Care Home: The Croft Nursing Home (Barrow)

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What the care home does well The Croft Nursing Home provides plenty of useful information and support for people thinking of coming to live there through a planned introduction ranging from having a look round to staying for a meal, an overnight stay and longer at their own pace. The home`s needs assessments provide a comprehensive assessment of individual needs and preferences about how a person likes to live their life and any specialist support they may require. Comments from the families and friends of people living there we received in surveys were very positive. One relative said, "In the case of my relative I think the service that the Croft provides is very good and in our case could do no better". People living there are very involved in the way things are done in the home and are consulted about changes and what they want in their home. They are very involved in planning how they want to be looked after and in setting their own personal goals. Each person has their own personal care record that they have in their room, developed and agreed with them or their representative. Information is made available in ways that suits a persons abilities. There are good opportunities for people to be involved in a wide range of activities in the home, in the community and educational opportunities that people are supported to access as they choose. When asked what they thought the home did well people living there made positive comments in their surveys, Including, " It does a lot of good work and it is one of the best homes". " They look after me well". "I am very happy here". There are good systems in place for recruitment and training and this helps make sure that people are supported by the right staff who understand their conditions and needs. The management team have good systems for monitoring the home`s performance with regular quality audits. This helps make sure they are meeting their stated objectives and shows if they need to improve any aspects of the service. There are effective complaints and safeguarding systems for the people living there so people can be sure that concerns and complaints will be taken seriously, investigated and action taken. The home is well staffed and is clean and tidy. Attention is paid to making it a homely, safe and personal place for people and they are involved in decisions about changes in the environment. The management in the home has an `open door` policy and suggestions and ideas are welcomed. What has improved since the last inspection? The Croft nursing home continues to monitor and assess its services and facilities, looking for continual improvement and development. It has a good track record in doing this. The quality monitoring system has been effective in highlighting areas using the annual audit that the service wants or needs to develop. Improvements have been made in systems such as the laundry and the handling of complaints. The management team learns from what it gets wrong and uses that positively putting systems into place to try to try to make sure the same problems do not occur again. The home environment has been improved with the addition of a separate dining room, relaxation room and a multi sensory light room. These provide for people both relaxing or stimulating environments that can be used on an individual or group basis. Four bedrooms have been redecorated to make sure they reflect what the people using them want in their personal rooms. Changes have also been made to the nurse`s office by enlarging it for the staff and record keeping and the managers office made larger to provide a private area for meeting. Additional storage facilities have been developed to keep clutter to a minimum and the addition of a new sluice and disinfector has improved waste handling and infection control measures. From listening to the people who live there the home has purchased a new mini bus to improve transport for outings. A small car has also been bought to enable people to have easier access to the local community, appointments and individual rather than group outings. The home continues to improve it care planning systems and has introduced very individualised easy read and pictorial care pathways that support a person`s preferred methods of communication to help them make their own choices. Information on medication and health care are now available in easy read formats so people can go through them with staff. The home continues to develop its links with other organisations in the community. This gives people more opportunities for wider community involvement. One person was able to use these links to meet up with other people locally to play pool. Improvements have been made to improve and extend the induction training staff are given when they come to work there. New staff all follow the `Skills for Care` induction programme.This helps make sure they have the right knowledge when they begin working in the home. To improve the skill mix and better meet specialised needs the home has recruited a dual registered nurse with qualifications in Learning Disability nursing as well as general nursing. In order to reduce the risk of error and maintain continuity one registered nurse now takes responsibility for all aspects of medication management. What the care home could do better: The service has effective procedures in place for monitoring and improving practices and acts on areas it identifies as needing improvement. We have found that the management team welcome suggestions that will help them improve. We did not make any requirements at this inspection but did make some good practice recommendations that the management team should give serious consideration to further as good practice issues. The home has safe and effective systems in place for medication handling. However, for additional safe practice we recommend that when staff make written changes to the medication record charts there is a system in place to verify and sign the change. This extra check can help reduce the risk of any addition or change being written down incorrectly. When administering `as required` medicines for specific needs it is good practice for those administering to have information and guidance or `protocols` for their specific use to make sure they give them to people only when needed. We asked people living there in their surveys what they thought the service could do better. One said "Nothing, I am very happy here" and another told us " I don`t think a better home could be found". Key inspection report Care homes for adults (18-65 years) Name: Address: The Croft Nursing Home (Barrow) Hawcoat Lane Barrow In Furness Cumbria LA14 4HE     The quality rating for this care home is:   three star excellent 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: Marian Whittam     Date: 0 1 0 9 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 35 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 35 Information about the care home Name of care home: Address: The Croft Nursing Home (Barrow) Hawcoat Lane Barrow In Furness Cumbria LA14 4HE 01229820090 01229431645 colette@croftcaretrust.