Care Home: The Croft

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What the care home does well The home obtains good information about new residents before they are admitted, to make sure it can meet their needs. Residents can be independent but the home supports those who needs staff to help them go out and about and take part in activities. Staff work well with health and social care professionals to meet a range of different needs. Residents can say what they think about the home and the manager asks them for comments, in residents` meetings. The building provides opportunities for people to make their own meals if they want to, and a number of different lounges, so people can choose who to sit with. The more experienced staff in the home have developed the skills they need, guided by the manager, to respond effectively to the needs of residents. What has improved since the last inspection? Senior staff in the home have improved the way they check that staff are doing what they should, by regular checks of the medication and in the kitchen. The home has continued to check whether the system for buying food allows residents to have the food they prefer, and makes sure they never run out of essentials. Staff now keep much better records of the food each person eats, so they know whether residents are having an adequate diet. Some of the medication systems have been changed, in line with advice provided by a pharmacist, to make it safer and easier for staff to manage medication. Staff have been checking that the building is at a comfortable temperature and that the temperature of hot water is controlled. What the care home could do better: An up-to-date Statement of Purpose, with details of the new owners, must be provided. The contract with residents should explain more clearly the arrangements for paying for transport. Care plans must explain clearly the care each person needs and wants, so that staff know what they must do. They should include details of the best ways of responding to people, so that all the staff can benefit from the knowledge of the more experienced staff. When staff write on the medication administration records, the medication which is to be given to each person, a second member of staff should check they have copied the information from the pharmacy label correctly. Both should sign and date this record. The home should try and obtain a standard bound controlled drugs register to help staff record clearly the storage and administration of controlled drugs. Records of staff training must be kept up-to-date, so the manager can make sure all staff have received the training they need. All staff who have not already had this, must be trained in food hygiene, moving and handling, first aid and the protection of vulnerable adults. The manager must look at what training staff need to meet the needs of older and disabled residents. The owners of the home must inform CSCI of proposals for the management of the home. They must carry out and record the visits which are required under Regulation 26, to check the home is running properly. Staff must continue to try to reduce the risk of residents smoking in bedrooms. If a resident needs their bedroom door to be kept open, the manager must discuss with the fire officer if the home can fit a device which allows the door to stay open, but close automatically if the fire alarm sounds. The owners should consider following the Fire Officer`s advice to upgrade fire doors. CARE HOME ADULTS 18-65 The Croft Sabin Terrace New Kyo Stanley Durham DH9 7JL Lead Inspector Ms Kathy Bell Key Unannounced Inspection 20th February 2008 10:00 The Croft DS0000071286.V359682.R01.S.doc Version 5.2 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 The Croft DS0000071286.V359682.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 Adults 18-65. 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. The Croft DS0000071286.V359682.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Croft Address Sabin Terrace New Kyo Stanley Durham DH9 7JL 0151 651 1716 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) Potensial Limited Ms Ann Marie Dines Care Home 25 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (25) of places The Croft DS0000071286.V359682.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 the following gender: Either Whose primary care needs on admission to the Home are within the following category: Mental Disorder, excluding learning disability or dementia, Code MD maximum number of places 25 The maximum number of service users who can be accommodated is: 25 6/12/06 (last key inspection) 2. Date of last inspection Brief Description of the Service: The Croft is registered to provide care (but not nursing care) for up to 25 people with mental health problems, above and below 65 years. The home is divided into two units, with a number of lounges throughout the building. All the bedrooms are single, apart from a flat which a married couple live in. The building is in a village near the town centre of Stanley with local shops and a leisure centre. There are good bus services to Stanley, Durham and Newcastle. The home was bought by the Potensial company in November 2007. This is a national organisation which runs a number of homes, mainly for people with learning disabilities. Fees for the service are from £384.50 per week. Care managers can also buy the homes outreach service which provides staff to give individual residents extra support and take them out and about. This information was provided to CSCI in February 2008. The Croft DS0000071286.V359682.