Care Home: The Croft

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What the care home does well The deputy manager in charge of the interim management of the home demonstrates much commitment towards meeting the aims of the service and improving practises at the home. Some residents were observed showing positive body language in a staff members presence which involved recognising the staff by smiling and touching and were clearly at ease in their company. Staff were aware of the importance of providing a choice of food and drink for residents What the care home could do better: There were some areas of immediate concern which affected the safety and welfare of residents, these were: The home must be appropriately managed in the absence of a registered manager as residents were at risk as not all of the people left in charge, had the skills and competence to ensure residents safety and to be able to meet resident`s needs. Medication practises must be improved as residents were at risk of misuse from the prescribed instructions not being followed by staff. Staff must be appropriately supervised by competent persons at all times in order to protect residents from some poor medication practises, care planning and inappropriate staff conduct. Further areas where shortfalls in practises were noted which resulted in requirements being made in order that they be addressed were: To ensure that staff have the guidance they need to be able to meet residents needs in an individual and consistent way by care plans providing clear accurate guidance on their needs and how to meet these needs and which are reviewed regularly to help ensure their accuracy. The meal time practises need to be reviewed to ensure that residents receive the individual support they need and support which promotes their independence as part of an enabling lifestyle Residents would benefit from staff undergoing specialist training in learning disabilities in order to update their knowledge on best care practises and changes in legislation in the care of people who have a learning disability. To ensure staff are fit and competent to work and thus promote residents welfare and safety staff deployment must be reviewed to ensure that their deployment /hours complies with European working time directive guidance on the times between shifts and to review the effect of staff working long hours. Good practise recommendations were made for the menus to be provided in a moreaccessible format to help aid residents understanding of the choices available. And to help ensure consistency additional instructions should be provided for staff on the administration of "As required" medication. These should make clear the individual requirements for when this medication was prescribed. This is necessary for staff to know when to administer these medicines in order to protect from the misuse of such medication. Much discussion took place with the provider regarding their need for greater involvement in overseeing the home in this interim period, in order to ensure appropriate supervision and standards in the absence of a registered manager. The provider demonstrated much commitment towards this and therefore no requirement was made. The provider agreed to look into the poor standards of care plan recording to identify what additional training staff need in order to improve recording standards. Concerns raised regarding the personal conduct and supervisory style of senior staff were fedback to the provider in order for them to address, with staff urged to contact the provider with their specific concerns. The provider agreed to look into the management of medication errors to ensure that there was a clear process to follow and agreed to identify what action would be taken to address a recent medication error. Random inspection report Care homes for adults (18-65 years) Name: Address: The Croft Buckland Road Reigate Heath Surrey RH2 9JP two star good service The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Jane Jewell Date: 1 5 0 2 2 0 1 0 Information about the care home Name of care home: Address: The Croft Buckland Road Reigate Heath Surrey RH2 9JP 01737246964 Telephone number: Fax number: Email address: Provider web address: croftboss@yahoo.com Name of registered provider(s): Name of registered manager (if applicable) Heddmara Ltd Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 18 Number of places (if applicable): Under 65 Over 65 0 learning disability Conditions of registration: 0 The maximum number of service users to be accommodated is 18. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD). Date of last inspection Brief description of the care home The Croft is a care home providing accommodation and personal care for adults with a learning disabilities, including some people who are over the age of 65 years. The home was opened in 1991 by its current provider. Care Homes for Adults (18-65 years) Page 2 of 13 Brief description of the care home The premises are a large converted Edwardian three storey detached house situated in its own grounds. The home is within walking distance of Reigate town. Communal areas are on the ground floor, comprise of two spacious lounges, a separate dining room, kitchen and utility room. Bedroom accommodation is mostly single occupancy and is arranged on all three floors. These are fitted with an emergency call system and washbasins and are accessible to bathing and toilet facilities. The home has a platform lift and an outside furnished terrace. Service provision includes a mini bus and driver. The car park is shared with staff and visitors of the on-site day centre for adults with learning disabilities. This is operated by the same organisation under separate management. The fees for residential care are currently £570 to £1600 