Care Home: The Croft

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What the care home does well The Croft is a very warm and comfortable environment, decorated and furnished to suit the needs of the service user group living there. The home provides a very high standard of care and the registered manager and staff are to be commended on their efforts to enable the service users to maintain their independence through social activities both within and outside the home. Staff training is given high priority to ensure staff continue to enhance their knowledge and skills in order to meet the changing needs of the service users. The well maintained garden and grounds are a great asset to the home and provide a pleasant outdoor area where service users can wander and relax. The home has a staff team that have been together for some time and are experienced and committed to providing the best possible care to those living at the home. What has improved since the last inspection? The three requirements made at the last inspection have been met, although the staff files were not actually examined. A brief discussion with the manager, who was on her day off on the day of the inspection, and information provided in the AQAA confirmed that staff files now conform to schedule 2 requirements. The home has purchased additional equipment to help meet the personal care needs of service users needing assistance. What the care home could do better: To further improve already good safeguarding practices the home should consider installing a fixed metal cabinet to store controlled drugs, even though there is a very infrequent use of controlled drugs at the home. CARE HOMES FOR OLDER PEOPLE Croft, The The Croft 20 Castlecroft Road Finchfield Wolverhampton West Midlands WV3 8BT Lead Inspector Martin George Key Unannounced Inspection 29th November 2007 09:45 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Croft, The DS0000020886.V351788.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Croft, The DS0000020886.V351788.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Croft, The Address The Croft 20 Castlecroft Road Finchfield Wolverhampton West Midlands WV3 8BT 01902 380022 F/P 01902 380022 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) Croft Residential Ltd Mrs Patricia Parkes Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Croft, The DS0000020886.V351788.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th July 2006 Brief Description of the Service: The home is situated in a residential area of Finchfield, approximately three miles from Wolverhampton city centre. Local amenities are about a quarter of a mile away. The house was originally built as a private residence in the 1890’s, converted in the 1980s, then following extensive alterations some ten years later it was registered as a residential care home for 16 older people. The home has since been improved and extended at the rear of the premises to provide additional accommodation. The home is now registered for 24 older people. The staff team are committed to improving their knowledge and skills through training. The home ensures that visiting GP’s and paramedical services meet the health needs of all service users. The fees range from £387 to £417 per week. Croft, The DS0000020886.V351788.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection was carried out by a single inspector between 09:45 and 14:45. As part of the inspection all National Minimum Standards defined by the Commission for Social Care Inspection (CSCI) as ‘key’ were inspected. Information about the performance of the home was sought and collated in a number of ways. Prior to inspection we were provided with written information and data about the home through their annual quality assurance assessment (AQAA). The views of a number of people living at the home and staff working there were also acquired, both through on site surveys and discussions during the inspection. Information was analysed prior to inspection and helped to formulate a plan for the visit and helped in determining a judgement about the quality of care the home provides. On the day of the inspection we spoke to staff and service users, as well as the registered manager and owner, and observed practice and this provided evidence in support of the records that were also checked on the day. What the service does well: What has improved since the last inspection? The three requirements made at the last inspection have been met, although the staff files were not actually examined. A brief discussion with the manager, who was on her day off on the day of the inspection, and information provided in the AQAA confirmed that staff files now conform to schedule 2 requirements. Croft, The DS0000020886.V351788.R01.S.doc Version 5.2 Page 6 The home has purchased additional equipment to help meet the personal care needs of service users needing assistance. 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. Croft, The DS0000020886.V351788.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Croft, The DS0000020886.V351788.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 and 6 Quality in this outcome area is excellent. The home works hard to ensure service users and their families are clear about what the home provides and actively seeks their views to identify areas for improvement. Service user needs are assessed and reviewed to ensure quality of care is maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Written information about the home is made available to prospective service users and their families and is reinforced by encouraging introductory visits, which both the individual and family members are welcome to take up, to assure themselves that The Croft is the right place for them. Croft, The DS0000020886.V351788.R01.S.doc Version 5.2 Page 9 We examined a number of service user files and found good quality and comprehensive multi-disciplinary pre-placement assessments for service users funded by the Local Authority. For those who are self funded the manager has completed the assessment form developed by the home. All assessments examined provided staff with information enabling them to satisfactorily meet the range of service user needs. The service user agreements/contracts have been updated to include room numbers and information about fees and what the home provides for service users is clearly detailed. Necessary signatures have been acquired. The senior on duty confirmed that the home does not provide intermediate care. Croft, The DS0000020886.V351788.