Care Home: The Croft Rest Home

Similar services:

• Chirnside House
• Keer Sands Residential Home
• Ruskin Lodge
• Bushell House
• Langrigg House
• Parkside
• Dystlegh Grange
• Thornton Lodge

What has improved since the last inspection? To provide clear assurances when the home is able to meet peoples` needs, prospective residents were being informed in writing following their initial assessment. Some progress had been made with the resident`s individual care plans, more details had been included, so staff had a better understanding of what to do for each person. One staff said, "Care plans are useful, for telling us about peoples needs they tell us what their needs are" To make sure people are properly and safely supported with their medication, some progress had been made with medication practices including storage and written guidelines. To make sure managers and staff do the right thing to protect people living at The Croft, some guidelines had been changed to provide better guidance. To make sure the home is being properly run; a manager had applied for registration to take legal responsibility for running home. For the benefit of residents and staff, the owner had been making regular visits to the home and reporting on the findings. To improve the living environment for the residents, some parts of the home had been decorated and new carpets fitted. To show improvements in the home are ongoing, some plans had been made indicating what is to be upgraded and when.The Croft Rest HomeDS0000009432.V375311.R01.S.docVersion 5.2Page 8 What the care home could do better: To help provide a safe environment, all areas, inside and out needed to be given careful consideration and plans made and action taken, to reduce risks to residents. Some recruitment practices needed improving to better protect the residents living at The Croft. The resident`s individual care plans though better, needed to include full details of all their needs and how they are to be met, to ensure staff know exactly what to do for each person. To make sure people are properly and safely supported with their medication, some medication practices and records needed attention. To provide more scope for choice, further meal options should be routinely offered at lunchtime. To help improve people`s satisfaction of the food, catering arrangements should be reviewed and discussed with the residents. To make sure people are properly and safely supported, staffing levels should be continually reviewed and adjusted as necessary. To make sure the home provides a pleasant environment, improvements to the accommodation needed to continue. Key inspection report CARE HOMES FOR OLDER PEOPLE The Croft Rest Home 84 King Street Whalley Lancashire BB7 9SN Lead Inspector Mr Jeff Pearson Key Unannounced Inspection 29th April 2009 09:15 DS0000009432.V375311.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. 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 older people 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. The Croft Rest Home DS0000009432.V375311.R01.S.doc Version 5.2 Page 2 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 The Croft Rest Home DS0000009432.V375311.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Croft Rest Home Address 84 King Street Whalley Lancashire BB7 9SN 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) 01254 822821 01254 822608 tattyc@hotmail.co.uk Lancashire Nursing and Residential Homes Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (26) of places The Croft Rest Home DS0000009432.V375311.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only - Code PC To Service Users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old Age, not falling within any other category - Code OP The maximum number of Service Users who can be accommodated is: 26 Date of last inspection 28th May 2008 Brief Description of the Service: The Croft is a detached property set within its own, well-maintained grounds. The home is within easy reach of the main street and facilities of Whalley, including shops, churches, post office, health centre and public houses. The Croft is registered to offer accommodation and personal care to 26 older people. Accommodation is provided in 26 single bedrooms, some with en suite facilities, over two floors. There are lounges on both floors, with a dining room on the ground floor. Smoking for residents is permitted in one lounge area. There is a small lift to provide access to the 1st floor; however, this is not suitable for wheelchair users. A stair lift has been installed. There are various adaptations to assist the residents with self- help and mobility. The garden has seating areas for residents and car parking spaces available. Staff are available to provide assistance with personal care and support 24 hours a day. The home had available a Statement of Purpose and Service User Guide providing information about the care and services available. This information should help people make an informed choice about moving into The Croft. At the time of this inspection visit, the range of fees charged were between The Croft Rest Home DS0000009432.V375311.R01.S.doc Version 5.2 Page 5 £360.00 and £443.00 per week, there were additional charges for hairdressing, toiletries and newspapers. The Croft Rest Home DS0000009432.V375311.