Care Home: The Croft Village

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What the care home does well The Croft Village provides plenty of useful and accessible information for people thinking of coming to live there to help them make a decision. People are also well supported, through a planned admission process that ranges from having a look round, spending the day, staying for a meal with other people living there, an overnight stay and longer. The admission is a process led by the individual and at their own pace. The staff and manager at the Croft do individual needs assessment with people to provide a comprehensive assessment of individual needs and preferences so they know before people come to live there how a person likes to live their life. This also allows them to prepare people`s rooms with them and make sure any specialist support or equipment they may require is in place for them. 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, what they want to do for recreation and in setting their own personal goals. The manager and staff make sure there are plenty 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 use as they choose. Our expert by experience also observed and commented upon the friendly and welcoming atmosphere within the Croft Village and that the people they spoke with were happy and living full lives. When asked if there was anything people would like to tell us about the service people living there made positive comments in their surveys, Including, " I would like to say that I am really, really happy at the Croft Village and also I am happy with all the staff that are helping me. I am staying here at the Croft for good now". The service has 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 and detailed quality audits and through consultation with the people living there. This helps make sure they are meeting people`s expectations and shows if they need to improve any aspects of the service to make it better or safer for people. 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 and people living there decide on the decor in their rooms and communal areas in their homes . Attention is paid to making the houses and bungalows homely, safe and personal places for people. The management and staff are skilled at prompting people to help themselves therefore promoting their independence. What has improved since the last inspection? The Croft Village continues to monitor and assess its services and facilities and update the information it gives out to people, looking for continual improvement and development. It has a good track record in doing this and in making sure people living there help decide how the service is run for them.The staff and manager at Croft Village are continuing the process of improving their person centered care plans and individualised health and personal support plans for all the people who live there. People living there continue to be heavily involved in developing their care plans and profiles, writing them and saying what they want and making any changes. This encourages a feeling of ownership of their own information and control over daily life for people living there. The service has started using `Emotions cards` to help people in expressing their thoughts and feelings. Since the last visit to the home the manager and staff have introduced more `easy read` information sheets for people into their support plans. This is notable in medication so people can be supported to understand the medicines they take and staff can be clear why they are giving some medicines. An `easy read` Health File has been introduced to help people living there deal with other personal and health care issues. The management team also continue to maintain and try to find ways to improve quality monitoring systems through its use of surveys. Policies and procedures have been altered or updated in light of changes in good practice and this includes improving documentation for safeguarding people living there and for whistle blowing by staff on any poor practices. The home environment has been improved for people with the addition of a new laundry with industrial washing machines. Although people can still also do their own washing if they want with support from staff. A new sluice and disinfector facility has been installed in the old laundry room in Trust bungalow to improve waste handling and infection control measures in general. To further promote good hygiene hand sanitisers have been put in reception areas for visitors to use. More bedrooms have been redecorated to make sure they reflect what the people using them want and need in their personal rooms. New computers have been bought for staff use and also for the computer area in the workshops. The manager and deputy manager have done training to improve their computer skills and improve their efficiency in this area and the training and development budget has been improved overall. The management has introduced the `Skills for care` induction programme for new staff and this is monitored by senior managers. This helps make sure staff have the right knowledge when they begin working in the home. Staff handbooks and contracts are currently under review to ensure best practice and the service has introduced a programme of repeating staff security and Criminal Bureau Records (CRB) checks every 3 years. This is good practice to help ensure the welfare and best interests of people living there are promoted. Other management improvements include improving health and safety procedures and checks. The management team has also been proactive in developing contingency plans and pictorial information for possible flu epidemics. This can help people be aware of these issues and prepared without creating undue anxiety. What the care home could do better: The service has its own effective procedures in place for monitoring and improving practices and acts on areas it identifies as needing improvement or change. We have found that the management team welcome suggestions that will help them improve their service to benefit the people living there. We did not make any requirements at this inspection. Key inspection report Care homes for adults (18-65 years) Name: Address: The Croft Village 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: 1 6 1 1 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 34 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 34 Information about the care home Name of care home: Address: The Croft Village Hawcoat Lane Barrow-in-furness Cumbria LA14 4HE 01229840064 01229431645 lorraine@croftcaretrust.