per week, depending on the services and facilities provided. Extra such as: newspapers, hairdressing, chiropody, transport , toiletries are additional costs. Refer to the homes literature for the actual amounts charged for any additional costs. Care Homes for Adults (18-65 years) Page 3 of 13 What we found: This random inspection was undertaken as the Commission had concerns about the running of the home in the absence of a registered manager. Specific concerns had been raised with the commission relating to the standard of management cover and staffing levels. The inspection was undertaken between 10:30am to 18:00pm and was facilitated by the deputy manager and the provider ( Mrs Angela Haeems). The inspection involved discussion with all the staff on duty, sampling of care plans, rosters and reviewing some medication practises. This is the homes second random inspection in six months. Two care plans and daily notes were viewed in order to ascertain the guidance provided to staff on how to meet the care needs of two residents at night and the standard of daily recording. Care plans contained little to no guidance on the needs of the individuals at night or the guidance on how to meet these needs. This is necessary to ensure that residents individual needs were identified and could be met in an individual and consistent way. Care notes did not accurately reflect events that had been described by staff and which resulted in a significant medical decisions being made. Some care notes in fact contradicted the verbal feedback being provided by staff to management. This highlighted that care notes were not being monitored by management on a regular basis to ensure they provided an accurate up to date account of events and occurrences. The provider agreed to look into the poor standards of recording to identify what additional training staff need to improve recording standards. It has been required that care plans provide clear accurate guidance on the needs of residents and which are reviewed regularly. To ensure that staff have the guidance they need to meet service users needs in an individual and consistent way. Part of the lunch time meal time was observed. Staff were observed providing a choice of drinks and main meal, however not all residents appeared to be able to understand the verbal choices they were presented with. Although there were some visual prompts of food stuffs these did not reflect the food on offer. It is recommended that menus are provided in a pictorial format to help aid understanding and choice making. Not all residents received consistent appropriate personal support during lunch, with various staff observed prompting and supporting the same residents in different ways. Staff were observed to be largely task focused and missed several signs by residents in need of assistance or in need of specialist equipment to aid their independence. No residents were enabled to make their own lunch or be involved in the meal time arrangements. As previously noted care plans need to ensure that the individual needs of residents are highlighted to ensure continuity. Meal time practises must also be reviewed to ensure that residents receive the individual support they need which promotes their independence as part of an enabling lifestyle. Some residents were observed showing positive body language in a staff members presence which involved recognising the staff by smiling and touching. Staff responded to this in an appropriate manner which was clearly enjoyed by the resident. Care Homes for Adults (18-65 years) Page 4 of 13 The medication administration records (MAR) were viewed. A significant example was noted whereby the prescribed instructions were not being followed. This is with particular reference to the administration of As Required night medication. This resulted in a resident receiving this medication on a regular basis which was not in accordance with the prescribed instructions. It was immediately required for staff to follow the prescribed instructions at all times to ensure the individuals health and welfare. The provider took immediate steps to stop this practise and also agreed to investigate why staff had not been following the prescribed instructions and to any necessary disciplinary action. A verbal instruction had been given by management to staff as to the use of the As Required medication for this individual, which had not been followed. It is recommended that additional written instructions be provided for staff on the administration of As required medication, which make clear the individual requirements for when this medication was prescribed. This is necessary for staff to know when to administer these medicines in a order to protect from the misuse of such medication. Some aspects of the management of a medication error were noted to be poor. There was no clear action put into place to ensure that; the incident was properly investigated; action for future prevention and what action must be taken regarding the staff member who made the error. In addition the provider had not been informed by the interim manager of the error in order for them to ensure the safety of residents. The home operates a minimum staffing level of five staff on duty thorough the waking day, this currently includes the person in charge per shift. Discussion with staff and the roster confirmed that this level of staffing is planned for each day. There had been a few occasions over a four week period, due to last minute sickness, that this has dropped to four, when cover has not been able to be obtained. Generally staff felt that there was usually sufficient staff on duty to be able to do what they were being asked to do. There remains a small core group of staff who work the majority of the staffing hours, which includes