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means people using this service experience good quality outcomes. A key unannounced inspection, which included a visit to the service, was conducted at The Croft on the 29th April 2009. The visit took almost 9 hours and was carried out by one inspector. The people living at the home, their relatives and staff were invited to complete surveys, to tell the Commission what they think about the care service provided at The Croft. Some were received at the Commission and results included within this report. Before the site visit, the acting manager was required to complete and returned to the Commission an Annual Quality Assurance Assessment (AQAA). This was to enable the service to show how they were performing and provided details about arrangements, practices and procedures at the home. The files/records of three people were examined as part of ‘case tracking’, this being a method of focusing upon a representative group of people living in the own home. We spoke with people living at the home; the acting manager, administrator, staff and a relative. Various documents, including policies, procedures and records were looked at. Most parts of the home and some outside areas were viewed. What the service does well: The home was being run by a team of staff, who were keen to provide a good service for the residents. One visitor said, “The staff are brilliant, very nice, can’t fault the home” Before people decided to move into The Croft, they were being encouraged to visit, to see the home and meet the residents and staff. People were getting attention for health care needs and personal privacy needs were being dealt with sensitively, they were being treated with respect and as individuals. The Croft Rest Home DS0000009432.V375311.R01.S.doc Version 5.2 Page 7 Most people were happy with the arrangements for activities and daily routines were flexible. One staff member explained, “Every afternoon we do some kind of activity, maybe just sitting chatting or listening to music” Positive comments were made about the staff team, one resident said, “The staff are superb all the lot of them, they treat you with respect and are fun as well” To help make sure staff provide effective care, good arrangements were in place for ongoing training and development. What has improved since the last inspection? To provide clear assurances when the home is able to meet peoples’ needs, prospective residents were being informed in writing following their initial assessment. Some progress had been made with the resident’s individual care plans, more details had been included, so staff had a better understanding of what to do for each person. One staff said, “Care plans are useful, for telling us about peoples needs they tell us what their needs are” To make sure people are properly and safely supported with their medication, some progress had been made with medication practices including storage and written guidelines. To make sure managers and staff do the right thing to protect people living at The Croft, some guidelines had been changed to provide better guidance. To make sure the home is being properly run; a manager had applied for registration to take legal responsibility for running home. For the benefit of residents and staff, the owner had been making regular visits to the home and reporting on the findings. To improve the living environment for the residents, some parts of the home had been decorated and new carpets fitted. To show improvements in the home are ongoing, some plans had been made indicating what is to be upgraded and when. The Croft Rest Home DS0000009432.V375311.R01.S.doc Version 5.2 Page 8 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. The Croft Rest Home DS0000009432.V375311.R01.S.doc Version 5.2 Page 9 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 The Croft Rest Home DS0000009432.V375311.R01.S.doc Version 5.2 Page 10 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The admission process helped ensure peoples’ needs and wishes, were considered and planned for before they moved into the home. EVIDENCE: Information about he home, including the previous inspection reports were on display in the entrance hallway, copies were available on request from the home’s office. The AQAA (Annual Quality Assurance Assessment) completed by the acting manager and administrator, showed that further details had been added to the homes’ brochure and they were planning to keep all their information, “Fresh and up to date”. All residents completing surveys, The Croft Rest Home DS0000009432.V375311.R01.S.doc Version 5.2 Page 11 indicated they had received enough information about the home prior to moving into The Croft, some had been supported by their relatives, comments made were, “My son told me all about living here” and “I live in Whalley and I have known The Croft for many years” The acting manager explained the homes admission process; this involved gathering information from various sources such as Social Services, but mainly from the prospective resident and their families, who would be visited in the own homes if possible. People are encouraged to look around the home first to meet other residents and staff and “get a feel for the place”. The acting manager said, “We explain the services available and give them a brochure and service user guide” The records seen showed initial assessments had been completed; briefly