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): The Croft Care Trust Name of registered manager (if applicable) Type of registration: Number of places registered: care home 23 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: The registered person may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD Physical disability - Code PD The maximum number of service users who can be accommodated is: 23 Date of last inspection Brief description of the care home The Croft Nursing Home is a purpose built home providing nursing and personal care for 23 people aged over 18 years, with either a physical or a learning disability. The home is run and operated by the Croft Care Trust, a registered charity. The home is in a residential area on the outskirts of the town of Barrow in Furness. The home is set back from the road in landscaped gardens and is on local bus routes and close to local amenities. The home is within the same grounds as the Croft Village Care Homes for Adults (18-65 years) Page 4 of 35 Over 65 0 0 23 23 Brief description of the care home Residential Care Home, which provides accommodation in bungalows for less dependant service users with physical and learning disabilities. Both homes share the facilities of workshops, tuck shop, clubhouse and landscaped gardens. The gardens are accessible to wheelchair users and have seating and barbeque areas for residents. All the 23 bedrooms in the home are single occupancy and over half of these have en suite facilities. The home is on two floors and there is a passenger lift for access to the first floor The home has ample communal space, a separate dining room, relaxation room and a multi sensory light room and private rooms for family meetings or social worker reviews. Fees payable at the home, which are reviewed each year in April, are currently 675.00 pounds a week. Fees vary depending on the level of assessed care and support an individual needs. There are additional charges for newspapers and magazines, personal toiletries and sweets and a charge of 35.00 pounds per day for workshop activities. The home makes information about its services available through its service user guide and statement of purpose, its newsletters and its web site. These documents and previous inspection reports are available in the home. Care Homes for Adults (18-65 years) Page 5 of 35 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: three star excellent 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: The quality rating for this service is 3 star. This means that the people who use this service experience excellent quality outcomes. This site visit to The Croft Nursing Home forms part of a key inspection. It took place 01.09.09 and we (CQC, The Care Quality Commission) were in the home for seven hours. Information about the service was gathered in different ways: 1. We sent an Annual Quality Assurance Assessment (AQAA) form to the home and this was completed and returned by the date requested. The AQAA is a self assessment and a dataset that is completed annually by all providers of registered services. It is one of the ways we gather information from the providers of services about their service and how they believe they are meeting outcomes for the people living there and using their service. The AQAA also gives us statistical information about the individual service and trends and patterns in social care. Care Homes for Adults (18-65 years) Page 6 of 35 2.We sent out surveys to people living at The Croft and to the staff who work there in order to get their views and experiences of living and working at the home. We also gave people living there surveys to give to their families and friends if they wanted to do this. 3. We looked at all the information we have about the service, any changes that have been made and how the manager has dealt with any complaints or the safeguarding vulnerable adults. 4. We looked at what the management has told us about things that happened in the service, these are called notifications and are a legal requirement. We looked at the previous key inspection and any calls or visits we have made to the home since their last inspection. 5. We spent time talking to people who live there, and spent time with them during the day and at mealtimes to see what happens during their day and see what they think about the way the home is run for them. We also spent time talking with staff who work there to get their views and experiences on working there. 6. We looked at information we had received from other people, agencies and organisations and any written comments people have made to us. During the day we spent time talking with people in the lounges and also in private. We looked at care planning documents and assessments to make sure that people received the level of care they needed and expected. We made a tour of the premises to look at the environment people lived in and what facilities were available to them. We also looked at staff training and recruitment files and a sample of records and safety assessments required by regulation. As part of this key inspection we assessed the handling of medicines through the inspection of relevant documents, storage, and meeting with the nursing staff. The last key inspection of this service was on 20th November 2006. Care Homes for Adults (18-65 years) Page 7 of 35 What the care home does well: What has improved since the last inspection? The Croft nursing home continues to monitor and assess its services and facilities, looking for continual improvement and development. It has a good track record in doing this. The quality monitoring system has been effective in highlighting areas using the annual audit that the service wants or needs to develop. Improvements have been made in systems such as the laundry and the handling of complaints. The management team learns from what it gets wrong and uses that positively putting systems into place to try to try to make sure the same problems do not occur again. The home environment has been improved with the addition of a separate dining room, relaxation room and a multi sensory light room. These provide for people both relaxing Care Homes for Adults (18-65 years) Page 8 of 35 or stimulating environments that can be used on an individual or group basis. Four bedrooms have been redecorated to make sure they reflect what the people using them want in their personal rooms. Changes have also been made to the nurses office by enlarging it for the staff and record keeping and the managers office made larger to provide a private area for meeting. Additional