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: The Croft Care Trust 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 only - Code PC. To service users of the following gender: Either. Whose primary care needs on admission to the home is within the following category: 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 Village is a purpose built care home that provides accommodation and care for up to twenty-three adults with learning and/or physical disabilities. The home is owned and run by the Croft Care Trust. The village has two bungalows named Hope and Peace and two houses named Trust and Love. There is also a house, called the Lodge, that one person, who is moving towards being more more independant, can live in. The village has its own clubhouse, workshops and craft rooms, a post box and telephone box and a tuck shop that sells every day items. There are attractive landscaped gardens that are accessible to all people living or visiting there, including Care Homes for Adults (18-65 years) Page 4 of 34 Over 65 0 0 23 23 Brief description of the care home those using wheelchairs. The Croft Village is close to local bus routes, public houses, churches, shops and general amenities. The main kitchens where main meals are prepared are within the Croft Nursing Home, although the bungalows and houses all have their own kitchen areas for people to use to make their own snacks and meals with support. Fees payable at the home range from 450.00 pounds a week to 650.00 pounds a week depending on individual support needs. There are additional charges for newspapers and magazines, personal toiletries, sweets, individual hobbies and activities and holidays. The home makes information about its services available through its service user guide and statement of purpose. These and previous inspection reports are easily available in the home. Care Homes for Adults (18-65 years) Page 5 of 34 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 the Croft Village is 3 Star. This means that the people who live there and use this service experience Excellent quality outcomes. This site visit to the Croft Village forms part of a key inspection. It took place on 16.11.2009. We gathered information about the service in different ways in order to make a judgement: We sent an Annual Quality Assurance Assessment (AQAA) form to the home and this was completed by the registered manager, Wendy Coward, 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 Homes for Adults (18-65 years) Page 6 of 34 care. We sent out surveys to people living at Croft Village and to the staff who work there to get their views and experiences of the service. We also sent out surveys for people living there to give to, if they wished, their relatives, friends and advocates who come into contact with the service. We looked at all the information we have about the service, any changes they have made and how the manager has dealt with any complaints or safeguarding vulnerable adults. We looked at what the manager 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. We spent time talking to people who live there, and spent time with them during the day 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 to get their experiences of working there. We looked at any relevant information we had received from other agencies and organisations and any written comments people have made to us. We asked an Expert by Experience to visit the Croft Village with us. This is a person who because of their shared experience of using services and /or ways of communicating visits the service with us to help us get a picture of what it is like to live in or use the service. We use the information from experts by experience to help us to gather and verify information we have about the service. During the day we spent time talking with people living at Croft Village, in the work shops, communal areas and also in private in their rooms. 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 live in and what facilities are available to them. We also looked at staff training and recruitment files and a sample of records and safety assessments required by regulation. Care Homes for Adults (18-65 years) Page 7 of 34 What the care home does well: What has improved since the last inspection? The Croft Village continues to monitor and assess its services and facilities and update the information it gives out to people, looking for continual improvement and development. It has a good track record in doing this and in making sure people living there help decide how the service is run for them. Care Homes for Adults (18-65 years) Page 8 of 34 The staff and manager at Croft Village are continuing the process of improving their person centered care plans and individualised health and personal support plans for all the people who live there. People living there continue to be heavily involved in developing their care plans and profiles, writing them and saying what they want and making any changes. This encourages a feeling of ownership of their own information and control over daily life for people living there. The service has started using Emotions cards to help people in expressing their thoughts and feelings. Since the last visit to the home the manager and staff have introduced more easy read information sheets for people into their support plans. This is notable in medication so people can be supported to understand the medicines they take and staff can be clear why they are giving some medicines. An easy read Health File has been introduced to help people living there deal with