Inspection on 09/01/09 for Conifers

This inspection was carried out on 9th January 2009.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Conifers 18/01/08

Conifers 13/07/07

Conifers 18/04/06

Conifers 05/10/05

Conifers 09/06/05

Conifers 14/10/04

Conifers 11/05/04

Similar services:

Deepdene Care Centre

Ferndale Residential Care Home

David Gresham House

Elizabeth House

Elvy Court Nursing Home

Fontenay Nursing Home

Clairmont Residential Home

Cornford House

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Conifers Seal Square Selsey Chichester West Sussex PO20 0HP     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jo Hartley     Date: 0 9 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Conifers Seal Square Selsey Chichester West Sussex PO20 0HP 01243602436 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Family Care Private Company Limited Name of registered manager (if applicable) Mr Martin Pelling Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users to be accommodated is 20 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Dementia (DE) Date of last inspection Brief description of the care home Conifers is a care home providing personal care and accommodation for up to twenty service users in the category of dementia, over sixty-five years. It is owned by Family Care Private Company Limited and managed by Mr Pelling. The home is located in Selsey and is close to shops and other amenities in this seaside town. It is a detached property with accommodation on three floors with eighteen single rooms and one double room. Several rooms have sea views. There are sitting areas and a dining room. The responsible person on behalf of the company is Mr Samarasekara. The Care Homes for Older People Page 4 of 27 care home 20 Over 65 0 20 Brief description of the care home homes weekly fees range from 400 to 500 pounds depending on the level of needs of the resident. This information was obtained at the time of the inspection visit. Members of the public may wish to obtain more up-to-date information from the care home. Care Homes for Older People Page 5 of 27 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: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means the people that use this service experience adequate quality outcomes. The purpose of the inspection was to assess how well the home is doing in meeting the key National Minimum Standards and Regulations. It was carried out by Jo Hartley. The findings of this report are based on several different sources of evidence. These include: previous reports of visits to the home, the Annual Quality Assurance Assessment (AQAA) completed by the home, an unannounced visit to the home, which was carried out on the 9th January 2009 and discussions with residents and staff. During the visit we looked at the homes policies and procedures, staff records and residents records. All regulatory activity since the last inspection was reviewed and taken into account Care Homes for Older People Page 6 of 27 including notifications sent to the Commission for Social Care Inspection. The last inspection on this service was completed on the 18th January 2008. What the care home does well: What has improved since the last inspection? 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 27 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 and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. 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 them 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have a pre-admission assessment prior to moving into the home to ensure that the home can meet their needs. Conifers does not provide intermediate care therefore Standard Six does not apply. Evidence: During the visit to the home we looked at three service users files. All the files we saw included a pre-admission assessment to enable the home to ensure they can meet the needs of prospective service users. Evidence was seen that the home gathers information from various sources; depending on the circumstances this can include the prospective service user, relatives, carers, hospital and social services. During our visit the staff at the home showed round a prospective service user and also the relatives of another prospective service user. They were welcomed by the Care Homes for Older People Page 10 of 27 Evidence: staff team who showed them round the home and spent time talking to them about what the home can provide and what the needs were for the prospective service users. In the Annual Quality Assurance Assessment that the home completed prior to the visit, they told us that they work with care managers and the local dementia unit to improve the admission process. This is done through obtaining a correct diagnosis and ensuring that appropriate therapy is in place before admission. This was evidenced in the care planning of a person who will soon be moving into the home. Care Homes for Older People Page 11 of 27 Health and personal care 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 health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they 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. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are treated with dignity and respect by the staff. Care plans have been updated but the personal care needs of people who use the service still need to be detailed more thoroughly to ensure that individuals personal preferences and choices are respected. Daily records need to be more detailed and risk assessments need to be put in place for residents who have pressure areas. The home has good procedures for managing medication. Evidence: Following the previous inspection a requirement was made that care plans must be based on full assessments of individual needs, and include specific guidance for staff giving personal care. Another requirement was made that care plans must include risk assessments and management strategies to address aggressive behaviour and the risk of falls. Care Homes for Older People Page 12 of 27 Evidence: We looked at three care plans and found that the acting manager has implemented