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 8 0 8 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 11 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 11 What we found:
This random inspection was carried out by two inspectors from the Care Quality Commission over a period of 5 hours. The focus of this inspection was to see if the home had complied with the requirements, some which were outstanding, from the last inspection. The new Manager has, in the few weeks she has been in post, worked with the staff to aim to meet the requirements set and although not all areas are fully met the improvement is substantial. Although this inspection was primarily planned to looked at the past requirements it was noted during the tour of the building that information in residents rooms was not correct and that names and titles within the service users guide and statement of purpose go back to a Manager of over a year ago. The information about the service offered at this home was out of date, very minimal and not precise. More information about the type of support the service offers would enable potential residents to make an informed choice as to the suitability of the service. The sample of care plans inspected was being progressed positively to address shortfalls previously highlighted with regard to the content. With guidance from the new manager, care staff, who deliver the care, were beginning to participate in the care planning process. This should help develop their understanding and ensure the residents needs are met in a pro active and consistent way, and improve outcomes. The manager is also keen to reintroduce the key worker system, this will ensure a more individualised approach to care within care planning arrangements. On the day of this visit two senior carers were not part of the duty rota but were in the building working on the content within the care plans and ensuring the information was current and informative for staff to follow. On talking to the staff the Manager is supporting them to have the time to develop the care plans and make them more person centred. During this visit we observed that residents with high support needs were less likely to be fully engaged in meaningful activities or involved in positive stimulation. Many residents in one lounge were asleep but easily aroused when spoken to, whilst one lady was receiving a manicure from the activity co-ordinator, little was happening for the rest of the residents in that room. In the designated activities room the inspectors observed a care worker trying to facilitate a game of skittles with a small group of five residents seated around the room. Two residents were asleep, two ladies did not understand what was required of them, a gentleman who participated after encouragement received little positive outcome from the experience as the momentum of the game was lost by the facilitator. Social care at the home needs to improve further to ensure that residents individual needs are met and their strengths recorded and understood by staff to enhance their well being from day to day. The manager spoke positively of future plans to develop the environment in a way that would provoke interest and stimulation for residents in the form of a pub and a shop. Whilst this a positive step for future improvement consideration for the individuals need to be clearly assessed to ensure the activity is suitable for the person. Immense improvement was observed in the whole mealtime experience for residents with good outcomes. The dining room was pleasantly laid out, serviettes, choice of drinks in jugs and glasses supplied. Residents were greeted and shown to their tables and provided
Care Homes for Older People Page 4 of 11 with a drink. A choice of meals were given and served fresh and hot from the heated serving trolley by the cook and kitchen assistant and taken to the residents by the care and ancillary staff. Staff from all departments sat at the tables with the residents to provide assistance and good supportive conversations took place to encourage residents to eat and enjoy there food. The meal time was staggered enabling all staff to provide everybody with the level of assistance they required prior to and during the meal. The manager advised that three sets of special cutlery had been purchased to enable residents and promote independence. These were not observed in use and we would recommend that more are purchased to provide all residents with suitable eating aids. Shortfalls highlighted previously in relation to the lighting in some areas of the home have been addressed to meet with this requirement. It was positive to note that the manager, together with a resident, had undertaken an assessment of the lighting throughout the home and highlighted areas requiring further improvement from the perspective of the resident. We hope that the outcome of this assessment is met positively by the providers to improve an environment suited to the older person with age and dementia related needs. It was noted that one wall in a corridor had been inappropriate decorated with splashes and paint runs that gave the appearance of a child like creation. Involvement and choice in the homes environment development should be encouraged but also should also be age appropriate. The manager advised that arrangements were in place to ensure that waste bins were emptied on a regular basis and extra bins were purchased to hold yellow bags for clinical/human waste. The inspectors did not observe anything at the time of the inspection that did not meet infection control guidance. On their arrival to the home, at 10.30am, we observed residents up and appropriately groomed and dressed. Some activities were being undertaken as described previously. The manager arrived soon after the inspectors. There were six care workers, two domestics, two kitchen staff and one administrator on duty supporting thirty residents. The arrangements in place for managing the main meal time that was supported by all staff, were sufficient at the time of the inspection to meet the current resident groups individual needs for that day. The manager was advised of the need