storage facilities have been developed to keep clutter to a minimum and the addition of a new sluice and disinfector has improved waste handling and infection control measures. From listening to the people who live there the home has purchased a new mini bus to improve transport for outings. A small car has also been bought to enable people to have easier access to the local community, appointments and individual rather than group outings. The home continues to improve it care planning systems and has introduced very individualised easy read and pictorial care pathways that support a persons preferred methods of communication to help them make their own choices. Information on medication and health care are now available in easy read formats so people can go through them with staff. The home continues to develop its links with other organisations in the community. This gives people more opportunities for wider community involvement. One person was able to use these links to meet up with other people locally to play pool. Improvements have been made to improve and extend the induction training staff are given when they come to work there. New staff all follow the Skills for Care induction programme.This helps make sure they have the right knowledge when they begin working in the home. To improve the skill mix and better meet specialised needs the home has recruited a dual registered nurse with qualifications in Learning Disability nursing as well as general nursing. In order to reduce the risk of error and maintain continuity one registered nurse now takes responsibility for all aspects of medication management. What they could do better: The service has effective procedures in place for monitoring and improving practices and acts on areas it identifies as needing improvement. We have found that the management team welcome suggestions that will help them improve. We did not make any requirements at this inspection but did make some good practice recommendations that the management team should give serious consideration to further as good practice issues. The home has safe and effective systems in place for medication handling. However, for additional safe practice we recommend that when staff make written changes to the medication record charts there is a system in place to verify and sign the change. This extra check can help reduce the risk of any addition or change being written down incorrectly. When administering as required medicines for specific needs it is good practice for those administering to have information and guidance or protocols for their specific use to make sure they give them to people only when needed. We asked people living there in their surveys what they thought the service could do better. One said Nothing, I am very happy here and another told us I dont think a better home could be found. Care Homes for Adults (18-65 years) Page 9 of 35 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 10 of 35 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 11 of 35 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The admission process ensures people are able to make an informed choice about moving in to the home and be confident that it is suitable to meet their individual needs. Evidence: The Croft Nursing home has an up to date Statement of Purpose that clearly sets out the homes objectives and philosophy of care. There is also a guide for people using the service and a copy was provided in all their rooms. The guides are in formats suited to the needs of the individual, such as easy to read and pictorial and are subject to frequent review. Previous inspection reports are also available for prospective residents and families to read. People coming to live in the home had been supported and encouraged to visit the home through a planned introduction ranging from having a look round to staying for a meal, an overnight stay and longer at their own pace. People coming into the home are asked for their views on their admission process. Satisfaction surveys had also used to help make sure the admission had met with their expectations and that they Care Homes for Adults (18-65 years) Page 12 of 35 Evidence: had the information they wanted and that staff had answered all their, or their families, questions satisfactorily. After an initial settling in period a review is held with the person and their family or advocate to help make sure they are fitting into the home environment and are happy with their life there. We could see that their had been an occasion recently when a place had not been offered to a person because, following the detailed assessment, the staff and management team did not feel they would be able to fully meet their individual needs and expectations. Based on our discussions with the management staff and through examining individual care plan files there were good examples of how people were supported to visit the home on several occasions before making a decision to move in. Staff from the home visited each person in different more familiar settings as well as arranging visits and overnight stays in the home as part of the decision making process, which is good practice and provides the individual a real opportunity to make an informed decision. The homes needs assessments have been reviewed and improved and provide a comprehensive assessment of individual needs and preferences about how a person likes to live their life and any specialist support they may require. Social work and other specialist assessments are also held on file ensuring staff have a full understanding about the person. They included detailed communication assessments that help and guide staff in understanding how individuals with sometimes very complex and challenging behaviours may make their needs known. A good example of this was one person we met who uses a pointing stick and communication card, displaying the alphabet and commonly used phrases, which they used very effectively to communicate with people they meet. Staff we met were very aware of individual idiosyncrasies around communication and dealt with people in a kind yet respectful manner. Observing staff throughout the visit there was a genuine warmth and friendship between staff and the people they support. People living in the home have a contract or terms and conditions of their residency so they or their representatives are aware of their rights and responsibilities and what is included in the fees. The senior management team told us they are going to have the contracts reviewed and legal advice taken to ensure the document reflects best practice and clarity. Care Homes for Adults (18-65 years) Page 13 of 35 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 excellent 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 know their assessed needs and choices are reflected in their own personal plans to help support their chosen lifestyles. Evidence: The home is continuing the process of developing and improving their person centered care plans for all the people who live there. Staff are receiving relevant training to guide and develop their practice and make sure the care plans reflect individual needs and promote independence and choice in peoples lives. It was evident from the files we examined that comprehensive care plans are developed during the admission process and on an ongoing basis once the person moves in to the home. Staff we met gave good examples of how care plans were reviewed and updated as needs changed or new information became available, ensuring the plan was working effectively for that person. The management team complete regular quality audits of the care plans making sure they are up to date and accurate. Staff work closely with other professionals and Care Homes for Adults (18-65 years) Page 14 of 35 Evidence: agencies making sure individual and specialist needs are being monitored and responded to appropriately. There is a key worker system in operation and there was also evidence of regular multi disciplinary reviews taking place, which is good practice. In each persons room a personal care record has been developed and agreed with the person or their representative, which describes in detail the type of support and personal care they want and need. This plan is very much the individuals property and is a working document with frequent changes to needs and what people want being made to give an accurate picture of that person. This plan is signed by staff when agreed tasks have been completed. It also includes a comprehensive manual handling risk assessment and guidance for staff when assisting people. The care record has detailed guidance for staff relating to morning, afternoon and evening routines and preferences, which helps them to provide a good continuity of care and make sure individual personal preferences are respected. Based on our survey responses, our discussions with people living and working in the home and on records and our own observations we judged that people are being consulted about how they like to live their lives and have a lot of autonomy with decision making. This is not always easy when people have very limited communication and no natural advocate. However the home have been proactive in dealing with these situations and have used the services of the IMCA (Independent Mental Capacity Advocate) to support two people with decision making. A good range of risk assessments are completed as part of the care plan including specialist assessments for specific or significant risks such as manual handling and pressure care. There was evidence these are kept under review and updated as required. Despite communication difficulties different techniques and aids and adaptations are used to maximise peoples skills and abilities. A good example was one person who is able to spell out words using an alphabet board, which is very effective and enables them to make their needs known and make decisions in their life. Another person used pictures in their own file to express what they wanted. Staff showed a good understanding of individual needs and how to communicate with people effectively. They were skilled at prompting people to help themselves therefore promoting their independence. There are good systems in place that make sure people are consulted and take an active role in all aspects of home life. Regular residents meetings are held in addition to regular 1-1 consultation to make sure people views are heard and responded to. People are involved in satisfaction surveys and a monthly newsletter is also used to share information. People living there are actively involved in producing the newsletter and the features inside. This is produced in easy read format making more accessible Care Homes for Adults (18-65 years) Page 15 of 35 Evidence: to people living in the home. Policies and procedures, complaints and health care information are also available in easy read formats that make them more accessible to people living there. This includes accessible information to support people making choices about medicines and on dealing with difficult life situations such as bereavement and loss. Relatives comments, given via surveys, indicated a high degree of satisfaction with lifestyles and support people living there receive. One such comment illustrated their view on how needs and choices are supported. My sons needs are complex but the Croft have looked into his individual needs and have asked for help from the behaviour intervention team. They strive to do their best for him, managing his care and keeping his medication to a minimum. We have no complaints, I just wish there were more homes such as the Croft elsewhere. Care Homes for Adults (18-65 years) Page 16 of 35 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 excellent 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 are enjoying fulfilling lifestyles both in the home and in the local community. Evidence: Since the last inspection the home environment has improved with the addition of a separate dining room, relaxation room and a multi sensory light room. These provide for people both relaxing or stimulating environments that can be used on an individual or group basis. These facilities provide both leisure and developmental opportunities for people and have proved very popular and beneficial. The surveys we received from people living there and what they told us indicated that they are able to make decisions about what they do each day. People living at the Croft are involved in a wide range of activities with some people choosing to attend a day service five days each week, some on a part time basis and Care Homes for Adults (18-65 years) Page 17 of 35 Evidence: some people choosing to stay at home. Other community activities and educational opportunities are identified and people supported to access them as they choose. One person wished to attend a concert to see their favourite pop group and go shopping in Manchester and they were supported to plan and achieve this goal. Currently the person is planning another such concert trip with their key worker and staff, this time with some friends as well. Within the grounds of the home there is a multi purpose building which is used effectively to provide a range of activities for people including a social club for a dance or sing along and craft activities. It has also been fitted with a large wide screen television and film nights have been held, which have been a popular addition to the activities provided. There are two vehicles people can access at any time one being a larger van the other a smaller care both with wheelchair access. These are invaluable in supporting people to access community facilities of their choosing either in small groups or on an individual basis. Formal day trips are