CARE HOMES FOR OLDER PEOPLE
Fenwick House Fenwick House 1 Cowper Road Bedford Bedfordshire MK40 2AS Lead Inspector
Sally Snelson Unannounced Inspection 30th November 2005 09:40 X10015.doc Version 1.40 Page 1 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 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Fenwick House DS0000063121.V270751.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Fenwick House DS0000063121.V270751.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Fenwick House Address Fenwick House 1 Cowper Road Bedford Bedfordshire MK40 2AS 01234 350887 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) WAGh Ltd T/A Fenwick House Mrs A Trimble Care Home 30 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (30) of places Fenwick House DS0000063121.V270751.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. A maximum of 10 beds can accommodate service users in the category of DE(E). The rooms on the top floor of the home can only accommodate service users in the category OP who have good mobility and eyesight and do not require personal care. 16th may 2005 Date of last inspection Brief Description of the Service: Fenwick House is a large detached house that has been extended and converted for use as a residential home several years ago. It is located in a pleasant residential area of Bedford with convenient access to the amenities of the town. It was registered to provide care for thirty older people, 10 who may have dementia. The home has twenty eight single rooms and two that could be used for double occupancy. The bedrooms are distributed over three floors, the first floor being the only floor accessible via staircases. There are two steps up to four of the bedrooms on the first floor. The bedrooms on the second floor can only be accessed by a steep staircase. These bedrooms are not suitable for those with mobility problems and an occupational therapist has recommended that these rooms are not used by residents due to the steepness of the stairs and the decreased tread depth. Three communal lounges are provided on the ground floor as well as a large lounge/dining room. One lounge is designated for smoking, the others are non-smoking. An additional table and chairs has recently been provided in the dining room to ensure that there are sufficient seats for all residents who wish to eat there, although some residents choose to eat in their rooms. There are sufficient toilet, shower and bathing facilities. Fenwick House DS0000063121.V270751.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection of Fenwick House was unannounced and took place on 30th November 2005 from 09.40hrs. The registered manager Mrs Ann Trimble was present throughout. During the inspection the care of two service users was “case tracked”, which involved looking at the care they received, speaking to them and reviewing the documentation that the home held on them. Other service users, staff and visitors were also spoken to and the information they provided used to make a judgement of the home. The commission requires that all homes should be inspected twice annually. This report is the second of the year and as a result some standards that were assessed or were met during the first visit were not assessed on this occasion. It is therefore important to read this report with that of 16.05.05. On the day of the inspection the manager, three care staff, a domestic, a cook and a kitchen assistant were providing the care for 19 service users. What the service does well: What has improved since the last inspection?
Fenwick House DS0000063121.V270751.R01.S.doc Version 5.0 Page 6 The manager and the owner had taken seriously all the requirements and recommendations made at the last inspection and had worked towards meeting the majority of them. Any doors that previously had been wedged open were now fitted with automatic door closures that conformed to the requirements of the fire service. As all the doors had not been fitted with automatic door closures, the wishes and the needs of the service users in bedrooms without these devices must be kept under review. The Statement of Purpose had been updated following the last inspection and a copy sent to the CSCI. The manager confirmed that the information included in care plans was discussed with the service users, however she stated that the majority were not very interested and did not provide any additional information or comment on the contents of the documents. There was no documented evidence to support that these discussions were taking place. Ten new mattresses, new chairs for the lounge and a mobility aid in one of the toilets had been provided following the last inspection. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Fenwick House DS0000063121.V270751.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Fenwick House DS0000063121.V270751.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,6. There was clear information documented about service users. However it was not clear when this information had been gathered and if this information was used to make the decision that Fenwick House could meet the needs of the service user. EVIDENCE: The Statement of Purpose had been reviewed and updated, as required at the last inspection. The manager confirmed that she would assess a service user prior to admission. The pre-admission visit provided information for the care planning process. However, in the two plans sampled, it was not possible to see exactly what information had been sought at the pre-admission and what had been gained at, or after, admission. It was therefore unclear how the decision that Fenwick House could meet the needs of the service user had been made. The home would benefit from a separate pre-admission tool that included all the
Fenwick House DS0000063121.V270751.R01.S.doc Version 5.0 Page 9 headings listed in standard 3.3 of the National Minimum Standards for older people. This tool should be signed and dated by the person making the assessment. The home did not offer intermediate care. Fenwick House DS0000063121.V270751.R01.S.doc Version 5.0 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,9,11. Satisfactory processes were in place to ensure that the health and personal care needs of service users could be met, which resulted in appropriate care being offered to the service users. The home was good at recording the wishes of service users in the event of their death; as a result service users and the staff were happy that last wishes would be carried out. EVIDENCE: It was apparent that the staff had worked hard to improve the care plans and ensure that service users were consulted about the contents. The manager stated that few of the service users were interested in their care plans and none had offered any additional information or comments about what was written about them. However one of the plans sampled had not been reviewed monthly. The manager stated this was because the care needs of the service user had not changed in that time. Fenwick House DS0000063121.V270751.R01.S.doc Version 5.0 Page 11 Service users confirmed that the care they received was good and that they were referred to various external professionals in order to have their needs met. One service user had seen her GP twice in ten days because she did not feel she was responding to the treatment given. A service user spoke of her visit to the hospital the day before, for minor