other personal and health care issues. The management team also continue to maintain and try to find ways to improve quality monitoring systems through its use of surveys. Policies and procedures have been altered or updated in light of changes in good practice and this includes improving documentation for safeguarding people living there and for whistle blowing by staff on any poor practices. The home environment has been improved for people with the addition of a new laundry with industrial washing machines. Although people can still also do their own washing if they want with support from staff. A new sluice and disinfector facility has been installed in the old laundry room in Trust bungalow to improve waste handling and infection control measures in general. To further promote good hygiene hand sanitisers have been put in reception areas for visitors to use. More bedrooms have been redecorated to make sure they reflect what the people using them want and need in their personal rooms. New computers have been bought for staff use and also for the computer area in the workshops. The manager and deputy manager have done training to improve their computer skills and improve their efficiency in this area and the training and development budget has been improved overall. The management has introduced the Skills for care induction programme for new staff and this is monitored by senior managers. This helps make sure staff have the right knowledge when they begin working in the home. Staff handbooks and contracts are currently under review to ensure best practice and the service has introduced a programme of repeating staff security and Criminal Bureau Records (CRB) checks every 3 years. This is good practice to help ensure the welfare and best interests of people living there are promoted. Other management improvements include improving health and safety procedures and checks. The management team has also been proactive in developing contingency plans and pictorial information for possible flu epidemics. This can help people be aware of these issues and prepared without creating undue anxiety. What they could do better: The service has its own effective procedures in place for monitoring and improving practices and acts on areas it identifies as needing improvement or change. We have found that the management team welcome suggestions that will help them improve Care Homes for Adults (18-65 years) Page 9 of 34 their service to benefit the people living there. We did not make any requirements at this inspection. 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 34 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 34 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 and pre assessment process supports people to make an informed choice about moving into the home and be confident that the Croft Village will be able to meet their individual needs. Evidence: The Croft Village 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 is provided to all the people living there. 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 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. We could see from records and care plans that people coming to live in the home had been supported and encouraged to visit the home through a planned introduction involving making visits to events, having a look round and staying for a meal followed Care Homes for Adults (18-65 years) Page 12 of 34 Evidence: by an overnight stay. This is done at the individuals own pace so they get to know the people and surroundings. People coming into the home are also asked for their views on their admission process using a quality assurance questionnaire. This is to help make sure the admission had met with their expectations and that they had the information they wanted and that staff had answered all their, or their families, questions satisfactorily. The home has an initial settling in period for people after which 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. There was evidence on file that the manager had acted quickly to get specialist support and advice to support a person who had come to live there as they settled in and made the change to living in a new place. Based on our discussions with the management staff and through examining individual care plan files we could see that a comprehensive assessment of peoples needs and preferences is done before the person comes to live there. Information is gathered from the individual and other agencies involved in a persons care including from social services, nursing and medical professionals and any specialist support services they use. This information 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 using emotion cards to help communicate with staff what they were feeling or what was bothering them. Staff we observed, and spoke with, interacted with people in a kind yet respectful manner. Observing staff throughout the visit we could see they knew the people living there and their individual expectations well and there was a genuine warmth and friendship between staff and the people they supported and cared for. Care Homes for Adults (18-65 years) Page 13 of 34 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 Village know their assessed needs and choices are reflected in their own personal plans to help support their chosen lifestyles. Evidence: The staff and manager at Croft Village are continuing the process of developing and improving their person centered care plans for all the people who live there. We could see from looking at peoples individual records and then from talking with them that they had been heavily involved in developing their care plans and profiles, writing them and saying what they wanted and making changes. We could see that care plans were being reviewed and updated as peoples needs or expectations changed or new information became available, helping to make sure the plan was working effectively for that person. The plans set out clearly how current and anticipated specialist needs would be met and plans for managing conditions and behaviours for staff to work