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 that the people who use the service experience good quality outcomes. This inspection took place during two days in February 2008. During this visit, the Inspector looked around the building, including a few bedrooms, and looked at records in the home. She spoke to nine residents, a visiting community psychiatric nurse and to the manager, deputy, three care staff and the cook. Also, 10 residents completed surveys before the random inspection in October 2007. The home has experienced an unsettled year. The manager has had two long absences because of ill-health, two temporary managers have worked in the home and the ownership of the home changed in November 2007. What the service does well: What has improved since the last inspection? Senior staff in the home have improved the way they check that staff are doing what they should, by regular checks of the medication and in the kitchen. The home has continued to check whether the system for buying food allows residents to have the food they prefer, and makes sure they never run out of essentials. Staff now keep much better records of the food each person eats, so they know whether residents are having an adequate diet. Some of the medication systems have been changed, in line with advice provided by a pharmacist, to make it safer and easier for staff to manage medication. Staff have been checking that the building is at a comfortable temperature and that the temperature of hot water is controlled. The Croft DS0000071286.V359682.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this 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. The Croft DS0000071286.V359682.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Croft DS0000071286.V359682.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1 and 2. People who use 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 new owners of the home have not yet produced a new Statement of Purpose. This means that anyone thinking of using the home does not have all the information they need about it in one document. The manager gets full information about possible new residents so she can be sure the home will meet their needs. EVIDENCE: A new company took over this home in November 2007. They have not yet completed a new Statement of Purpose which is the document which sets out who is running a home and what kind of service they provide. This is important information for anyone choosing a home. But residents have been given new contracts which contain the information about what they receive for their money and what they must pay for themselves. But the information on transport costs should be made clearer. Records of new residents, seen during the last random inspection, showed that the home had obtained full information from care managers and had completed its own assessment as well. This included available information from hospitals, occupational therapists and care managers. Information to guide the home in managing any risks was also included. The Croft DS0000071286.V359682.R01.S.doc Version 5.2 Page 9 The records on a potential new resident showed that the home continues to obtain all this information. This person was having visits to the home to help her decide whether to move in. Staff were using this opportunity to add to the information they already had and assess her needs. Discussions with the manager showed that she thinks carefully about how any new resident would get on with the people already living there. Records showed that the home is also prepared to make the difficult but correct decision to give someone notice to leave when they can no longer meet their needs safely. The Croft DS0000071286.V359682.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7 and 9. People who use 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. Each person has a care plan which describes the support they need but staff need to make sure these contain all the detailed information they need. The manager has taken seriously the points raised during this inspection about this and has already started working with staff to improve the care plans. Residents can make choices in their daily lives but staff sometimes need to help them do so. The home has recorded how it manages any risks and supports people to take part in activities and be independent. EVIDENCE: The inspector looked at a number of care plans and checked if the information staff described about each resident was in their care plan. The care plans were good at setting goals for each person and looking at their psychological needs. Each day staff recorded how residents had spent the day and linked this to each area in the care plan. But staff had not always been recording when something had changed, for example, when somebody started using a walking frame. There was not The Croft DS0000071286.V359682.R01.S.doc Version 5.2 Page 11 enough detail in one care plan about what help someone needed when they had a bath. The care plan for another person said that he needed some help with a catheter but didnt say exactly what staff had to do. Information about one persons special diet and the advice given by the speech and language therapist was not in the care plan, but it was pinned up in the kitchen, together with good detailed advice for staff. The senior member of staff on duty was clear about what people needed and said that he had to tell newer staff what to do. Reassuringly, a new member of staff said that she had been encouraged to ask if she wasnt sure. Other staff were obviously very familiar with residents particular needs. But a care plan must be available for each person, giving clear detailed information about their needs so that staff can work consistently and always give people the care they need. Care plans could also be more useful to staff if they included more detail about how to respond to any behavioural problems. Some staff may have found a particular approach to someone which works well and the care plan should help them share this knowledge with colleagues. Residents are involved in reviewing their care plans and sign to say they agree with them. The manager described a situation where a resident had not been happy with the way something was written in a care plan and so it had been altered. Since she has returned to work, the manager has been reviewing the care plans and had already told staff to improve them. Following the inspection, she met with staff and has discussed with them how the care plans must be improved. The inspector saw residents making choices about their daily lives, whether they wanted to go out, what they wanted to do, and who they wanted to spend time with. Some residents have extra staff hours provided for one-to-one attention. The manager described how these residents discuss with their key workers what they want to do with this time. Staff now