Care Home: The Croft

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What the care home does well The staff recruitment process is thorough; this means that people living at The Croft are protected by the safe recruitment of professional and friendly staff. Relatives told us they were very happy with the service and care provided, they particularly expressed they could approach the manager at any time with any concerns they may have and be confident they would be dealt with appropriately. People live in a relaxed, homely and domestic environment. What has improved since the last inspection? Since the previous visit to this service a conservatory had been added making the communal lounge areas larger and brighter. The kitchen had been partly refurbished making it fresher and easier to keep clean. Care plans had been further developed to make them more user friendly. What the care home could do better: People need to be supported to enjoy activities away from the home and to appreciate life outside The Croft. The manager`s AQAA needs to include more evidence of what services and support the home provides for the people living there. Daily records need to be consistently completed to include accurate detail of the care and support provided for individuals. These records, when accurately completed, are useful tools to inform care plan reviews and evaluations ensuring that peoples` changing needs will continue to be met. Key inspection report Care homes for adults (18-65 years) Name: Address: The Croft Thorrington Road Great Bentley Colchester Essex CO7 8PR     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home 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 full review a ‘key’ inspection. Lead inspector: Jane Greaves     Date: 0 6 0 7 2 0 0 9 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 23 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 Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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. 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 Care Homes for Adults (18-65 years) Page 3 of 23 Information about the care home Name of care home: Address: The Croft Thorrington Road Great Bentley Colchester Essex CO7 8PR 01206251904 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Ramoo Sunnassee,Mr Ian J Thomas,Mrs Selimah Thomas,Mr Yoosoof Morowa care home 6 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Mr Sunnassee will not have any part in the day to day running of the home Persons of either sex, under the age of 65 years, who require care by reason of a learning disability (not to exceed 6 persons) Date of last inspection Brief description of the care home The Croft is a large detached bungalow located in the pretty Essex village of Great Bentley. The home provides care and accommodation to 6 people with learning disabilities. The roof space has been converted to provide an office, laundry facilities and staff facilities. The bungalow has a large well maintained rear garden that backs on to fields with a substantial vegetable plot and barbecue area. There is some off street parking to the front of the property. Charges levied for the care and accommodation provided at the Croft range from £650.75 to £668.00 per week, items such as hairdressing, chiropody and aromatherapist are extra costs. Inspection reports published by us were available from the manager on request. Care Homes for Adults (18-65 years) Page 4 of 23 Over 65 0 6 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key site visit that took place over 4 hours. At this visit we considered how well the home meets the needs of the people living there and how staff and management support people. A tour of the premises was undertaken, care records, staff records, medication records and other documents were assessed. Time was spent talking to, observing and interacting with people living at the home, visitors and staff. Prior to the site visit the manager had completed and sent into the Commission for Social Care Inspection the homes Annual Quality Assurance Assessment (AQAA). This is a self assessment document required by law and tells us how the service feels they are meeting the needs of the people living at the home and how they can evidence this. Care Homes for Adults (18-65 years) Page 5 of 23 Feedback on findings was provided to the manager throughout the inspection and the opportunity for discussion and clarification was given. We would like to thank the residents, the manager and the staff team for the help and co-operation throughout this inspection process. The previous Key Inspection of this service was undertaken on 11th July 2007. Care Homes for Adults (18-65 years) Page 6 of 23 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 23 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 23 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have access to plenty of meaningful information telling them about the home and the services and facilities available enabling them to make a decision about whether the home can meet their needs. Evidence: Since the previous inspection visit to this service no new people had moved into The Croft. It was therefore not possible for us to assess the pre admission processes. However the manager was able to tell us there would be extensive family involvement, a trial period would be offered to ensure home would be the right choice for the people considering moving in and that the prospective resident would fit with the dynamics of the established group of people living there. There was a Statement of Purpose and a Service User Guide available providing details of the services and facilities available at The Croft. This is so people can make an informed decision about whether the home would meet their needs. The manager told us that this information would be made available in a suitable format specifically to meet the individual needs of the person considering making The Croft their home. Care Homes for Adults (18-65 years) Page 9 of 23 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were supported by a system of care planning to make choices and decisions about their lives. Evidence: We looked at care plans for two people living at The Croft. These were detailed and covered the