Random inspection report
Care homes for older people
Name: Address: Felmingham Old Rectory Aylsham Road Felmingham North Walsham Norfolk NR28 0LD zero star poor service 03/04/2009 The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Ruth Hannent Date: 2 0 0 7 2 0 0 9 Information about the care home
Name of care home: Address: Felmingham Old Rectory Aylsham Road Felmingham North Walsham Norfolk NR28 0LD 01692405889 01692405528 felmingham@schealthcare.co.uk www.southerncrosshealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Southern Cross BC OpCo Ltd Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 41 Number of places (if applicable): Under 65 Over 65 0 41 dementia old age, not falling within any other category Conditions of registration: 41 0 The maximum number of service users who can be accommodated is: 41 The registered person may provide the following category of service only: Care Home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the Home are within the following categories: Old Age, not falling within any other category, Code OP - maximum number of places 41 Dementia Code DE, maximum number of places 41 Date of last inspection 0 3 0 4 2 0 0 9 Care Homes for Older People Page 2 of 12 Brief description of the care home Felmingham Old Rectory is situated in the village of Felmingham, approximately 2 miles from North Walsham on the Aylsham Road. The building has two extensions and is registered as a care home to provide accommodation for older people with dementia. There are 31 single and 5 shared bedrooms, many with en-suite facilities. The home is situated within two acres of landscaped gardens, including an enclosed area. There is parking space to the front of the premises. The home provides information about the services it provides and a copy of the most recent inspection report in the entrance foyer. Felmingham Old Rectory is one of several homes in Norfolk owned by the proprietors. The range of weekly fees for the home is £402 to £651 according to need. Care Homes for Older People Page 3 of 12 What we found:
This was a random inspection to look at the requirements set at the April key inspection and to see if the home had complied, within the timescale, the requirements made. The Registered Manager has resigned and a new person has been placed in the management position just two weeks prior to this random inspection. As this Manager is so new in post the Operations Manager for Felmingham Old Rectory assisted us with the up to date position the home is at with complying with the requirements. The residents care plans were looked at during this day and showed an improvement. The content was more focused on the individual persons needs and was written as if the person or the persons family/friends had contributed the information. It was still not clear how much these care plans were put into practice. On looking at some information, it is clear what the personal care support required is, but on checking the daily reports it is not evident if the tasks are carried through. On looking at some residents there appeared a number who had long dirty nails and some who had greasy, lank hair. Information from relatives prior to this inspection tells us that residents baths are not carried out as often as they should be. It was difficult to find evidence as to when the baths occur and how often. As stated in the last inspection report the care plans need to be detailed to enable staff to follow clear directions. To date it is not clear this is happening. Although this was not a requirement at the last inspection, we did look at the newly designated medication room as this had changed since the last inspection. This is an improvement with the room now having a hand wash sink which was not available previously and the room is at a much more suitable temperature. Unfortunately the staff have not been recording the temperatures of this room or the fridge temperature consistently, with no recordings for July at all. The Manager spoke to the Senior Staff member who confirmed that these recordings had not been taking place. On the day of this inspection the designated activities staff member was allocated to cooking the lunchtime meal. A newly recruited cook is to begin his employment the week following this inspection. This left the care staff to carry out activities. A balloon was used to create stimulation and certainly a number of residents were taking part and enjoying the game. Unfortunately at least 5 residents were left in the room next door with no staff member attending and who were falling asleep, slumped forward in upright chairs. There was no stimulation in this room and with all available staff in the one room, there were no staff to interact with them throughout the morning until someone happen to walk through the room. The Operations Manager had asked the staff to place a clip board in the lounge so recording of any event with any residents could be logged but this was not available for inspection and limited records of activities were seen. Around the home there had been an effort to place items such as hats on pegs so that residents could try them on. In the corner of the room games for activities had been purchased but with the Activities Organiser in the kitchen limited stimulation was seen. We spent quite a bit of time observing the mealtime process. The first residents were taken to the newly designated dining room at midday yet the meal did not start to be served for nearly 3/4 of hour. People were up and wandering, playing with items on the table or falling asleep. When the food was served 2 plates of food were shown to the
Care Homes for Older People Page 4 of 12 residents, meat pie, cabbage, cauliflower and potato or, pastie, cabbage, cauliflower and potato. This was not a choice and looked the same on the plate. No finger foods were provided and a few residents were lifting whole pies up and dropping the contents down their fronts or on the floor. There were no napkins, no spoons and a number of residents were not monitored on how much they were eating. Three residents did have staff members sat with them, who needed assistance, and these people were encouraged and most of the meal was eaten. The observation taken through this meal shows no improvement from the last key inspection visit. The home is about to have the corridor lighting changed to ensure the levels of light are appropriate. Both the Manager and Operations Manager informed us that the contractors are moving in on the Thursday after this visit. At the last inspection poor infection control was noted in the laundry. This has been improved with a procedure introduced to ensure soiled laundry is not left on the floor. Unfortunately this was not so evident when walking into a bathroom where a