keep a record, explaining how these hours have been used and the residents record on them if they were satisfied with this. A senior member of staff was aware that some people needed to be prompted to make choices. One man needs staff to ask him if he would like to go to his room. This is information which should be in his care plan so that all the staff know to do this. Residents can make their rooms individual to them and some have their own furniture in them. Each care plan includes assessments of any risks there may be to residents or other people. These risk assessments explain what staff must do to reduce the chances of people coming to harm. The action to be taken is often that staff must go out with people to enable them to take part in an activity. The manager has recently looked again at whether a resident is safe to look after The Croft DS0000071286.V359682.R01.S.doc Version 5.2 Page 12 her own medication. As a result, she has changed the way the medication is provided, so that the resident can continue to have the independence of looking after her own medication, but with a smaller risk of something going wrong. In some situations, residents choices are restricted for their safety or that of others. The care plans show clearly when this is happening and explain why it is necessary. The manager described how these decisions are made with the care managers responsible for each person, for their protection. The Croft DS0000071286.V359682.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14, 15, 16 and 17. People who use 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. People in this home can use local community and leisure facilities but dont always choose to do so. They are supported to develop and maintain their independence. Residents can maintain personal relationships. The home provides a satisfactory diet with choices and special diets are catered for. EVIDENCE: Some residents go to day services outside the home. In the past the home has supported someone to try and get a job. Residents can use an independent kitchen in the building to prepare their own meals, if they are able to. Records and discussion in the home showed that residents use local community facilities like the corner shop and club. The manager said that the local working mens club is available for social nights like birthday parties and provide a karaoke night for them. Residents go out and about, shopping, and for walks. In the surveys completed before the random inspection in the The Croft DS0000071286.V359682.R01.S.doc Version 5.2 Page 14 autumn, some residents said there were not enough leisure activities. During the inspection, other residents agreed with this view. Staff spoken with at that time also felt that the home could improve in this area. Activities may be limited by people not being motivated to try something, or being reluctant to spend money on them. In one case, activities were limited for one resident because the home had not been able to recruit someone to work with this person. But staff described how they have tried offering swimming sessionspeople seemed to enjoy the first visit but did not want to try it again. Sometimes they have tried nights out and people havent wanted to go. Some residents are able to go out by themselves if they wanted to. Residents confirmed that in the home, bingo, dominoes and quizzes are arranged. The home has arranged for one resident to play the piano weekly in a home for older people, so he can keep up his skills. Some residents have extra staff hours provided for one-to-one attention. The manager described how these residents discuss with their key workers what they want to do with this time. Staff now keep a record, explaining how these hours have been used and the residents record on them if they were satisfied with this. The manager agreed with the inspectors suggestion that key workers discuss with each resident exactly what they would like to do, how often they would like to do it, what is possible and how they can achieve this. This discussion should be recorded so the home can be clear it is doing what it can to meet peoples wishes in this area and residents can be clear about what they can do themselves to live more interesting lives. The home respects residents rights to have personal relationships. One couple are married and have their own flat and another couple in the home have a relationship. The manager described a difficulty with one relative. She has responded to this by supporting the resident to maintain contact but providing a member of staff to go with them to safeguard them. The previous owners said that commissioning care managers were aware this was a home which respected residents individual sexual orientations and understood how these had influenced their lives. Staff seem to respect residents rights to be independent and set their own daily routines. A visiting community psychiatric nurse felt that the home gets the balance right between respecting peoples rights and setting the boundaries some people need for their well-being. The inspector saw that residents sometimes make the choices which staff would prefer they didnt. There is a choice of meals each day and each morning the cook asks people what they want. Staff record the meals each person chooses. They monitor how much some people who are underweight are actually eating. Staff are now weighing people regularly to check if they are gaining or losing weight. Most meals are made to fit healthy eating guidelines but the cook is aware that some people need extra calories to build them up. Information is pinned up in the kitchen about healthy eating for people with diabetes. Detailed guidelines The Croft DS0000071286.V359682.R01.S.doc Version 5.2 Page 15 provided by the speech and language therapist for one persons diet were also in the kitchen. Twice a year, the home does a survey of residents, asking them which meals they like and what they would like to have. When the menus are revised, the manager said she asks the local dietician to check they are satisfactory. One resident told me that there had been a problem with staff taking the teapots away before everyone had finished their meal. This had been raised in a residents meeting and the manager showed me the minutes of the next staff meeting where staff had been reminded they must not do this. At the time of the last inspection, some comments were made about the food not being hot enough. This time, residents who were asked, said it was hot enough. The manager thought the problem may have arisen when people dont come to the dining room promptly when their meal is ready. Both fresh and UHT milk were available in the home so people can have whichever they prefer. The deputy manager is doing regular spot checks in the kitchen to make sure that it is kept clean and records are being kept properly. The Croft DS0000071286.V359682.