main needs and risks experienced by each person and guidance to staff as to how these should be managed. The care plans we looked at showed us that specific health and support needs were identified such as continence, mobility, personal hygiene, constipation, use of bed rails, eating and drinking, communication and becoming terminally ill. Assessments of risks and hazards to peoples health, safety and well being included areas such as hot drinks, choking, moving and handling, use of wheelchair and falls. The risks were identified and clear strategies were documented to enable staff to remove or reduce the identified areas of risk. Records showed us that reviews of care plans were taking place at a minimum of six monthly intervals with a monthly evaluation made of each area of identified need to ensure the current regime was still meeting the persons needs. Care Homes for Adults (18-65 years) Page 10 of 23 Evidence: The quality of daily recording varied considerably, one care plan we looked at stated All personal care given whereas another entry for the same person provided us with detail to show that the person was awake sitting up in their bed. They were assisted with a shower, cleaning teeth and dressing. The person chose their favourite jewelery and went to the lounge to have their breakfast which they ate and drank well but very slowly. The manager was aware of this shortfall in the quality of daily record keeping and was able to tell us of ongoing work with the staff team to ensure that an accurate record was maintained of the care and support provided for the people living at the home. The care plans we looked at included detail about peoples likes and dislikes such as aromatherapy sessions, music and dancing, clothing and accessories. The care plans also showed where people required a lot of prompting to take part in activities but there was no recorded detail of the effective way to encourage people to participate. Care Homes for Adults (18-65 years) Page 11 of 23 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People enjoyed the routines and lifestyles they experienced at the Croft. Evidence: We saw evidence in peoples care plans and daily records to show that activities and past times such as doing jig saw puzzles, dancing to music and involvement in household tasks such as dusting and clearing dinner tables took place. The manager gave us examples of where people were encouraged to help with some gardening. One person visited a coffee shop weekly. Sensory lights had been installed in the new conservatory that looked out over the rear garden. The manager told us that wild life such as pheasants visited the garden to the delight of the people living at The Croft. The manager reported how much people had enjoyed the recent local carnival. Records showed us and conversation with the manager confirmed that people visited the local shops and visit their family members where possible. Trips outside the home Care Homes for Adults (18-65 years) Page 12 of 23 Evidence: had reduced over the past 2 years. This was due to a variety of reasons. The annual shopping trip to France had been postponed due to the weakness of the Euro. The trips to the seaside had ceased as one person now needed a harness to keep them safe in the car and this had not yet been provided. People used to attend a club where they were able to meet up socially with people however this had ceased to operate. The manager acknowledged that these factors had severely impacted on peoples engagement with the world outside the care home. Routines of daily living were flexible around individuals needs and preferences. It was reported that whoever was awake first was assisted to wash and dress first. The registered manager reported that people could rise when they wished unless they had to be ready for specific appointments or outings. The manager told us, and records confirmed, that bed times varied, some people chose to watch television until quite late in the evening where others preferred to go to bed earlier. Meals were scheduled at specific times to provide a feeling of normality and security however when people had activities outside the home their meal times were flexibly arranged around them. Menus showed us that people were provided with a nutritious, varied and appetising diet. Food hygiene training had been provided for all staff members. The kitchen was in good repair and appropriate food stocks were maintained to meet the planned menu. The chef told us that individual choices were catered for. For example one person didnt like spaghetti but preferred to have a pie instead and another person didnt like cheese so had a curry instead. At lunchtime we noted staff providing sensitive assistance to people to eat their lunch. The manager told us of one person who previously did not eat meals without assistance but had now been supported to eat independently with gentle prompting. Care Homes for Adults (18-65 years) Page 13 of 23 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive consistent care and support that is based on their individual needs and wishes. Evidence: Observation and discussion with the manager showed us that people living at the Croft were supported to maintain a good standard of personal hygiene and appearance. It was evident on the day of this inspection visit, and from records, that people were encouraged to shower frequently and given necessary support in a manner that respected their privacy and dignity. Records showed us that people were supported to access health care facilities and treatment as necessary. Weight records were included in care plans, this was good practice as part of health and nutritional screening. No person living at the home was able to self medicate. All the staff team had received training in the safer administration of medicines. Medication was stored appropriately in a locked cupboard secured to the wall of the office and Medication Administration Records were maintained appropriately. Care Homes for Adults (18-65 years) Page 14 of 23 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at The Croft were protected from abuse, neglect and self harm. Evidence: There had been no complaints received by the home or the commission since the previous key inspection