new care plans that are based on full assessments. However, care plans still lack detailed information about individual preferences in receiving care, for example whether the person prefers baths or showers, what time of day they like to receive their personal care, what time they prefer to get up and go to bed etc. A new requirement has now been made for this to be addressed. All the care plans we looked at now include risk assessments for falls. There are currently no residents living at the home that display aggressive behaviour so no risk assessments are needed for this at present. This requirement has now been met. The records we saw in the home show that people who use the service have access to health and social care professionals such as doctors, district nurses, chiropodist, psychiatrists and social workers. Health care appointments are recorded, however it was noted that on some occasions these just include very basic details. For example for two service users it was recorded that district nurses had visited to change dressings but there were no details about the wound, what dressings were used or how the treatment was progressing. A requirement has been made that the home undertakes risk assessments for people with pressure areas and record treatment in more detail. There was also a lack of detail in the daily record recordings. For example, the recording for some residents were X spent the day well or X slept well no problems, personal care given. When this was discussed with the acting manager she said that she was aware of this. She showed us that she had written a message in the communication book to all staff reminding them that they need to record in more detail. We also looked at the homes medication procedures. The medication administration records include a photograph of each individual. A sample of these records showed that staff members had signed the record each time a medication had been administered. Training records held in the home show that staff who administer medication have received training to do this. We saw that medication is stored securely and there is a safe for the storage of any controlled drugs. We saw that the administration of controlled drugs is being accurately recorded in a separate register. Incoming medications are checked in against the details on the prescription and medication records and signed for by the manager. The disposal of any unused medication is recorded with the pharmacists signature. Care Homes for Older People Page 13 of 27 Evidence: Throughout the visit we witnessed staff treating residents with dignity and respect. One resident has been assessed as being able to manage a key for his room and is therefore able to lock his door when he is not in his room. Care Homes for Older People Page 14 of 27 Daily life and social activities 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 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. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. 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 who use the service benefit from an activity programme in the home. Visitors are made welcome. The meals offered are varied and nutritious and promote individual choice. Evidence: Conifers provides an activity programme for residents that includes films, parties for birthdays and festive occasions, sing-alongs, musical shows, musicians, crafts, going out for walks, trips out in the car and shopping. Each resident has an activity assessment in their file and a record of which activities they take part in that records the concentration, response and enjoyment of the activity by the individual service user. Care plans show the individual preferences for some areas of peoples lives, however, as referred to earlier in the report, they need to be more detailed to maximise residents capacity to exercise autonomy and choice in their lives. The cook at Conifers told us that she has been working through the menus with the acting manager to ensure that residents receive well balanced, nutritious meals. Care Homes for Older People Page 15 of 27 Evidence: Residents are able to choose an alternative meal if they dont like what is on the menu. Staff monitor residents who are unable to communicate verbally during mealtimes and if someone is not interested in their meal they are offered something else. A list is kept in the kitchen of individuals likes and dislikes that has been collated from information provided by the residents, their families and from the staff monitoring what residents eat/dont eat if they are unable to communicate this verbally. During the visit a resident asked if they could have a fruit salad for their pudding and this was provided for them. The home keeps a food intake chart for each resident so they can monitor nutrition. On the day of the visit the main meal was fishcakes, chips and mushy peas. There is a cooked pudding every day or residents are able to have fresh fruit instead. The supper menu includes meals such as sandwiches, scrambles eggs, pasties, pizzas, kippers, soup. When a resident has a birthday the Cook makes a birthday cake and they usually have a party. For residents who need pureed food, each item is pureed separately so that the individual tastes are preserved. During a visit several visitors came to see their relatives. One husband of a resident said he comes most days at lunch time and eats with his wife and assists her with her feeding. We looked at the visitors book and it showed that visitors are welcomed at all reasonable times. Care Homes for Older People Page 16 of 27 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. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has suitable procedures for dealing with concerns and people who use the service are protected by the homes policies, procedures and staff training. Evidence: The home has a complaints policy and procedure, which is displayed in the home and is also contained in the Service Users Guide. The home keeps a record of any complaints made and the outcomes of the homes investigation into these. The level of detail that is recorded has improved since the last inspection. Staff confirmed they have received training in safeguarding issues and showed that they were aware of the homes policies and procedures. The home has an up-to-date copy of the local authority safeguarding procedures. Care Homes for Older People Page 17 of 27 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, 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. 