of ongoing review and evaluation of staffing levels. Levels would require to be revised according to the assessed needs of the residents. This would ensure individual needs are appropriately met at all times, particularly as the service provides for people with dementia related needs that are usually assessed as high. The manager advised that 84 percent of the care staff have received training through either external or internal sources in understanding dementia. This is evidenced by the training matrix and by staff spoken to. Staff competence is currently being assessed through supervision and some limited notes were seen. The manager advised of future plans for staff to prepare a case study on a resident linking into the care planning system. Whilst this level of training is satisfactory as an introductory level of training to support staff in provision of care, further development is required in the training programme to ensure that the basic level of training is complimented by further initiatives to enhance the care needs of the high dependency residents. Particularly in areas such as nutrition, activity assessment and need, person centred planning and assessment, listening and communicating skills and behaviour management to enhance the understanding and needs of the older person particularly in relation to dementia care. Care Homes for Older People Page 5 of 11 Quality assurance and monitoring systems were not fully developed to meet this outcome area and regulation. The home had begun to address quality monitoring by the implementation of surveys completed by relatives, however they were basic and not formulated to identify the homes strengths and weaknesses and no collated documentation was available to show how the home had evaluated and constructed a plan on the development needs of the home to improve the service provided that was relevant to the individuals who live at the Old Rectory. The Manager had progressed in catching up with some outstanding supervisions for staff. Records of the formal one to one meetings seen, show a need for more detailed discussions and recordings during these meetings that will have a stronger link to care practice and for clear objectives to be planned with staff to enable the care needs of each resident to be met. The Manager felt there was an improvement in the frequency of formal supervision and indicated that as yet agendas were limited and unforthcoming from staff. The need for agendas to be reflective of working practice and competence was discussed particularly in relation to short course attendance only training. Other forms of supervision, all with equal benefit was also discussed, and included in the managers improvement agenda. The new manager appointed demonstrated a positive and pro-active attitude towards the development of the home. We were assured that an application to the Commission for registration was forthcoming. Continued and consistent leadership and guidance for staff will enable structured service delivery and improve outcomes for residents. History of this provider tells us that management arrangements are not always sustained for long enough periods to complete improvement agendas. The Commission will continue to monitor the service within its improvement strategy to ensure the service develops further. We hope that the providers continue to provide the additional resources and support to the manager. This will ensure that the improvements, acknowledged within this report are developed further to acquire a quality rating in this outcome area at the next key inspection. What the care home does well:
The care plan documentation is slowly improving. More person centred details are beginning to be recorded but there is still a need to make them user friendly for the staff to be able to use as a working tool. The activities and stimulation seen shows time has been considered throughout the day for group activities but more consideration is needed for individuals social support that is appropriate for them. The home has improved the midday meal significantly. The residents were assisted appropriately and the meal was offered with choice in a much more relaxed and enjoyable setting. Some areas around the home have had the lighting replaced with plans for further improvement over the next few months. All areas around the home appeared clean and there was no evidence to show infection
Care Homes for Older People Page 6 of 11 control was not being adhered to as previously found. The Manager ensures that the staff duty rota is covered at all times and all posts are covered when a vacancy occurs. 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 2. Care Homes for Older People Page 7 of 11 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, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 8 of 11 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 1 1 5 The Service Users Guide must be up to date. To ensure the relevant information is current and available. 01/11/2009 2 1 4 The Statement of Purpose that is up to date must be available. To ensure aims and objectives of the home and the services provided are clearly written and up to date 01/11/2009 3 33 24 The home must develop a measurable quality assessment process . To ensure that good practice is recognised but also how improvements to the service will be monitored and developed. 01/11/2009 Care Homes for Older People Page 9 of 11 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 1 7 The continuing development of the care plans need to show progression of the information recorded to include the social care needs of each resident. The home needs to continue in finding and delivering the correct training programmes for staff to be able to develop their skills and deliver a service to people who have complex needs. The Manager needs to ensure the supervision of all staff is recorded in detail to show how the development of the staff member, with the objectives set, will meet the needs of the residents 2 18 3 18 Care Homes for Older People Page 10 of 11 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 11 of 11 - 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!