to. We could see from the plans and from actions being taken that where a specialist need had been identified the appropriate specialists or agencies had been contacted and the service worked with them to support the individual. Care Homes for Adults (18-65 years) Page 14 of 34 Evidence: The care team complete regular quality audits of the care plans making sure they are up to date and accurate. There is a key worker system in operation and there was also evidence of regular multi disciplinary reviews taking place, which is good practice. Peoples care plans are very much the individuals property and are working documents with frequent changes to needs and what people want being made to give an accurate picture of that person. It also includes a comprehensive manual handling risk assessment and guidance for staff when assisting people. The care records have detailed guidance for staff relating to activities schedules and peoples social plans, 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 and planning how they spend their time. We spoke with people in the workshops and in their own rooms and all the people we spoke with told us only positive things about how they chose to live their lives at Croft Village. There are good systems in place that make sure people are consulted and take an active role in all aspects of home life, organising social events, visits and days out and their annual holiday. Regular residents meetings are held in addition to regular daily informal consultation to make sure peoples 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 using their IT skills. The newsletter is produced in easy read format making it more accessible to people living in the home. A good range of risk assessments are completed as part of the care plan including specialist assessments for specific or significant risks such as behavioural and mental health. There was evidence these are kept under review and updated as required. Staff showed a good understanding of individual needs and how to communicate with people effectively and offer them reassurance and support. They were skilled at prompting people to help themselves therefore promoting their independence. Policies and procedures, complaints and health care information are also available in easy read formats that make them more accessible to people living there. People living there and their relatives comments, given via surveys, indicated a high degree of satisfaction with lifestyles and the personal support people living there receive. Comments from relatives of people living there illustrated their view on how needs and choices are supported: This service is excellent. and The Croft village do a very Care Homes for Adults (18-65 years) Page 15 of 34 Evidence: good job in the care of all the residents. There is always something going on or places to go for the residents. One person living there told us, I have always been thinking of the Croft Village as my home and it is the best home, I am happier here and I will live here for ever while I am alive. Also all the work that I have been doing in the workshop is very interesting, its good to go out such a lot and go into town by myself. Care Homes for Adults (18-65 years) Page 16 of 34 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 Village are enjoying fulfilling lifestyles that support their friendships and personal development both in the home and in the local community. Evidence: The surveys we received from people living there, what we observed and what they told us during the day indicated that they are able to make decisions about what they do each day. Detailed plans of peoples daily social, recreational and personal preferences were available and included their own views and, where they could, people had written what they liked and wanted for themselves. The expert by experience who joined us for the visit also found that people living there had opportunities for fulfilling recreation and daily lives. They found people living there to be happy and satisfied with the services and support they got. People living at the Croft Village are involved in a wide range of activities and the staff Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: and manager take a flexible approach to daily routines with some people choosing to attend a day service during the week and some people choosing to stay at home in the Village and use the workshops. There was evidence on file to show that the management team actively seek out funding avenues to make sure people have the opportunity to attend suitable day services, training or have 1 to 1 support to get the most out of life. Community activities and educational opportunities are identified in peoples plans and people supported to access them as they choose. The homes own workshops provide people with a choice of varied classes that are both recreational and can also support life skills such as cooking and dining, crafts, woodwork, gardening, road safety, swimming, using the library and sports. Within the grounds of the home there is a multi purpose building which is used regularly 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 car both with wheelchair access. These are very useful in supporting people to access wider community facilities of their choosing either in small groups or on an individual basis. Formal day trips out are planned and advertised on notice boards around the home but there are also less formal last minute trips out where people have decided to do something on the spur of the moment or because the weather is good for a day out. People have the chance to learn life skills through planning activities such as their annual holiday and one person with a particular interest was supported to organise a visit to the local Fire Station along with friends to see what goes on there. People keep records and personal books about what they have done and places they have been on visits and holidays. Several people showed us their own accounts of the things they had been involved in and the places they had been that were inportant to them. To support