taking into consideration peoples individual needs abilities and wishes in matters such as, diet, allergies, medical history, physical well being, sleeping, personal hygiene, family involvement and mobility. The acting manager said, any assessment information from Social Services, was always included within the first care plan. The acting manager and administrator confirmed a letter had now been devised, to inform prospective service users of the outcome of their assessment. At the time of this inspection The Croft did not provide intermediate care. The Croft Rest Home DS0000009432.V375311.R01.S.doc Version 5.2 Page 12 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Most health and personal care practices and procedures were effective in ensuring people’s individual needs are sensitively met. EVIDENCE: Residents spoken with were satisfied with care and attention they received at The Croft. This response was also reflected within surveys completed by residents, which indicated they always or usually, get the care and support they need. One person wrote, “It’s the best care and support I have ever had” Care plans were looked at as part of ‘case tracking.’ It was apparent some progress had been made with the care planning systems. Records showed some further details were being included, for example, relatives had been asked to contribute to peoples’ personal history as appropriate, one resident The Croft Rest Home DS0000009432.V375311.R01.S.doc Version 5.2 Page 13 spoken with remembered signing in agreement with the plan. But, the plans seen were still lacking in specific details to provide good person centred care. This matter was discussed at length with the acting manager, who agreed to take action to ensure better details were kept to promote communication and continuity of person centred care. Records showed that peoples care needs were being monitored and reviewed, however, some plans were not being reviewed each month. Health care needs were included within care plans; additional assessments had been completed in relation to pressure areas, moving and handling, risk of falls and nutrition. Records and discussion showed people were getting attention from healthcare professionals such as GPs, District Nurses and Chiropodists. Most residents completing surveys indicated they always receive the medical support needed. One relative spoken with said they were happy with the healthcare provided at the home and said, “When mum was poorly they called us straight away” Progress had been made with medication practices; policies and procedures had been updated, improvements had been made with storage and security and considering peoples’ ability to manage their own medication. Arrangements were being made for senior staff to receive further training. Although there were some individual instructions for ‘when required’ and ‘variable dose’ medication, it was noted one person did not have such information, which meant directions for administering were not clear. Records did not always show the number of a ‘variable dose’ item administered, or an audit trail of the unused medication; therefore this did not protect the residents or staff. There were further discrepancies needing attention, such as variances to information supplied on labels and recording sheets, the acting manager agreed to take action in respect of these matters. The acting manager said medication, was being checked daily, however, it was advised this process be given further attention. The AQAA (Annual Quality Assurance Assessment) completed by the acting manager and administrator, showed medication training to be an area for improvement in the next 12 months. The residents spoken with did not express any concerns about how they were treated. Observations of care practices during the inspection showed peoples’ privacy needs were being respected; staff spoke with residents in a courteous manner. People were being supported to maintain their appearance, one resident said, “They do things how I want, they treat me well”. A summary of care values, including promoting dignity and privacy had been included in care plans for staff guidance. The Croft Rest Home DS0000009432.V375311.R01.S.doc Version 5.2 Page 14 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at The Croft had some opportunities to make choices and had lifestyles that generally matched their expectations. EVIDENCE: The residents spoken with indicated they were generally happy living at the home, comments made were, “I was doubtful at first, but am very pleased with it now” and “It’s alright, its what you would expect”. Routines seemed flexible, it was apparent people could spend time in their rooms whenever they wished, “There are no restrictions on what you can do” said one person. Staff and residents spoken with said activities were offered each afternoon, some people preferred not to join in and their wishes were respected. The activities on offer included, dominoes, reminiscence, arts and crafts, sing-a-longs and seasonal events. During the afternoon of the inspection visit, very positive interactions were observed during a reminiscence discussion. The Croft Rest Home DS0000009432.V375311.R01.S.doc Version 5.2 Page 15 People were pursuing their own interests and hobbies, such as reading, word puzzles and going out with friends. Some informal group and one to one discussions had