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19 and 20. People who use 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 meets a range of personal and health care needs well but more detail should be written in care plans to make sure that physical care needs are always met properly. The home has responded to advice and improved the way medication is looked after. EVIDENCE: This home provides care and support for people with a wide range of needs. Some people are independent in terms of physical care but need support for their psychological needs. Others are ageing and/or physically disabled. The home has also been successful in caring for people whose behaviour has made it difficult to provide care in other settings. This reflects the high expectations of the manager about how staff should treat people with respect, and the success of staff in forming positive relationships with anyone. Records and discussions with the manager showed that the home works closely with medical and care professionals to meet the needs of residents. A community psychiatric nurse confirmed that the home has close working relationships with health workers and care managers. Close links mean they can quickly receive help for psychiatric needs and it was clear that staff have The Croft DS0000071286.V359682.R01.S.doc Version 5.2 Page 17 developed a close knowledge of each individual so they can be aware if someone is becoming unwell. Good records were kept of visits to doctors. A community psychiatric nurse said that the home is prompt in dealing with medical issues Records showed that the home has made referrals for specialist advice, to the speech and language therapy team and to an occupational therapist. Care plans were not as good at providing the details to guide staff, when people needed physical care or help with things like catheters. But senior staff spoken with seem to be well aware of the care of people needed, and ready to advise newer staff. Previous inspections have found a number of serious failings in how the home has handled medication. However, the home has received help from the Primary Care Trust pharmacist to make the medication systems easier to manage safely. The manager and previous owners have made it clear to staff that procedures must be followed and it is encouraging that staff acknowledge a firm line needed to be taken on this. The manager and deputy continue to monitor closely how medication is handled. All the staff who handle medication, and six others, have started an external safe handling of medication course. The home has responded to all the previous recommendations except the advice that when staff write out a new medication administration record, a second member of staff should check that they have written the correct details from the medicines container. The Croft DS0000071286.V359682.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23. People who use 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 can say what they think about the home and their complaints are taken seriously. They are protected from harm as far as possible. EVIDENCE: The home has an existing complaints procedure but the new company has not yet provided an up-to-date version with details of who to contact above the manager. Records are kept of complaints and how the home has responded to them. These show that residents feel free to complain and their complaints are taken seriously. The only small failing was that a complaint raised during a residents meeting had not been recorded as a complaint. However the action taken in response had been recorded. All of the staff apart from three new staff have had training in the protection of vulnerable adults and will have refresher training this year. Sometimes, the needs and personalities of residents mean they come into conflict with each other. On these occasions the home has informed their care managers and the situation has been reviewed with them, to make sure that everyone is satisfied all residents are protected. The inspector advised that the manager should also discuss with the local team manager for social services, who is responsible for safeguarding vulnerable adults, when it is appropriate to refer these cases under the safeguarding adults procedures. The manager has done this within a week of the inspection and agreed to refer any incidents. Proper records are kept of any money handled for residents and residents sign when they have received their money. Staff do not start work before the The Croft DS0000071286.V359682.R01.S.doc Version 5.2 Page 19 home has received a Criminal Records Bureau/Protection of Vulnerable Adults list check, to make sure that only suitable people are employed. The Croft DS0000071286.V359682.