people in planning for holidays and to follow their interests people had their own holiday books, in written and pictorial formats, with detailed information they needed about the location they were visiting, the holiday resort and airports and traveling in general. People we talked to also told us about the local community where they lived, using the amenities of the town such as shops and cafes, line dancing groups, the local church they attended or a visit to the pub. The homes own transport provides daily trips out during the week. Organised trips are also planned to the local theatre and arts centre Care Homes for Adults (18-65 years) Page 18 of 34 Evidence: to see concerts, dance shows and musical shows on both an individual and a group basis depending upon what people want to do. We asked people living there what they thought the home did well and received positive responses, including, Its caring. The best things are the food, holidays, nights out and trips. Nice food Arranges trips and my nice room. 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 crafts that are produced during the craft sessions are sold at Seasonal Fairs throughout the year that are held in the home grounds. People working on items for the forthcoming Christmas fair were happy to show us the items they had produced or were in the process of making to sell. These seasonal fairs provide another good opportunity for people, their families and staff to get together socially as well as the regular barbeques or coffee mornings. People thinking of living in the home can also attend such days to get a taste of life there and one person who had recently come to live there had done this as an early part of their admission process. Around the communal areas in the houses and bungalows are photographic records of the events, fetes and outings people living there, their families, friends and staff have been involved in both inside and outside the home. People can attend a weekly meeting to discuss and review the previous weeks events and to exchange ideas and future projects. Our expert by experience met with people using the workshop just as this meeting was ending and they were deciding what to make in the workshop that week. Staff have received training on cultural and spiritual awareness to support people in this area of their life. We could see on record and hear from people first hand how they are supported to attend their chosen place of worship. The Village has a multi faith area in its Chapel of Friendship to allow people to express their spiritual needs if they want to. 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. We could see from care plans that the dietician had been consulted where needed and diet and weights are monitored to support good health. At the last visit from the environmental health department the catering services achieved a 5 star rating. Menus are displayed in all the houses and bungalows and one person showed us round the house where they lived and the kitchen where they could make their breakfast and light meals for themselves. People are supported to cook and make their own meals and understand about the importance of nutrition and what Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: they eat. One person offered to make us a cup of coffee whilst we were in their house and brought it for us. Care Homes for Adults (18-65 years) Page 20 of 34 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 Village are detailed to make sure that people living there 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 being developed with people during the admission process and on an ongoing basis once the person moves in to live in 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 needs and risk assessments to support staff in achieving this with them. We looked at peoples plans and could see that key workers put a lot of time and effort into supporting people to develop and review their own plans. People are able to make clear what their preferred daily routines are and communicate their needs in the best way for them. We could see that staff knew the people they supported well and their approaches were open and friendly. People we talked with were able to tell us about their key worker and the support they got from them. Care management Care Homes for Adults (18-65 years) Page 21 of 34 Evidence: records, and practice we observed, indicated that staff work with medical and health care 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 Behaviour Intervention Team to support and advise on managing any challenging behaviour. The work done by staff to create detailed personal plans with people, and the high level of consultation with people living there, allows resources to be used where particular needs and preferences are identified. This includes any equipment that people might need to promote their independence and safety. All the people living at the Croft have their own personal health facilitation book, in addition to their own support plans, which they take to all their appointments with medical and other specialist services. This included visits and consultations with their doctors, practice nurses for health checks and vaccinations, dentists, opticians, dietician and specialist care. There was up to date information on health care issues, current medications, allergies and individual needs and also what is available to support people in understanding and making decisions about their health care. Positive risk assessments are also developed with people to to try to promote and develop peoples independence and help them achieve personal goals. Comments received from relatives were positive about personal support and healthcare. One relative commented This service is excellent and provides a real home for its clients, which is its aim. 