planned and advertised on notice boards around the home as well as less formal trips out for a drive in the countryside or to the beach for an ice cream. People also enjoy walking in the local community, using the amenities of the town such as shops, local church or a visit to the pub. Organised trips are also planned to the local theatre to see concerts, dance shows and musical shows. Forthcoming events, birthdays and special celebrations are also advertised in the monthly newsletter making sure people are aware of what is going on in the home and the local community. Residents meetings are also used to evaluate how people have enjoyed different activities and trips and to get ideas for future events. Some of the events planned included a shopping evening, bingo, walking, an X factor night, a quiz and a trip to a local seaside town for a fish and chip supper. Some of the crafts that are produced during the craft sessions are sold at the Christmas or Easter fairs that are held in the home grounds. These provide another good opportunity for people, their families and staff to get together socially as well as the regular barbeques or coffee mornings. Around the communal areas are photographic records of the events and outings people living there, their families, friends and staff have been involved in both inside and outside the home. We joined a group of people for lunch which was served in the dining room. This was a relaxed social occasion with staff providing 1-1 support to people as required. This was done in a respectful manner with the staff taking their lead from the person they were supporting and offering them choice about what they ate and drank and the pace that they ate the meal. The dietitian and speech and language team have been involved in assessing the support people with particular nutritional needs will need at Care Homes for Adults (18-65 years) Page 18 of 35 Evidence: mealtimes. The food was freshly prepared and well presented and provided a nutritious meal. Individual diets are catered for and people have a good choice of food available at each mealtime. A new chiller cabinet in the dining room allows people to see a variety of desserts to chose from after their meal, as they would in a restaurant. Menus are displayed and these are changed seasonally with suggestions from people living there. The home has 2 chefs covering seven days a week, one of these is attending additional training on Nutrition in care homes at the local college to support good practice. At the last visit from the environmental health department the catering services achieved a 5 star rating. Care Homes for Adults (18-65 years) Page 19 of 35 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The personal and health care records of people living at the Croft are detailed to make sure that people receive a personalised service that meets their individual needs, goals and preferences. Evidence: It was evident from the files we examined that comprehensive care plans are developed during the admission process and on an ongoing basis once the person moves in to the home. Individual care plans are regarded as peoples own property and record their personal support needs, how they like to structure their days, how they prefer to be assisted and clear assessments to support staff in achieving this with people. Staff we met gave good examples of how care plans were reviewed and updated as needs changed or new information became available, ensuring the plan was working effectively for that person. Care pathways have been introduced in pictorial and easy read formats to promote peoples involvement in their care and assessments. Care records and practice we observed indicated that staff work with other professionals and agencies making sure individual and specialist needs are being monitored and responded to appropriately. This includes, physiotherapists, the occupational heath team to advise on aids and equipment and the local community Care Homes for Adults (18-65 years) Page 20 of 35 Evidence: learning disability team. All the people living at the Croft have their own personal health facilitation book which they take to all their appointments with medical and other specialist services. There is up to date information on health care issues available to support people in understanding and making decisions about their health care. This includes important areas like medication, contraception, diet,exercise, weight waterworks and on personal hygiene. The health care information files are all in easy read formats. There was also evidence of good contingency planning for possible flu epidemics with pictorial information on infection and what to do. People living there had been involved in this so they were aware in advance but not alarmed by it. There was also evidence in records of regular multi disciplinary reviews taking place, which is good practice. We talked with nursing staff and the management team about work they are doing to develop health facilitation frameworks. This was using a specialist nursing practitioner, already working in in the home, to improve monitoring when people use primary health care facilities. This is to make sure people get the most out of their health care appointments. Each person has their own personal care record that they have in their room, developed and agreed with the person or their representative. This describes in detail the type of support and personal care they require and want and signed by staff when agreed tasks have been completed. It also includes a comprehensive manual handling risk assessment and guidance for staff when assisting people. The home has two moving and handling trainers who are available to work with staff and people living there to identify and changes needed in how people need to be guided or moved. We examined medication policies and procedures, the storage of medicines and the recording and handling of medicines kept for people in the home. Our checks of the records and current stock showed that medicines were being given to people properly and accurate records were being made. We found the medicines stock to be well organised and securely stored. There were clear records of medication coming into the home, administration records and records of those medicines being disposed of. When medication had been omitted the reasons were clearly recorded on the charts. Some people living at the Croft have medicines that are meant to be taken occasionally for a specific need such as tablets for pain, agitation or fits. Some medicines that are important in treatment of conditions have the side effect of sedating people, for example in epilepsy. In such cases staff supporting the person should have clear instructions or protocols to guide them when the direction is to take as required to help ensure they are given only when needed. When given these medicines had been clearly recorded in