working long days or condensed hours. Following the previous inspection where the potential problems of these practises were discussed the provider reduced staff hours to a maximum of 54 hours per week. However this does not include sleep in hours and in some cases meant that senior staff were present at the home for several days at a time, working late shifts followed by sleep in shift then an early shift. This is not good practise and working long hours was sighted as a contributing factor leading to a senior staff member not following the appropriate reporting procedures. This resulted in information not being forwarded to the provider for immediate action to safeguard residents. Although staff have signed European working time directive to agree to work in access of 48 hours over a period of time, consideration must also be given to the working time guidance on the Down time between shifts. This is designed to ensure that staff are suitable rested. It has been required that staff deployment be reviewed accordingly to ensure that staff on duty are sufficiently fit and competent as is appropriate to ensure residents health and safety. There has been some turnover of staff since the last key inspection, there remain a core group of staff who have worked at the home for several years. There was a mixture of experienced staff and new staff on duty, with agency staff only working along side permanent staff. Very few staff had completed any specialist training in learning disabilities. Through observation of practises and feedback from staff and social care professionals this identified the need for staff to undergo additional training in learning Care Homes for Adults (18-65 years) Page 5 of 13 disabilities. This is necessary in order to update staffs knowledge in good practises and changes in legislation of the care of people who have a learning disability. The provider and deputy manager at inspection identified a comprehensive training course that would be appropriate. Consistent feedback was received regarding the sometimes inappropriate conduct of a senior member of staff towards colleagues. A staff member commenting there has been an atmosphere of bullying and intimidation towards staff when this person is on shift. This was fedback to the provider who agreed to take prompt action in order to address this. Staff consulted with who expressed concerns were urged to speak the provider in order to assist the provider in addressing this. Some staff fedback that they had received some formal supervision from senor staff, however it was evident from some practises observed, reported inappropriate conduct of a senior staff member, poor care planning and the inadequate management of a medication error that staff were not being properly supervised during the day and night, which placed residents at risk of harm. The provider was immediately required to ensure that staff are being appropriately supervised at all times. The provider during the course of the inspection made arrangements to address this. Due to leave the home had been without a registered manager largely since December 2009. The manager then formally left the service in late January 2010. The provider took positive steps to immediately appoint a recruitment agency to identify suitable candidates for them to interview. In the interim the deputy manager was appointed by the provider to oversee the running of the home. The provider had been visiting the service Pop in to offer any practical assistance but the day to day management of the service was the responsibility of the deputy manager. The provider employs a care consultant to undertake monthly auditing visits to the service. The deputy manager confirmed that they contact the care consultant also for any advice and support and have done so recently. Information and concerns highlighted in the monthly auditing visits by the care consultant were not always being picked up by the provider in order for them to take action. Much discussion took place with the provider regarding their need for greater involvement in overseeing the home in this interim period in order to ensure appropriate supervision and standards in the absence of a registered manager. The provider demonstrated much commitment towards this and therefore no requirement was made. Much positive feedback was received from staff regarding the deputy managers competency to interim manage. They have undergone a range of training and have much experience in working with people who have a learning disability. They demonstrated an awareness of good practises and showed much commitment and enthusiasm towards trying to maintain standards at the home. Although they had little managerial experience it was evident that with support and guidance they were able to manage the home in the interim. However significant concerns were highlighted regarding the staff in charge in the absence of the deputy manager. Concerns highlighted the level of competency, lack of training, personal conduct, their deployment and lack of supervision. The provider was immediately required to ensure that the home is being managed with sufficient care competence and skill as is necessary to meet the needs and safety of residents. Care Homes for Adults (18-65 years) Page 6 of 13 What the care home does well: What they could do better: There were some areas of immediate concern which affected the safety and welfare of residents, these were: The home must be appropriately managed in the absence of a registered manager as residents were at risk as not all of the people left in charge, had the skills and competence to ensure residents safety and to be able to meet residents needs. Medication practises must be improved as residents were at risk of misuse from the prescribed instructions not being followed