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24 and 30. People who use 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 provides a comfortable and clean place to live, which meets peoples needs. EVIDENCE: The home has all single rooms which people have been able to decorate and furnish as they want to. One area has been turned into a self-contained flat for a married couple which provides them with a living room, kitchen, bedroom and bathroom, and independence and privacy. There are a number of separate lounges which means that people can choose who they want to sit with, and whether they want to be in a smoking or nonsmoking lounge. Residents can use the laundry and a separate kitchen has been provided for residents who want to prepare their own meals. There are enough toilets and bathrooms around the building and adaptations have been made downstairs to meet the needs of older residents. The Croft DS0000071286.V359682.R01.S.doc Version 5.2 Page 21 The new owners have carried out a full audit of the building to see what needs to be done to maintain it and to keep it a pleasant place to live. Corridors have been redecorated and lounges were going to be decorated soon. In the past, some residents have said that the building gets too cold at night-since this time the manager has found that some residents adjust the heating in communal areas themselves, so staff now check, four times a day, that radiators are on. There is a cleaner on duty in the home from 8 a.m. to 5:15 p.m. each day. In the surveys, most residents said that the home was kept clean. During the random inspection in October, the inspector found there was a problem with smoke from the smoking lounge, drifting into the non-smoking lounge/dining room through the doors which were left open. There is an extractor fan in the dining room but another extractor was fitted in the smoking lounge shortly after the inspection which should help this situation. The manager also intends to discuss with the owners changing the door between the two rooms so that it closes automatically. This should help solve the problem. The Croft DS0000071286.V359682.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 33, 34 and 35. People who use 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. Staff have the personal qualities and qualifications to meet residents needs. There are enough staff on duty at all times. New staff are checked to make sure they will be suitable and safe to work with residents. Staff receive training so they can understand and meet the needs of residents. But they must all receive training in key areas. EVIDENCE: The National Minimum Standards recommend that at least half of care staff in each home should achieve the recognised qualification for care workers of the National Vocational Qualification in care at level 2. The Croft Unit has done better than this because all the staff apart from four, two of whom are in new employees, have level 2 or above. Residents said good things about the staff. The staff are all nice, make you feel welcome, staff care a lot about everybody, caring and kind, I am confident I can talk to them. A community psychiatric nurse felt that the staff were skilled, and followed the lead of the manager in how they related to residents. The Croft DS0000071286.V359682.R01.S.doc Version 5.2 Page 23 There are a minimum of three staff on duty through the daytime and evening, and the manager and deputy are at work in the day, Mondays to Fridays. Also, some residents have extra hours for one-to-one care and support. These can be from a few hours a week to all through the day. A cook is on duty each day from 8 a.m. to 6 p.m., and a cleaner between 8 a.m. and 5:15 p.m. each day. There is also a handyman on duty four days a week. This means that the care staffs time is not taken up with domestic work. As many of the residents do not need help with personal care, these hours seem to be enough to meet peoples needs. The records of staff who had started work recently showed that the home took up two references and carried out a Criminal Records Bureau and Protection of Vulnerable Adults List check before people were allowed to start work. These checks are important to help homes avoid employing people who would be unsuitable or unsafe to work with vulnerable adults. Not all staff have had training in food hygiene and protection of vulnerable adults but training is arranged for April this year. Other staff will receive refresher training in these areas and in infection control then. Except for newer employees, staff have received first aid training in the past but some did not have the refresher training due last year. Enough staff have up-to-date first aid certificates to provide one trained person on each shift and all the staff are to do first aid training in April this year. Some staff have received training about the particular needs of the people they care for. This has included personality disorder, communication, challenging behaviour, eating disorders, substance misuse and schizophrenia. Training about diabetes has been arranged for the newer staff. Ten staff have started external training in the safe handling of medicines. The home is registered to care for people with mental disorder but a number of its residents are ageing and/or have physical disabilities as well. The manager must look at the training staff need to help them meet these extra needs. The Croft DS0000071286.V359682.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 39 and 42. People who use 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 manager has the experience and commitment necessary for her job but illhealth has caused a long absence from work. She and the owners of the home will be discussing future arrangements for its management with CSCI. There are systems in place so that the home finds out what residents and other people think of the care provided. But the owners of the home have not been doing the monthly visits to check the home is running well as often as the Regulations say they must. In most ways, the home is a safe place to live and work. But staff must continue trying to reduce the risk of fire. The Croft DS0000071286.V359682.R01.S.doc Version 5.2 Page 25 EVIDENCE: The manager has already achieved the Registered Managers Award and was going to do the NVQ 4 in care. Together, these are the recommended qualifications for managers of care homes. However she has been absent from the home for two long periods in the last year, because of ill-health. The previous owners of the home provided support during this time and two temporary managers worked there for a few months each. Also a member of the care staff was promoted to deputy, and was effective in checking how well staff were following procedures in the home. She has also taken responsibility for improving the standards in handling medication. The manager discussed with the Inspector her intentions of resigning as manager. She will discuss further with her employers whether she can continue to work in the home in a more junior role, so that staff can