been held, however, it was again suggested regular residents meetings be held. Social and spiritual care needed to be better reflected in the care planning process, to make sure all needs are more effectively responded to. The homes’ visiting arrangements were included in the homes’ guide; the residents spoken with mentioned the contact they were having with families and friends. One relative explained, “Visiting is anytime”. Efforts were being made to enable people to go into the village and garden furniture had been provided. The day’s lunch and tea menu was displayed in the dining room, choices were routinely offered at breakfast and teatime. Mealtimes were flexible, breakfast being available from 7:30 onwards and there were two sittings at lunchtime in response to a residents’ suggestion. The dining room provided a pleasant environment for people to meet and eat; new crockery had been provided, meals could also be served in bedrooms. Records were kept of personal preferences, likes and dislikes. There was a mixed response from the residents spoken with about the meals provided at The Croft, comments made were, “The food is not so bad” - “The food used to be good” – “It’s okay – “The food is good, but we are not always able to choose”. Some people indicated in surveys that they “usually” liked the meals provided. Records were no longer being kept of actual meals served; such records provide information about people’s dietary intake and assist with menu planning and communication. The acting manager agreed to ensure appropriate records were kept. There was no designated cook on duty at teatimes, with other staff sharing responsibility for some catering tasks. This raised questions about hygiene practices and the availability of sufficient staff to provide for the residents needs, particularly at weekends. The acting manager agreed to pursue this matter to ensure additional support is available. The Croft Rest Home DS0000009432.V375311.R01.S.doc Version 5.2 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Most policies, procedures and practices supported the complaints process and provided safeguards for people living at The Croft. EVIDENCE: The residents completing surveys indicated they were aware of how to make a complaint, none of those spoken with expressed any concerns about the care and practices at the home. The complaints procedure included suitable information; it was displayed in the home, included in the homes guide and contracts of residence. All staff completing surveys indicated they were aware of how to respond to concerns made by residents and others. The management and nature of 3 recent complaints made were briefly discussed with the acting and office managers. The AQAA (Annual Quality Assurance Assessment) identified the complaints policies as in need of review, to ensure matters are more effectively dealt with. Advice was offered in relation to the management of complaints. In particular, remaining impartial, devising investigation strategies and ensuring systems make proper provision for the recording of interviews, discussions and all action taken to effectively manage complaints. The acting manager and office manager had both signed up to complete NVQ (National Vocational Qualifications) in customer services. The Croft Rest Home DS0000009432.V375311.R01.S.doc Version 5.2 Page 17 Residents’ surveys indicated they knew who to speak to if they were not happy. People spoken with said they felt safe at the home. Care plans included an assessment of each person’s vulnerability. Staff had previously received POVA (protection of vulnerable adults) training and records showed further training had been arranged for all staff. The acting manager and staff spoken with expressed a good understanding of the action to be taken to protect people at the home. Protection form abuse polices and procedures were seen to have been update to provide more appropriate information and guidance. The staff ‘reporting bad practice’ procedure was seen; action was taken following the inspection visit to ensure this included the appropriate contact details of the Commission and Social Services. The Croft Rest Home DS0000009432.V375311.R01.S.doc Version 5.2 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Croft provided people with a comfortable and clean place to live; improvements were ongoing and needed to continue for the benefit and well being of the residents. EVIDENCE: The residents spoken with were satisfied with the accommodation provided at The Croft, they had been enabled to personalise their bedrooms with their own belongings, which helped create a sense of home and ownership. The Croft Rest Home DS0000009432.V375311.R01.S.doc Version 5.2 Page 19 The communal lounges and dining area were pleasantly decorated and provided comfortable and homely surroundings. Since the last inspection several areas of the home hade been improved. Some bedrooms and corridors had been decorated, some new carpets fitted. The home employs a full time handy person for ongoing repairs and refurbishment. Records were available to show areas for improvement and planned timescales, such as new vanity sink units in all bedrooms. It was apparent work was ongoing to upgrade the home to a good standard; however, some areas were seen to be in need of attention, for example, the carpet in the dining room was slightly rippled and