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 in a separate medication room. There were clear records of medication coming into the home, administration records and records of those medicines being disposed of. We saw evidence of good practice with any alterations to medication being checked and countersigned for accuracy and protocols in place for staff on using medicines precribed as required. This practice with as required medicines helps make sure staff only give such medicines, some of which that may have a sedating effect, when really needed. When medication had been omitted the reasons were clearly recorded on the charts. Care Homes for Adults (18-65 years) Page 22 of 34 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 Village 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 formats suited to peoples needs and abilities. The procedure is also in the service user guide and is displayed in the entrance to the main Trust bungalow where the main staff office is located. It clearly explains the complaints process and timescales involved in responding to and investigating a formal complaint. In addition people living there are given pictorial booklets on speaking out and saying what they want. These information booklets are useful for people living there to help them know about and understand how they can speak out, express what they are feeling and tell someone if they are unhappy about something or someone. There have not been any complaints logged in the last 12 months but the service does have a clear system for logging any complaints, timescales for responding in its procedures and clear formats for recording any investigation and actions needed. This includes an action planning process for the manager and detailed incident records and response systems. The survey feedback we received indicated that people living there and their families are aware of how to complain or raise a concern and that staff listened to them. Surveys from people living there we received indicated they knew Care Homes for Adults (18-65 years) Page 23 of 34 Evidence: who they could talk to if unhappy. There are regular resident meetings and satisfaction questionnaires in use to get peoples general views and for them to say what they want from life in the home. There are policies and procdures in place to safeguard vulnerable adults, these have been recently reviewed. There are whistleblowing policies and procedures to highlight any poor practice or concerns and provide independent support for staff should they need it. These have also been recently reviewed to make sure they reflect current best practice. As part of these improvements an independent source of support has also been found for people if they want and need it. Information is easily accessible in the home for people living there, in easy read formats, about what the legislation on deprivation of liberty may mean for them and also on the role and work of the Care Quality Commission (CQC) in their home. There is clear information for the manager and staff on making referrals to the Protection of Vulnerable Adults (POVA) register, if this is needed. There is also clear guidance for staff on making referrals and authorisation on deprivation of liberty, should it be needed. 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 safety and best interests of the person concerned. Training records indicate that the care staff have been given safeguarding training helping them to identify potential or actual abuse and how to report it. Staff also receive training on The Mental Capacity Act, Deprivation of Liberty and Independent Safeguarding Agencies. This and the guidance in place 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. Care Homes for Adults (18-65 years) Page 24 of 34 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 Village live in suitably adapted, clean, comfortable and pleasant environment that is arranged around the individual preferences and specific needs of the people living there. Evidence: We looked around the communal areas of the home, laundry and sluice rooms and several people took us to show us around their homes and bedrooms. We could see that improvements have been made to the physical environment of the home since the last key inspection including the refurbishment and redecoration of peoples bedrooms and communal areas in the houses and bungalows. Several people living there showed us their bedrooms and around the houses and bungalows they live in and told us how they had selected the decorations and colour schemes with help from their support staff. We could see that their bedrooms were very much their personal places reflecting their individuality, with their choice of decor and their own personal items of importance to them and pictures. Many items on display in their rooms they had made themselves in the workshops or as a result of their different interests such as paintings and model making. All the bedrooms in the houses and bungalows are single occupancy and have en suite facilities. The service now also has one separate house for use by one person and Care Homes for Adults (18-65 years) Page 25 of 34 Evidence: more suited to developing a more independent lifestyle with that person. People we spoke with were proud of their houses and bungalows and the effort they put into making them their own and they all have their own keys for their bedrooms and the front doors to their homes. Each house has its own kitchen and people told us they made their own drinks, snacks, some meals and also did baking there as well with support from staff. The main daily meals are cooked in the kitchens on site in the Croft Nursing Home, adjacent to the Village, and food is transported the short distance in heated trolleys. Our expert by experience was also shown around the home and rooms by the people living there. They also commented to us on how nicely decorated the houses and bungalows were and that bedrooms had been very personally decorated. Some people also invited him in for a drink and to have a chat about what they had been doing. The new laundry is also on site in Hope Bungalow and this was clean and tidy. 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. People living there can use the laundry if they want to wash any of their own clothes. 