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is excellent. The medication, health and personal care needs of service users are well managed by a competent and respectful team of staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We examined a number of service user files and saw evidence of comprehensive care plans, which were consistent with the initial assessment. There was also evidence of the plans being regularly reviewed to ensure service user needs continue to be met. Each service user file we examined contained a risk assessment and management sheet, which included information about the risks and management of falls. Croft, The DS0000020886.V351788.R01.S.doc Version 5.2 Page 11 Medicine Administration Records (MAR) are completed well and cross reference to daily records, providing staff with information necessary to effectively safeguard service users in this area of practice. Medication is administered by means of a monitored dosage system and senior care staff are trained in how to use it. Disposal of medicines is comprehensively recorded in a bound book and includes signatures of a member of staff and the pharmacist to whom the medicines were returned. The medication policy explains how the home works with service users who wish, and are able, to self medicate. Records evidence how the home regularly consults with external professionals, such as General Practitioners (GP’s) to ensure health and medication issues are consistent with service user needs and abilities. The medication needs of service users very rarely involves controlled drugs (CD’s) but when this is required the home stores them in a fixed, glass fronted, locked cabinet. The management of medication at the home safeguards service users from the risk of medication administration errors but we would recommend the home install a fixed and lockable metal CD cabinet, in accordance with the Misuse of Drugs (Safe Custody) Regulations 1973, to further enhance safeguarding practice. Service users can open their own mail but the home holds back some mail if it is likely to contain important information that a service user may have difficulty understanding. The home will then contact a relative as quickly as possible to determine how to proceed to best meet the interests of the service user. Surveys, observation of practice and comments made to us by service users evidenced that the home provides care in a way that is respectful and sensitive to the needs of service users. Croft, The DS0000020886.V351788.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is excellent. Service users are offered a range of activities, both within the home and in the community. Meals are varied and responsive to service user preferences, which are sought on a regular basis. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The records we checked indicate that the home encourages service users and their families to express their views about how needs and choices are met. Discussion with the senior on duty reinforced the information in the records and showed a very good understanding of the range of service user needs and preferences. Service users we spoke to were extremely complimentary about how they were treated, listened to and made to feel good about themselves. On the day of the visit several service users were having their hair done in the improvised hair salon and gained obvious benefit from this element of pampering. The only criticism they expressed in relation to this service provision was that the room used is too small. This has been regularly Croft, The DS0000020886.V351788.R01.S.doc Version 5.2 Page 13 mentioned in service user meetings and surveys and is part of the development plan to improve service provision. The home seeks to provide a variety of activity choices. There is a person who visits the home once a month to offer music and movement activities and staff regularly accompany service users on visits to places of interest and go out for pub lunches. The senior explained that uptake of activities is variable but also stated the importance of a service users right to choose. Involvement of families in the overall care of their relatives is actively encouraged and supported, maintaining important links and ensuring that past histories of service users are given the importance they deserve and inform the care they currently receive. Service users we spoke to rated the quality of food very highly and also commented positively on the choices available. Menus seen were varied and responsive to expressed service user preferences. The pleasant dining areas compliment the quality of food provided. Service users know they can have access to their records if they so wish but the senior on duty explained that very few requested to do so. Croft, The DS0000020886.V351788.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. The complaints procedure works well and safeguards service users. The practice and policies in the home are consistent with the protection of vulnerable adults. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a very good complaints procedure, which involves entering all complaints in an A5 sized, hard back book. The last two entries are dated 13/09/05 and 07/06/06. The AQAA states there have been no complaints in the past year. In February 2007 the Commission for Social Care Inspection (CSCI) was advised of a concern raised by the son of a service user about how early his father was got up in the morning. Consistent with the complaints policy this was not entered in the complaints book, as it was not submitted in writing. The manager explained to us that this matter was more a request for clarification of why the service user was asked to get up when he did, rather than an expression of unhappiness about it. The issue was resolved satisfactorily. The home may wish to consider whether it would be consistent with best practice to include all issues such as this within the complaints book, further reinforcing the already strong commitment the home has to safeguarding service users. It would also be good to see more consistency in how entries are made. One entry gave very specific details of the actual Croft, The DS0000020886.V351788.R01.S.doc Version 5.2 Page 15 complaint, action taken, timescale involved and details of the resolution. A later entry though was less detailed in terms of action taken and resolution, merely stating “dealt with and resolved amicably”. We are nonetheless satisfied that service users are being safeguarded and protected by the complaints procedure in the home. The awareness of how to protect vulnerable adults from abuse is evident through the records checked, observation of practice and discussion during the inspection. Training opportunities enhance the levels of knowledge and skill of team members, which compliments the established good practice already evident. Croft, The DS0000020886.V351788.