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 who live and work in the home are protected by the homes health and safety policies and procedures. The home is clean and pleasant and is continuously being updated and improved. Evidence: A tour of the premises showed us that there have been several improvements made since the last inspection. The dining room carpet has been replaced as has the flooring in several bedrooms. There has been a new chair lift fitted between bedrooms on the first floor to the ground floor that are not served by the lift. A new fence has been erected in the garden to improve privacy and security. Hand gel dispensers are located throughout the home. All radiators are covered and upstairs windows have restrictors for safety. Residents bedrooms are personalised with their own belongings. The home was found to be odour free and clean and tidy throughout. The acting manager has completed a thorough environmental audit and logged all work that needs to be done in the maintenance book. Evidence was seen that this is being completed by the maintenance man employed by the home. All equipment such Care Homes for Older People Page 18 of 27 Evidence: as hoists, lift, fire alarm systems and gas and electrical services are serviced regularly. Health and safety risk assessments for the environment are in place to promote safety for residents and staff. Previous reports have identified that there remains an issue with the position of the laundry, but a procedure is in place that staff use a side door rather than bringing soiled laundry through the kitchen, so that the risk of infection is minimised. There are plans for an extensive refurbishment of the property, which when complete will address this issue. Care Homes for Older People Page 19 of 27 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 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. 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. The home employs staff in sufficient numbers and provides them with training to meet the needs of people who use the service. People who live in the home are protected by the homes staff recruitment procedures. Evidence: The level of staffing at the home is good enough for the staff to meet the care needs of the residents and spend some time chatting, taking them out and doing activities in the home. The home has a thorough induction and staff training programme in place. In response to advice given at the last inspection the Skills for Care induction training for new staff has been introduced. Core training includes Adult Protection, Fire Safety, First Aid, Protection of Vulnerable Adults, Health and Safety, Medication Administration, Dementia Care and Food Hygiene. The home has over fifty per cent of staff with a National Vocational Qualification in Care at Level Two or above. The acting manager has recently undertaken a training audit to ensure that all staff have received the training they need. Care Homes for Older People Page 20 of 27 Evidence: We looked at the recruitment records for three members of staff and found them to include all the required documentation including Criminal Records Bureau Checks, two written reference and application forms. Care Homes for Older People Page 21 of 27 Management and administration 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 led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate 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. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. 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. Although the registered manager is on long term sick leave the home is being well managed by the acting manager. The health, safety and welfare of residents and staff are promoted and protected. Evidence: The registered manager is currently on long term sick leave. The provider has appointed an acting manager who will apply for registration if the registered manager is unable to return. The acting manager has an National Vocational Qualification in Care Level Four. The home has a Quality Assurance system in place that seeks the views of residents, visitors, staff and other stakeholders. The outcomes from the last Quality Assurance audit have been collated and points for action have been identified and carried out. The home does not deal with the financial affairs of those who use the service; this is Care Homes for Older People Page 22 of 27 Evidence: left to the family or advocates of individuals. The home has robust health and safety procedures in place. Any accidents and incidents are recorded thoroughly. Checks on equipment and services such as hoists, lifts, gas, electricity and fire systems were seen to be up to date. Care Homes for Older People Page 23 of 27 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 Older People Page 24 of 27 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 1 7 12 In respect of regulation 12 (1) (a) (b), (2), (3) the registered person needs to ensure that service users preferences and choices regarding their care are recorded in their care plans. To ensure that service users receive their care in the way they prefer. 14/03/2009 2 8 12 In respect of Regulation 12 14/02/2009 (1) (a) (b) the registered person must ensure that the incidence of pressure sores, their treatment and outcome, are recorded in the service users individual plan of care and reviewed on a continuing basis. To promote the health and welfare of service users. 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 Care Homes for Older People Page 25 of 27 improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 26 of 27 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - 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!