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 accesible to all who live there and is based on the individual needs of people living there. We could see where the environment had been altered or improved according to what would best meet a persons needs and promote independence. There are a range of bathing and mobility aids in bathrooms, toilets and bedrooms to provide appropriate equipment for peoples needs and prefreences. All the bedrooms have aid call systems in place so assistance can be summoned if needed. The grounds are easily accessible and attractively landscaped, including decorative water features, so people can use and enjoy their surroundings, especially in Summer. There is appropriate seating where people can socialise with others or be alone if they prefer. 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 been given training in infection control. A new sluice and disinfector has been fitted in the former laundry room in Trust Bungalow to promote high standards of infection control and also hand sanitisers in reception areas for visitors to use. Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: 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 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 34 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 excellent 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 Village are supported by a team of well trained staff who know them well and have gone through a robust recruitment process so peoples needs can be met and their welfare and safety promoted. Evidence: We looked at the staff rotas and these indicated that there are sufficient support staff on duty at different times of the day, in the houses and workshops, to support the people living there and meet their needs. There is a full compliment of domestic, laundry, maintenance and catering staff to keep the houses and grounds clean, tidy and well maintained and to provide the home cooked meals for people living there. The staff team is a stable one and there is very little staff turnover. As a result the care team can develop good supportive relationships with people in addition to their roles in the key worker scheme. The service does not use agency staff. We looked at staff training, induction and recruitment records. The service operates an thorough recruitment system and provides an induction period for new 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 Care Homes for Adults (18-65 years) Page 28 of 34 Evidence: 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. The comments we received from staff were positive about the working environment. Comments included, I feel the Croft Village is a very well run establishment and Management work alongside you. One staff member commented I really enjoy my job at the Croft Village. The home has a high percentage of staff with NVQ level 2 in care and the newest staff have started the course. 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. Training records we looked at indicated that training has been provided on specific conditions and behaviours, including handling physical and verbal aggression and that mandatory training was up to date. 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. We looked at staff supervision records and these indicated that staff have regular formal supervision and this looks at practice and training needs. There are also regular staff meetings so staff can raise items on the agenda for discussion and make suggestions. Care Homes for Adults (18-65 years) Page 29 of 34 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Croft Village is well run and the high levels of consultation with people means that people living there are able to contribute to the homes development. This helps ensure that the home continues to be run in the best interests of the people who live there. Evidence: From our observations and speaking to people we could see that the management approach of the home remains an open and inclusive one, which staff surveys also supported. The management team communicate a very clear sense of direction and forward planning in the home and consult regularly with people living there, the staff and support agencies. The registered manager Wendy Coward is qualified, experienced and well supported in her management role. She was attending training to update her skills and knowledge on the day of the inspection but the responsible individual was present and provided all the information, records and documents we requested. They also took the expert by experience around the home and introduced them to people living there. Our expert felt that this was done in an unobtrusive way and felt welcome in their home. Care Homes for Adults (18-65 years) Page 30 of 34 Evidence: The Croft Village has effective quality monitoring systems that are based upon its frequent consultation, through meetings, surveys and seeking the views of people who live there and come into contact with the home. There are annual reviews of all the homes policies and procedures and we could see that some have been added to or revised and updated and new procedural guidance introduced where needed. A thorough audit system is in operation annually against the mimimum standards. Audits are regularly 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 and in the Newsletter. 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 and reviews regularly. There is adequate insurance cover in place and contingency planning. Management and financial systems in the home are subject to review and there are clear financial procedures and financial auditing. We checked a sample of financial records and individuals monies and all were correct and in order. 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 equipment is being checked and serviced regularly. Records are kept of all checks done on equipment, lighting, call systems and electrical testing. There are 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 31 of 34 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 32 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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