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 25 and 26 Quality in this outcome area is excellent. Service users are provided with a very comfortable and safe living environment, conducive to their needs and responsive to their expressed preferences. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The emphasis the home places on maintaining high standards of decoration, furnishings and fittings is commendable. The same level of attention is given to the garden as well, which creates an overall environment that recognises the importance of those being cared for. Health and safety records were checked and we noted that all required monthly and annual checks have been completed. Faults with the emergency Croft, The DS0000020886.V351788.R01.S.doc Version 5.2 Page 17 lighting were identified on 28/11/07 and the records showed that this was reported immediately to the owner for action. The home continues to invest in equipment to enable the less able service users to maintain as much independence as they wish, and are able, to have. An improvement that the home is keen to complete is the installation of a shower room, which would give some of the more able service users additional personal care choice. All the bedrooms are single rooms with en-suite facilities. The standards of cleanliness are very good and records evidence the training provided to staff on issues such as food safety and hygiene, manual handling, fire safety and infection control. Croft, The DS0000020886.V351788.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, and 30 Quality in this outcome area is excellent. The owner, manager and staff team are committed to providing high levels of care for service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The AQAA identifies that the staff team includes people from all age groups other than the 18-24 age range, with a variety of experience, skills and knowledge. This gives service users a good balance of youthful exuberance, life experience and peer empathy. Staff turnover is very low, giving service users the opportunity to establish good relationships with their carers. The manager and senior on duty explained that those staff who do move on quite often apply to come back. The level of training provided to staff is good and goes beyond meeting mandatory requirements. NVQ’s have been, or are being, completed by the majority of staff. Staff who have extensive experience and are approaching retirement are not expected to complete the award. Records and observation suggest the level of care provided to service users by all staff is consistent with good safeguarding and health and safety practices. Croft, The DS0000020886.V351788.R01.S.doc Version 5.2 Page 19 Staffing levels are sufficient to meet the range of service user needs and observation on the day suggested a well organised, motivated and competent team of staff, supported by an energetic and enthusiastic manager. A brief discussion with the owner evidenced a commitment to supporting the team in continuous development of the service. Due to the manager being on a day off the staffing records could not be checked but a brief discussion with her confirmed they meet requirements and supervision is meeting National Minimum Standards. Croft, The DS0000020886.V351788.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is excellent. Service users benefit from a well managed, competent and supported team of staff. The wellbeing, safety and protection of service users are given high priority. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager has extensive experience and is well qualified for the post she holds. Discussion on the day evidenced there are clear lines of accountability and there is a good professional relationship between the manager and the owner. Croft, The DS0000020886.V351788.R01.S.doc Version 5.2 Page 21 The manager explained how she makes every effort to meet as many of the service users as she can, as often as she is able to. Records checked, surveys and discussion with some service users indicate that they are satisfied their views are listened to and taken seriously and there was a consensus that the home is run with their interests at heart. Administration procedures are good and the quality of recording is professional. The finances of service users are well managed and should they wish to manage their own finances then this is fully supported. All seniors and care staff have attended an infection control course and all staff have completed a fire prevention/awareness course. Maintenance checks are carried out regularly and records evidence that action required is acted upon. This helps provide a safe living environment for service users who are cared for by staff who have the necessary knowledge and skills to protect them from preventable harm. Croft, The DS0000020886.V351788.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x 4 4 x x 3 HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 4 4 4 x 3 x x 4 4 STAFFING Standard No Score 27 4 28 4 29 x 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 x 4 x 3 x x 4 Croft, The DS0000020886.V351788.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations To improve the already good safeguarding practices the current glass fronted, lockable CD cabinet could be replaced by a lockable metal cabinet, fixed to a solid wall with either rawl or rag bolts, consistent with the Misuse of Drugs (Safe Custody) Regulations 1973 Croft, The DS0000020886.V351788.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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. 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