individuals plans and the reasons why they had been given. We Care Homes for Adults (18-65 years) Page 21 of 35 Evidence: discussed using protocols with the management team and recommended they consider using them for as required medicines as an additional safeguard in their person centered systems. The medication administration records were generally printed by the pharmacy dispensing the monitored dosage system but alterations or new medications had been added in writing by staff. When it is necessary to do this we recommend that the staff have a system to check and verify that the details are correct. We checked how controlled drugs ( medicines that can be misused) were handled. The storage was secure and the home maintained a register for record keeping. Stock levels were correct and all entries had been witnessed. A designated member of the nursing staff takes responsibility for checking in medication and carrying out checks and audits. The registered nurse does this as supernumerary to the team so they are not disturbed or distracted during their medication checks. This is safe practice. All medication is administered to people living there by registered nurses. The focus in the home is upon promoting choice in peoples lives but it does support people, where appropriate and following their lead, with dealing with difficult life events such as aging and death and illness. The home has information in suitable formats in the health file to help inform people but also offers practical support. One person living there has planned how they want their funeral to be managed and the service they want when this time comes. Another person was supported through a bereavement and another with understanding dementia in a family member. Relatives commented positively on the care and support people living there received. One commented that I would never like my son to ever move homes. Another relative said they thought that, Each town in the country needs a Croft. Parents dread the day that they can no longer cope in the family home. To find a well run, safe and loving little community is a dream come true. Care Homes for Adults (18-65 years) Page 22 of 35 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 are protected by the complaints and safeguarding procedures that help make sure people are able to express their concerns and be listened to. Evidence: The home has clear and appropriate complaints policies and procedures in place that are available in different formats suited to peoples needs and abilities. The procedure is also in the service user guide and is available in the foyer of the home for anyone to look at. It clearly explains the complaints process and timescales involved in responding to and investigating a formal complaint. There have been two complaints logged in the last 12 months and these have been fully investigated by the service using its own procedures. Where required action plans have been developed and actions taken to prevent reoccurence. The home had also received many compliments cards and letters from friends and families of people who had stayed in the home. Survey feedback to us confirmed that people living there and their families are aware of how to complain or raise a concern and that staff listened to them. We looked at the records of the investigation records of the complaints and found these to be very detailed. Action plans to improve aspects of the service had been developed and put into practice where needed in response to the complaint. A great deal of management time had been spent on the detailed investigation of the ongoing complaint. As a result a thorough reassessment of aspects of the complaints procedures was undertaken to ensure that in the event of such a situation happening again staff had more guidance and information on dealing with it. The management team had made Care Homes for Adults (18-65 years) Page 23 of 35 Evidence: changes as a result of complaints received and had used the experience positively to learn from it. The service has made one referral to social services under safeguarding vulnerable adults procedures. This was done by the management of the home to make sure appropriate action was taken to ensure the welfare and best interests of people living there were being protected. Training records indicate that the nursing and care staff have been given safeguarding training helping them to identify potential or actual abuse and how to report it. We spoke with staff as we went around the home and they confirmed they had been given training on recognising abuse and adult protection and on handling physical and verbal aggression. Training records confirmed this and that staff have been given training on the Mental Capacity Act and Deprivation of Liberty and Independent Safeguarding Agencies. This helps make sure staff are fully up to date with legislation and best practice and have the information they need to support and enable people to live safe and fulfilling lives. We could see that the associated policies and procedures had been revised to ensure they reflect current best practice. New documentation and a checklist for staff to follow have also been introduced to make sure any concern is fully recorded, acted upon and appropriate support given. There are regular resident meetings and satisfaction questionnaires in use to get peoples views and for them to say what they want from life in the home. Surveys from people living there we received indicated they knew who they could talk to if unhappy. Relatives and friends surveys received indicated that any concerns they had raised had been dealt with to their satisfaction. One relative commented, They treat my son with dignity and humour. There are also revised procedures in place on whistle blowing to highlight poor practice or concerns and provide independent support for staff should they need it. Staff we talked with felt the responsible individual and chief executive were approachable and would support them if they had practice issues or whistle blew on colleagues or managers. Records indicated that the management has acted promptly and appropriately when issues of competence of poor practice have been raised. Care Homes for Adults (18-65 years) Page 24 of 35 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 excellent 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 live in a suitably adapted, clean, comfortable and pleasant surroundings that is arranged around the individual and specific needs of the people living there. Evidence: We made a tour of the premises and could see that many changes and improvements have been made to the physical environment of the home since the last key inspection including the redecoration of four bedrooms. The home has a maintenance programme and a general buildings audit is carried out monthly along with regular visits from the responsible individual. Effort and