thin white plastic bag had been left open on the bathroom floor with dirty pads inside. On returning to the bathroom with the Manager a domestic staff member was found mopping the floor around the plastic bag with no attempt made to remove it. On the day of this visit there was 6 care staff on duty and two domestics who were able to offer the care support required for 31 residents who were in the home on the day of this inspection. As mentioned earlier in this report it is not evident that the care needs are being met as written in the care plan and it is not clear if the training on dementia care is giving the correct skills to the care staff to enable them to care appropriately for some highly dependent people. The training matrix does show a good percentage of staff have attended a Yesterday, Today and Tomorrow training but what is not clear is the evidence in practice of the learning gained. The new Manager has already started the process of measuring the quality of the service provided. Residents families are being asked to complete a questionnaire and professionals and friends involved in the home are also about to be approached for their views. The outcome of the quality surveys are to be sent to the Commission on completion. We did see some evidence of the staff supervision that has been taking place since the last inspection. The records seen were very limited in the content and need to be developed with the staff who are supervising and those who are being supervised to understand and gain value from supervision sessions. What the care home does well: What they could do better:
Care Homes for Older People Page 5 of 12 The home needs to ensure the details written in the care plans are followed through and that all residents receive the person centred care that is required. The home needs to ensure all procedures for managing medication is adhered to and that records are up to date. The staff need to understand what activities, stimulation with a sense of purpose is, to occupy residents during the day. The meal time experience should be tailored to meet the needs of the individuals. Meals should be prepared and offered with choice to suit the needs of residents and offered as they arrive at the table with the correct utensils available. In-take of food should be monitored to ensure people are getting enough, well balanced meals at timely intervals, from finger foods, soft diets to normal plated meals. Infection control practices must be adhered to as written in the Southern Cross policies and procedures. Monitoring and reinforcement of procedures should be constantly referred to. Staff must be given the training and skills to be able to offer the appropriate care to people who have dementia related illnesses. They need to understand the behaviours that may be occur and have the skills to manage these behaviours. The supervision/one to one sessions for staff would help with the monitoring of the practice to ensure staff are developing in a way that meets the service requirements. 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 2. Care Homes for Older People Page 6 of 12 Are there any outstanding requirements from the last inspection? Yes R No £ 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, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 7 15 The home must complete a 01/06/2009 full detailed care plan on how the residents needs are to be met. To ensure that the persons own needs are detailed for staff to follow clear direction. 2 12 16 The residents should have available activities arranged on behalf of the home that meet the needs of the residents. To ensure that residents have the opportunity to take part in activities that are suitable and stimulating for them as individuals. 01/06/2009 3 15 18 The home need to have arrangements in place for residents to be able to eat their meal properly and appropriately with the support required by competent and experienced staff. To ensure that residents have their meals by staff assisting in a dignified manner. 01/06/2009 4 15 16 The home should provide food in suitable forms and 01/06/2009 Care Homes for Older People Page 7 of 12 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, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action with correct utensils that suit the needs of the residents. To ensure that residents can eat the meals in the manner that they appear to prefer. 5 22 23 (1) (a) (2) The premises and any (a, c, e) specialist equipment used must be suitable for the assessed needs of the residents. 23 The home needs to ensure that suitable light is in all areas of the home. To ensure that the residents are moving around in clearly lit areas. 7 26 13 The home must ensure that 01/06/2009 practises are in place to prevent any potential spread of infection To ensure that all good infection control procedures are in place. 8 27 18 The home must, according to 01/06/2009 need, have suitable numbers of competent staff on duty at all times. This is a repeated requirement which has not been met and enforcement action is now being considered. To ensure the care required is met. 9 30 18 The training offered to staff 01/07/2009
Page 8 of 12 31/10/2008 6 25 01/08/2009 Care Homes for Older People 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, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action must be suitable and appropriate to meet the needs of people with dementia. This is an outstanding requirement which has not been met. Enforcement action is now being considered. To ensure the outcomes for each resident is achieved correctly. 10 30 18 (1)(c)(i) Staff must receive suitable 31/08/2008 training in dementia care to ensure that the mental health needs of people using the service are met. The home must ensure that the quality of the care service is measured appropriately. To ensure the reviewing and improving of the service meets the outcomes for residents requiring this specialist service 12 36 18 The Manager must ensure 01/06/2009 that staff are regularly supervised in all departments of the home. This is an outstanding requirement which is still to be met. Enforcement action is now being considered. To ensure that all staff are carrying out their responsibilities correctly. 01/07/2009 11 33 24 Care Homes for Older People Page 9 of 12 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, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 13 36 18(2) Staff at the home must be formally supervised. 31/05/2008 Care Homes for Older People Page 10 of 12 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, 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 Older People Page 11 of 12 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 12 of 12 - 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!