benefit from her experience. The home carries out a survey each year to find out what residents, relatives and care managers think of it. The manager puts together an action plan of what needs to be done in the future, based on the replies to this survey. They also have residents meetings where people are asked their views about activities, meals etc. Residents use these meetings to ask for particular things. An example is that, two years ago, some residents wanted an extra shower upstairs and this was put in. Also, twice a year, residents are asked what foods they like and the menus are revised, based on their wishes. A senior manager in the company which runs the home is meant to visit each month and do a report on the running of the home. Only one report of his visit was available in this home. But the Inspector knows that he has been spending much more time at the home than this suggests. In most ways, the home is kept a safe place to live and work. Equipment is serviced and maintained, there are low surface temperature radiators to avoid the risk of burns and the temperature of hot water is controlled. But the record of hot water checks showed that the temperature had been too hot in a number of rooms quite often. Most people in the home can protect themselves from the risk of hot water but it still needs to be made safe for the few people who might be at risk. This was noted at the time of the last inspection. But the manager explained that a number of residents alter the thermostat themselves, when they want hotter water in their rooms. It seems reasonable to assume that someone who is capable of doing this is also capable of removing their hands from the water if it is too hot, so they are not at risk of scalding. The inspector advised her to record which bedrooms this applies to so that when the handyman checks water temperatures, he is clear whether each bedroom is one to be concerned about or not, if the water is hotter than it is meant to be. The manager has confirmed that residents cannot change the thermostats in the bathrooms used by other people, so cannot put other people at risk. The Croft DS0000071286.V359682.R01.S.doc Version 5.2 Page 26 Staff do regular checks of the fire safety system and have all had recent refresher training in fire safety. There has been a problem of residents smoking in their bedrooms. The home has tried to prevent this happening by including residents in fire safety training, so that they understand the risks, and by doing regular checks on the room of anyone who they suspect is doing this. One current resident is a particular risk and the problem has continued despite what they have tried. Staff must continue to be vigilant and do everything possible to stop him smoking in his room. When this may involve restricting his freedom, for example by confiscating cigarettes at bedtime, this must be discussed with his care manager to protect his rights. The fire safety officer has recommended that the home consider upgrading the standard of the fire doors. The fire doors are meant to delay the spread of any fire from the room where it started, so that there is time to evacuate the building. Also, one resident has reasons for wanting his bedroom door to be kept open when he is in his room. The manager must discuss with the fire officer whether they can fit a device which would allow the door to stay open, but close automatically if the fire alarm sounds. The Croft DS0000071286.V359682.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 2 4 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 3 X X 3 X The Croft DS0000071286.V359682.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes 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 YA1 Regulation 4&5 Requirement The new owners must provide a new Statement of Purpose which includes information about the company. The Service User Guide must provide a clearer information about the costs of transport for each resident. Care plans must explain clearly the care each person needs and wants and always be kept up-todate. They should include details of the best ways of responding to people, so that all the staff can benefit from the knowledge of the more experienced staff. When necessary, they must include moving and handling risk assessments and dietary needs. When staff write on the medication administration records, the medication which is to be given to each person, a second member of staff should check they have copied the information from the pharmacy label correctly. Both should sign and date this record. Records of staff training must be DS0000071286.V359682.R01.S.doc Timescale for action 30/04/08 2 YA6 15 30/04/08 3 YA20 13 31/03/08 4 The Croft YA35 18 30/04/08 Page 29 Version 5.2 5 6 YA37 YA39 8 26 7 YA42 23 kept up-to-date, so the manager can make sure all staff have received the training they need. All staff who have not already had this, must be trained in food hygiene, moving and handling, first aid and the protection of vulnerable adults. The manager must look at the training staff need to look after older and disabled residents. The owners of the home must inform CSCI of proposals for the future management of the home. A representative of the company must carry out and record the visits required under Regulation 26. Staff must continue their efforts to reduce the risk of fire caused by residents smoking in bedrooms. If a resident needs their bedroom door to be kept open, the manager must discuss with the fire officer if the home can fit a device which allows the door to stay open, but close automatically if the fire alarm sounds. 30/04/08 31/03/08 31/03/08 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 2 Refer to Standard YA20 YA42 Good Practice Recommendations The home should try and obtain a standard bound controlled drugs register to help staff record clearly the storage and administration of controlled drugs. The owners should consider following the Fire Officers advice to upgrade fire doors. The Croft DS0000071286.V359682.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 The Croft DS0000071286.V359682.R01.S.doc Version 5.2 Page 31 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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