of this service in 2007. There was a complaints policy included in the Statement of Purpose and Service User Guide and complaints forms were kept in individuals care plans. These documents need to be amended to include up to date contact details for the commission. There was a compliments folder that included many positive comments from people involved with the service. For example:The atmosphere is always warm and welcoming and the standard of care for the residents is excellent and They are always clean and comfortable and are treated with dignity by all the staff and I am pleased X is in the care of Croft Residential Home and I am very satisfied with the care and support X receives from all members of staff. Records showed us that refresher training in the Safeguarding of Vulnerable Adults was delivered for the staff team by means of E learning from Essex County Council. Safeguarding information was available in the office where there were information leaflets and contact details for the Adult Safeguarding Team. During this visit a local authority Deprivation of Liberty adviser visited the home to support and assist the manager with any concerns she may have in relation to the mental capacity and potential deprivation of liberty of the people living at the Croft. Care Homes for Adults (18-65 years) Page 15 of 23 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a comfortable and homely environment. Evidence: The Croft provides a small and comfortable home for people. There is a pleasant garden for people to enjoy with wooden garden seats available. A partial tour of premises showed the home to be in a satisfactory state of repair and decoration. Communal areas appeared homely and domestic in nature. Various improvements had been made since the last inspection, including installation of a conservatory to increase the communal living space and replacement windows and flooring in the kitchen. It was evident that people were encouraged to make their personal rooms their own with personal effects reflecting their personalities and interests. The home appeared clean with no malodours present. records showed us that all staff had attended refresher training in the control of infection. Care Homes for Adults (18-65 years) Page 16 of 23 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at The Croft receive support from a caring and safely recruited staff team. Evidence: The managers AQAA stated We employ staff with skills in order to meet service users needs. We provide staff with NVQ level 2 and 3. We offer staff a range of training. Including management team there were 9 people involved with hands on care of the people living at The Croft. We looked at the managers training matrix, this showed us that all staff had attended basic core training in 2008 including Safeguarding Vulnerable Adults, moving and handling, infection control, fire awareness, health and safety and food hygiene. The manager reported that repeat annual refresher training was due to start August 2009 however a schedule not yet available to provide evidence of this. Records were available to show us that 5 people working at the home had achieved a minimum of NVQ level 2 in care and one further staff member was currently working towards this qualification. Care Homes for Adults (18-65 years) Page 17 of 23 Evidence: We looked at recruitment records for two people. These showed us that all the information necessary to reassure people that the right staff were employed to work with this vulnerable service user group had been obtained prior to people starting to work at the home. Records showed us that people received regular 1:1 supervision and direct observation of their daily practice. Records showed us that normal daily staffing levels included the manager, the cook and 2 care staff in the morning, one of the remaining service providers and 2 care staff in the afternoon with 1 waking night staff with a provider on call overnight. Relatives of people living at the home spoken with subsequent to this inspection visit told us: The amount of affection shown to people living there is quite remarkable and All staff go above and beyond the call of duty. Care Homes for Adults (18-65 years) Page 18 of 23 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at The Croft benefit from living in a well managed home that is safe and meets their needs. Evidence: The manager/provider is qualified to run the home and has been in post for 10 years. She has achieved the Registered Managers Award and is a qualified registered nurse. The manager attended training necessary to protect and promote the health, safety and welfare of the people living at the home and refresher courses alongside the staff team. The home undertook an annual quality assurance survey. The people living at The Croft did not have the capacity to participate in the quality assessment questionnaires, the manager reported that she encouraged views from family members, advocates and friends in order to monitor the quality of service provided for the residents of the home. We looked at questionnaires and found these covered food, accommodation, information available at admission, personal care, and experiences of daily living. Care Homes for Adults (18-65 years) Page 19 of 23 Evidence: Relatives we spoke with subsequent to this site visit told us: Wonderfully run place, X is very happy there and Nothing but praise for The Croft. The home had a consistent record of meeting relevant health and safety requirements and legislation. Certificates were available for inspection to confirm that routine inspections of electrical, gas and fire alarm systems had taken place. The staff team had received training in health and safety, control of infection, Safeguarding of Vulnerable Adults, safer administration of medicines, moving and handling and first aid in order to protect the health, safety and well being of the people living at the home. Care Homes for Adults (18-65 years) Page 20 of 23 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 21 of 23 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 22 of 23 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. 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. 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