planning has been put into creating a homely and comfortable environment that is based on the individual needs of people living there. Bedrooms were highly personal places with people choosing their own decoration and furnishings with attention being paid to detail and personal preferences. Bedrooms are adapted to meet peoples needs as they change rather than move people when needs change. We could see where the environment had been altered or improved according to what would best meet a persons needs and promote independence. Wet rooms had been added to bedrooms to meet peoples individual needs, overhead hoists had been fitted in rooms where people needed this and one person had their toilet repositioned in their bathroom so they could continue to maintain their independence, as much as Care Homes for Adults (18-65 years) Page 25 of 35 Evidence: possible, in this aspect of personal care. There are a range of bathing and nobility aids in bathrooms, toilets and bedrooms to provide appropriate equipment for peoples needs and a passenger lift for easy access between floors. Advice had been taken from occupational therapist and physiotherapist in order to get the right equipment for people to make sure they had the right bathing and showering equipment for their needs and safety. In taking this person centered approach the service tries to fully meet the environmental needs and expectations of people living there. The overall home environment has been improved in communal areas with the addition of a separate dining room that is light and airy and opens out onto the garden for alfresco dining, when the weather allows. The home has attractive landscaped gardens that are accessible for all the people living there. Communal areas are light and uncluttered for ease of access by people living there and wooden non slip flooring make it easier for people using wheelchairs to get around and are easier to clean for good hygiene. There is a large conservatory area that leads out into the grounds and this is used all year round. There is a new relaxation room and an improved multi sensory light room. These give people both relaxing or stimulating environments that can be used on an individual or group basis. These facilities provide both leisure and developmental opportunities for people and have proved very popular and beneficial. The home has a friendship club and a club house and these are used for social events such as dances, parties and film nights. Changes have also been made to the office and storage space available. The nurses and managers offices have been improved and more general storage facilities added to keep the home free from clutter. The kitchen is sited close to the dining room and food is transported the short distance in heated trolleys. The laundry is also on site and this was clean and tidy with a laundry assistant working 5 days a week. New industrial washing machines and driers have been installed to improve the laundry capacity and changes have been made to the way laundry is organised. A new system is in use for organising peoples clothes and returning them to their bedrooms, this has been done is to reduce the possibility of someone getting the wrong laundry by mistake. The home has policies and procedures in place on infection control and information for people living there on infection and hygiene in easy read formats. Training records indicate that staff have recently been given refresher training in infection control. A new sluice and disinfector has been fitted on the ground floor and there is a colour coded system for handling waste and dirty linen designed to reduce handling and the risks of cross infection. The first floor sluice is due to be similarly upgraded. From records, observation and talking with people we could see that people living there have been involved in decisions about environmental changes and their views Care Homes for Adults (18-65 years) Page 26 of 35 Evidence: are asked for and taken into account. People living there and their relatives commented on the cleanliness of the home in their surveys and we could see that the home was fresh and clean with no lingering odours. Care Homes for Adults (18-65 years) Page 27 of 35 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. The people living at the Croft are supported by well trained staff who have gone through a robust recruitment process so their needs can be met and their welfare and safety promoted. Evidence: We looked at the staff rotas and these indicated that there are sufficient nursing and support staff on duty at different times of the day to support the people living there and meet their needs. There are a mixture of skills and experience during the shifts with a registered nurse, and senior carer on each day shift. There is a registered nurse on duty on all shifts and sometimes two on day shifts. There are additional staff during the busy morning period when some people are wanting to get up and get ready to go out to day services. The management team are presently looking at ways to further improve the staff to resident ratios to give more individual support and are recruiting an additional registered nurse. Some improvements have already been made in the skill mix as one staff member has trained and qualified in body massage and aromatherapy to provide people living there with this service. A dual registered nurse RGN/RNLD now on nursing team with specialised nursing qualifications in learning disabilities to further enhance practice and act as a resource. There is a full compliment of domestic, laundry, maintenance and catering staff to keep the home clean, well maintained and provide home cooked meals. The staff team is, overall, a Care Homes for Adults (18-65 years) Page 28 of 35 Evidence: stable one and there is little staff turnover so the team can offer continuity and develop good supportive relationships with people in addition to their roles in the key worker scheme. The service does not use agency staff. The home has a high percentage of staff with NVQ level 2 in care and the newest staff have started the course. Senior carers have NVQ level 3 as well as several support staff. Records and talking to staff indicated that staff are supported, and paid, to undertake training relevant to their roles and the changing needs of people living there, as well as their mandatory training. Records indicate that training has been provided on specific conditions and behaviours, including handling physical and verbal aggression and that mandatory training was up to date. Staff we met with told us they had completed NVQs and had regular supervision and one said they were always on training for something. Some had just completed person centered care planning. There are clear annual training and development plans, making clear the training to be done, booking arrangements, when it will be and who is to attend. Staff