presented as a potential tripping hazard, the floor covering in one bathroom had several joins covered by metal strips and was cracked in places. Some bedroom doors were still being propped open during the day at the request of the occupants, which could be a risk to fire safety. These matters were discussed with the acting manager, who agreed to ensure action was taken to address them. The home was found to be clean and free from offensive odours. The domestic staff spoken with had an NVQ (National Vocational Qualification) in cleaning and said she had been able to put her training into practice at the home. Residents completing surveys indicated the home is always kept fresh and clean, those spoken with expressed an appreciation of the service provided, one comment was “She makes a good job of my room”. Some improvements had also been made in the laundry, new equipment had been obtained and part of the floor covering had been changed. The AQAA (Annual Quality Assurance Assessment) showed, extending the home to provide better facilities and additional places, as a plan for improvement at The Croft. It is likely this extension will require an application for variation with the Commission. The Croft Rest Home DS0000009432.V375311.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. To ensure the resident’s needs are effectively and safely met, The Croft needed to improve and show continued good practice in relation to staff recruitment, staffing levels, and induction training. EVIDENCE: The staff rota indicated staffing levels were mostly satisfactory. However, it was noted that there was no cook on duty at teatimes, with designated care staff having to assist with food preparation and serving. This raised questions on providing safe and effective support for the numbers and needs of the people accommodated. The manager said she would look into this matter to ensure support was provided. Some residents considered there were ‘sometimes’ and ‘usually’ enough staff available. The residents spoken with made very positive comments about the Staff at The Croft, they said, “The staff are superb, all the lot of them” - “They are very kind” –“All very pleasant, they are very nice people” - “The staff are very good they treat me well”. The Croft Rest Home DS0000009432.V375311.R01.S.doc Version 5.2 Page 21 Most surveys from residents indicated they considered there were always staff available when they were needed, but, some suggested there usually were. Staff mainly indicated there were enough staff to meet peoples’ individual needs, some responded that there usually were, one comment was, “Sometimes there are not enough staff at weekends”. As mentioned, staff rotas seen indicated suitable staffing levels were mostly in place. However, there were less care and domestic staff on duty at weekends. This was discussed with the management team who agreed to address this matter to ensure peoples’ needs are effectively and safely met. All care staff had, or were working towards NVQ (National Vocational Qualifications) in care. Three of the senior carers had NVQ level 3 and one had commenced this training. Five staff had recently signed up for an NVQ in team leading; one cook was undertaking an NVQ in catering. Training courses in safe working practices such as first aid, health and safety, moving and handling and fire safety had been completed and arranged. Staff completing surveys and those spoken with during the inspection visit, confirmed relevant training was being given. The staff recruitment records seen showed most checks had been appropriately carried out for the protection of people living at the home. However, the application form only requested a five year employment history therefore; peoples’ work backgrounds had not been fully considered and any gaps explored, as required by the regulations. One applicant had not completed the information about their general education, which meant this had not been considered either. The acting manager and office manager agreed to take action to rectify this matter. The acting manager said new staff had an induction day working alongside more experienced staff. A recognised induction training pack was available at the home. Records should some basic health and safety induction training had been carried out with the new staff, however, the previous induction training programme had not been used. This approach meant, staff were not being given consistent initial basic training on the homes policies procedures and practices. Following the inspection visit, the Commission received information to indicate a more appropriate induction programme was being introduced. The AQAA (Annual Quality Assurance Assessment) showed staff training and development was an area for ongoing development. The Croft Rest Home DS0000009432.V375311.R01.