by staff. Staff must be appropriately supervised by competent persons at all times in order to protect residents from some poor medication practises, care planning and inappropriate staff conduct. Further areas where shortfalls in practises were noted which resulted in requirements being made in order that they be addressed were: To ensure that staff have the guidance they need to be able to meet residents needs in an individual and consistent way by care plans providing clear accurate guidance on their needs and how to meet these needs and which are reviewed regularly to help ensure their accuracy. The meal time practises need to be reviewed to ensure that residents receive the individual support they need and support which promotes their independence as part of an enabling lifestyle Residents would benefit from staff undergoing specialist training in learning disabilities in order to update their knowledge on best care practises and changes in legislation in the care of people who have a learning disability. To ensure staff are fit and competent to work and thus promote residents welfare and safety staff deployment must be reviewed to ensure that their deployment /hours complies with European working time directive guidance on the times between shifts and to review the effect of staff working long hours. Good practise recommendations were made for the menus to be provided in a more Care Homes for Adults (18-65 years) Page 7 of 13 accessible format to help aid residents understanding of the choices available. And to help ensure consistency additional instructions should be provided for staff on the administration of As required medication. These should make clear the individual requirements for when this medication was prescribed. This is necessary for staff to know when to administer these medicines in order to protect from the misuse of such medication. Much discussion took place with the provider regarding their need for greater involvement in overseeing the home in this interim period, in order to ensure appropriate supervision and standards in the absence of a registered manager. The provider demonstrated much commitment towards this and therefore no requirement was made. The provider agreed to look into the poor standards of care plan recording to identify what additional training staff need in order to improve recording standards. Concerns raised regarding the personal conduct and supervisory style of senior staff were fedback to the provider in order for them to address, with staff urged to contact the provider with their specific concerns. The provider agreed to look into the management of medication errors to ensure that there was a clear process to follow and agreed to identify what action would be taken to address a recent medication error. 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 2. Care Homes for Adults (18-65 years) Page 8 of 13 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 9 of 13 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 1 20 13 That the registered person 17/02/2010 shall make arrangements for the safe administration of medicines at the home. To ensure that staff follow the prescribed instructions at all times. 2 36 18 That staff are appropriately supervised at all times. To ensure that residents are not placed at risk by staff not following good practises and the homes policies and procedures. 17/02/2010 3 37 10 That the registered provider 17/02/2010 shall having regard to the size of care home, statement of purpose and number and needs of service users carry on managing the care home with sufficient care competence and skill. To ensure service users safety and that the aims of the service and service users needs are being met Care Homes for Adults (18-65 years) Page 10 of 13 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 6 15 That care plans provide clear 15/04/2010 guidance on all aspects of the health, personal and social care needs of service users and which make explicit the actions needed to meet these needs, including any night time care needs and must be reviewed regularly. To ensure that staff have the guidance they need to meet service users needs in an individual and consistent way. 2 18 12 That the meal time 15/04/2010 arrangements be reviewed to ensure that service users receive the support they need in accordance with their individual needs and wishes and which promotes their independence. To ensure that service users get the individual consistent support they need as part of an enabling lifestyle. 3 33 18 That staff deployment be 15/04/2010 reviewed to ensure that at all times staff are fit and competent to work as is appropriate for the health welfare and safety and service users. That staff only work shift patterns which enables them to be suitable rested between shifts to help ensure Care Homes for Adults (18-65 years) Page 11 of 13 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 service users safety. 4 35 18 That staff receive specialist training in accordance with the needs of the service users accommodated, in order that they can provide the appropriate support to people with learning disabilities. To update staffs knowledge of good practises and changes in legislation in the care of people who have learning disability. 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 28/05/2010 1 2 17 20 That menus are provided in an accessible format for service users to be help aid understanding and choice making. That additional instructions are provided for staff on the administration of As required medication, which make clear the individual requirements for when this medications was prescribed. Care Homes for Adults (18-65 years) Page 12 of 13 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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