have their own individual files and all training and records of qualifications gained are on file. The home also carries out annual staff appraisals and this looks at training needs, in addition to supervision, in line with the needs of the people living there. The service operates an effective recruitment system and provides a 12 week induction period for new staff and mentoring from more experienced staff. We looked at staff training and recruitment files and could see that appropriate security checks and references had been obtained before new staff began work there. People living in the home are able to give feedback on the new staff in their home and their views and opinions taken into account during the process. This is good practice as is the homes policy of renewing the Criminal Record Bureau (CRB) checks of all staff at a three yearly interval. This had recently been completed and provides additional safeguards for the people living there so they know that the people working with them have been subject to ongoing checks to protect their interests and well being. Records indicated that the staff had been provided with job descriptions,terms and conditions of employment and staff handbooks with health and safety and grievance procedures. Staff surveys also indicated that they had been given training appropriate to their roles and good induction training. Relatives comments made to us about the staff team were all positive. One person told us in their survey comments that they felt the staff in the home give, Total personal, emotional and physical care, given with love to all. Care Homes for Adults (18-65 years) Page 29 of 35 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. The management and administration of the Croft are based upon openness and respect. This helps ensure that the home continues to be run in the best interests of the people who live there. Evidence: At present the home does not have a registered manager in post. The Providers are in the process of recruitment to find a suitably qualified and experienced person to undertake the role and to register as manager. Arrangements have been put in place, whilst the recruitment is in process, to make sure that the smooth day to day running of the home continues. The Responsible Individual and Chief Executive, both experienced and qualified former registered managers, have taken over the responsibility in the short term and are available on call 24 hours. As a result the service is continuing to be effective in meeting its stated aims and objectives and we saw no evidence that outcomes for people living in the home had been adversely affected following the managers resignation. We discussed with the senior management team and that this could only be an interim emergency measure until a suitable manager is recruited. They had clear plans for managing the situation and we Care Homes for Adults (18-65 years) Page 30 of 35 Evidence: agreed with them the importance of being highly selective, with the recruitment of the right person for this important role being more important than simply filling the vacant post. The management approach of the home remains an open and inclusive one, which staff spoken with confirmed, and staff surveys also supported. The responsible individual and the chief executive, presently the management team, communicate a very clear sense of direction and developmental planning in the home that is open to consultation with people living there, the staff and support agencies. When making improvements and changes we could see that advice and support had been sought from planning officers, fire officers, occupational therapists, health care professionals and specialist services to help improve the service and achieve the home people living there want. The service has effective quality monitoring systems that are based upon consultation and seeking the views of people who live in, and come into contact with, the service. The service learns from what it gets wrong and we could see following a complaint that changes had been made in the ways some things were done to help make sure the same problems did not reoccur. There are annual reviews of all the policy and procedures and we could see that several had been revised and updated and new procedural guidance introduced where needed. An audit system is in operation, we saw this applied to care planning and medication systems to pick up any problems early. There are regular premises audits and satisfaction surveys are used to get the opinions of people living there, their families and representatives and also health and social care professionals coming into contact with the service. The results of the surveys and the actions taken are made available to all interested parties. We looked at records of a full annual quality assurance audit done by the chief executive to monitor the service provision against the National Minimum Standards. This showed what areas the service felt it could make improvements for the people living there. Records are kept securely and those required by regulation were up to date and accurate. People living there are made well aware that their records are their property and have access to all information on them and contribute to this with support. There is adequate insurance cover in place and contingency planning. Management and financial systems in the home are subject to review and their are clear financial procedures and financial auditing. We saw reports and financial statements and annual and 5 year financial forecasts indicating financial viability and accountability. We looked at records of safety and maintenance and these indicated that the home has appropriate fire training systems for staff and that emergency and evacuation Care Homes for Adults (18-65 years) Page 31 of 35 Evidence: equipment is being checked and serviced regularly. There was a good range of risk assessments in place that keep both people living in the home and the staff working there safe from identified hazards. There were records of appropriate testing of water temperatures and testing for Legionella and bacterial analysis to promote the safety of the people living and working there. Care Homes for Adults (18-65 years) Page 32 of 35 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 33 of 35 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 1 20 There should be systems in place to make sure that handwritten additions or alterations to medication administration record (MAR) charts are checked to help make sure the changed details are correct. For administering as required medicines for specific needs staff need to have information and guidance or protocols for their use to make sure they give them only when needed. 2 20 Care Homes for Adults (18-65 years) Page 34 of 35 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. 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