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,33 and 38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Effective leadership and good management practices need to continue, for the benefit and well being of the people living at The Croft. EVIDENCE: The Commission has had concerns in relation to effective management at the home, including the lack of progress in ensuring there is a registered manager to take legal responsibility for the day to day running of the home. At the time of the inspection visit, the acting manager had submitted an application for The Croft Rest Home DS0000009432.V375311.R01.S.doc Version 5.2 Page 23 registration which was currently being processed. Residents and staff spoken with made positive comments about the management of the home, staff considered the management team to be approachable and supportive, one resident commented, “The managers are very nice, you can ask them anything”. The acting manager had completed the Registered Managers Award and the office manager had an NVQ in business and administration. Although the inspection again highlighted some matters in need of attention, further progress had been made in the general management of the home, including meeting previously made requirements and some of the recommendations. The managers were proactive in their response to the inspection process and keen to improve the outcomes for the people living at the home. Since the last inspection, the home owner had been making regular monthly visits to the home and had kept a report on the findings; these had been forwarded to the Commission. Discussion again took place on effectively completing the AQAA (Annual Quality Assurance Assessment) for the benefit of the service; also ensuring sufficient information is included to show the home is being properly run in the best interests of the residents. The acting manager said quality assurance surveys were being given to different residents every couple of months; records were being kept to monitor this process. Relatives had also been invited to complete questionnaires. The acting manager said any issues raised were being dealt with and responded to, for example, additional garden furniture had been obtained following one relatives suggestion. It was advised responses from surveys be included as evidence within the AQAA. As indicated previously, arrangements were in place to for staff to receive training in safe working practices, various health and safety policies and information were available for staff reference. The AQAA showed the ongoing servicing and checking of equipment and installations. Fire safety risk assessments were said to have been completed and the handy person said fire drills and fire equipment checks were being carried out. Health and safety risk assessments had been carried out on a number of rooms, these needed to be completed on all areas in order to identify and minimize risk to residents and staff. The Croft Rest Home DS0000009432.V375311.R01.S.doc Version 5.2 Page 24 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 4 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X X X 2 The Croft Rest Home DS0000009432.V375311.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP29 Regulation 19 Schedule 2 Requirement Timescale for action 12/06/09 2. OP38 13 (4) For the protection of the residents, recruitment practices must always ensure applicants submit full employment histories, with any gaps being explored and appropriate records kept. To promote the welfare of the 12/06/09 residents and staff, action must be taken to identify hazards and eliminate or minimize unnecessary risks to health and safety. 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 OP7 Good Practice Recommendations Care plans should be used as a working document, be person centred and sufficient detail to provide clear guidance to staff, of all the actions to be taken, to meet the residents personal and social care needs. The Croft Rest Home DS0000009432.V375311.R01.S.doc Version 5.2 Page 26 2. 3. OP9 OP9 4. OP9 5. 6. OP12 OP15 7. 8. OP27 OP19 Systems should ensure all care plans are reviewed and updated on a monthly basis, to ensure peoples changing needs are effectively considered and responded to. A more thorough and accountable auditing system should be introduced, to ensure medication practices are safe and appropriate for the wellbeing of the residents. To make sure people are safely supported with their medication, check in systems should ensure dosage instructions on labels correspond with medication record sheets, with any discrepancies being discussed with the supplying pharmacist. To make sure people are properly supported to receive their medication, individual instructions should be written in relation to all variable dose and when required medication. Medication records should clearly indicate the number of items administered, or returned to the pharmacy. To promote opportunities for consultation and involvement, it was again suggested residents meetings could be introduced as regular activity. To cater for more effectively for individual tastes and preferences, further choices should be routinely offered at lunchtime. To help improve people’s satisfaction of the meals provided, catering arrangements should be reviewed and developed in consultation with the residents. To ensure people are effectively and safely supported, staffing levels should be continually reviewed and adjusted accordingly. To ensure the home provides a safe comfortable and pleasant environment for the residents, systems should be further developed to identify and more effectively respond to matters in need of attention. The Croft Rest Home DS0000009432.V375311.R01.S.doc Version 5.2 Page 27 Care Quality Commission Care Quality Commission Unit 1 Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. The Croft Rest Home DS0000009432.V375311.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!