is well below the recommended minimum percentage. One member of night staff did not have current moving and handling training and had not received any training in dementia care. We checked the personnel files for three recently employed members of staff and these contained satisfactory references, POVA and CRB checks. Primrose Croft DS0000015237.V370597.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,36,38 Quality in this outcome area is good. Residents live in a well run home and are protected good health and safety practices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has worked at the home for a number of years. She holds the registered manager’s award and keeps her training well up to date. She has gained in confidence over the years and has an open and inclusive management style. She is excellent about informing us of any issues affecting the home. Staff told us they felt supported and they do receive supervision that they report as useful. One member told us ‘my mentor is a good teacher and friend. She corrected me immediately when I did wrong’. However not all are receiving it as often as recommended and one member of staff had only received three supervisions in the last year. Primrose Croft DS0000015237.V370597.R01.S.doc Version 5.2 Page 21 A number of records in relation to health and safety were viewed (including gas, portable appliance testing, fire and, hoist and lift servicing): these were all up to date and in good order. The maintenance officer also regularly checks the safety and condition of the home’s window restrictors, bed rails and wheelchair. We undertook a brief tour of the kitchen and cleanliness was good (although the floor under the shelving unit was very dusty and full of crumbs) and all foodstuffs were stored correctly. Primrose Croft DS0000015237.V370597.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 3 3 x x 3 2 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x N/A 2 x 3 Primrose Croft DS0000015237.V370597.R01.S.doc Version 5.2 Page 23 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 OP8 Regulation 12(1) Requirement Food and fluid charts must be much more detailed so there is a clear record of what residents have eaten and drunk The recording of residents’ medications must improve so there is a clear record of what they have received The home must be kept free from offensive smells so that residents live in a pleasant environment. Staff must have appropriate language skills so they can communicate with residents Timescale for action 01/10/08 2 OP9 17(1)(a) 01/10/08 3 OP26 16 (2)(k) 01/10/08 4 OP30 18 (1)(a) 01/12/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP36 Good Practice Recommendations Staff should receive supervision at least 6 times a year Primrose Croft DS0000015237.V370597.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Primrose Croft DS0000015237.V370597.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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