surgery. She reported that a care worker had taken her and stayed with her, even though it had been a long day. At the time of the inspection none of the service users were self-medicating. At the last inspection some of the service users had been partially selfmedicating and the home was asked to provide an appropriate written procedure and supply a lockable space in bedrooms for the service users to store their medication. It is required that wherever possible service users are given the opportunity to self medicate and this should be encouraged. The medication records for the two service users whose care was being ‘tracked’ were examined. With the exception of names missing from the list of sample signatures of staff deemed competent to administer medication no problems were identified. The manager confirmed that the supplying pharmacy was helpful and that the home was near to a pharmacy that kept long hours if an emergency prescription was needed. Each of the files looked at included information about the service users wishes for the time of death. The manager confirmed that she also updated contact information when a service user was near the end of life to ensure that the person informed of the death was informed at a time that they agreed and wished. Fenwick House DS0000063121.V270751.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: None of these standards were assessed at this inspection. Fenwick House DS0000063121.V270751.R01.S.doc Version 5.0 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18. Satisfactory processes were in place to ensure care staff understood how to protect the service users from abuse, as a result service users safety would not be compromised. EVIDENCE: Displayed in the entrance of the home was a complaints procedure that detailed the action to be taken and the response necessary following a concern or complaint made to a staff member by a service user or visitor. The manager stated that the home had not had any complaints for some time. Service users said if something was not to their liking, for example the proposed menu they could speak to the manager and it would be dealt with immediately. Visitors also reported that the manager was available and would always deal with any issues. The manager and senior staff were able to tell the inspector how they would deal with a case of unexplained injury and the measures they would take to protect service users from all forms of abuse. The monies held by the home on behalf of service users were checked and found to be held and documented correctly. Fenwick House DS0000063121.V270751.R01.S.doc Version 5.0 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 The home provided a safe and comfortable environment for the service users that, was clean and free from offensive odours and as a result service users appeared happy and relaxed in their home. EVIDENCE: The home was clean and tidy and free from any obvious offensive odours; it was noted that domestic staff were cleaning at the time of the inspection. The service users spoken to were pleased with the way that the staff cared for their bedrooms, particular their own personal belongings. The last inspection had identified a number of concerns with the environment, which the owner and manager had rectified. This was commendable but it is expected that the owner is aware of the need to replace furniture and fittings and redecorate without having to be required to do so as part of an inspection. On the day of the inspection the cook reported that the dishwasher was broken but did not know whether there were plans to replace it.
Fenwick House DS0000063121.V270751.R01.S.doc Version 5.0 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29,30 The home had satisfactory processes to ensure the needs of the service users were met by employing sufficient numbers of staff that were competent and as a result a good standard of appropriate care was provided to the service users. EVIDENCE: Recruitment procedures had been reviewed and upgraded and the manager was now ensuring all staff had a POVA first check, which necessitated a Criminal Record Bureau check, before starting work. At the time of the inspection the home did not have any staff vacancies. Many of the staff were prepared and happy to work extra shifts to cover colleagues absences. The home was committed to training and a good percentage of the staff had taken NVQ courses and further training. The manager had started work on a training matrix but it was not in a form that would identify future training needs. The manager kept herself updated by reading care journals but did not have access to the internet where new practices and policies could be viewed. Fenwick House DS0000063121.V270751.R01.S.doc Version 5.0 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,35. Staff and service users were confident in the manager’s ability and felt safe at the home. EVIDENCE: The service users said the manager was approachable and easy to talk to. The manager was observed to have effectively communicated with the service users, care staff and relatives in a positive and friendly way. The care staff felt able to speak to the manager at any time. The inspector and the manager discussed the regulation 37 notifications and the need for the home to inform the CSCI of the death of a service user even if the death occurred in the hospital. There was clear evidence that the home had responded, in the main, to the requirements and recommendations made at previous inspections. However
Fenwick House DS0000063121.V270751.R01.S.doc Version 5.0 Page 17 there was no evidence that the owner during his regular weekly visits to the home reported on the premises and the condition of equipment as required by Regulation 26. More detailed reports would prevent the situation that occurred at the last inspection when a number of environmental issues were identified that the owner had not considered for improvement. There was also a need to demonstrate that an annual development plan for the home was based on planning, action and review. As already stated service users money held by the home was checked and found to be correct. Fenwick House DS0000063121.V270751.R01.S.doc Version 5.0 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 3 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 X 28 X 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 2 X 3 X X X Fenwick House DS0000063121.V270751.R01.S.doc Version 5.0 Page 19 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14(1)(a) Requirement The manager must use a separate pre-admission assessment tool and then use the information collected to write the care plans. There must be evidence that care plans have been reviewed at least monthly even if the care needs of the service user have not changed. A matrix of training needs and an annual training plan must be developed. Original timescale of 31/3/05 and 31/8/05 not met although some work had been done. There must be a development plan for the home. Timescale for action 01/01/06 2 OP7 15(2) 01/01/06 3 OP30 18(1)(a) 01/02/06 4 OP33 24 01/01/06 Fenwick House DS0000063121.V270751.R01.S.doc Version 5.0 Page 20 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP9 OP9 OP33 Good Practice Recommendations The manager should consider the ability of some of the service users to self-medicate. The list of staff who are competent to administer medication must be kept up-to-date. The regulation 26 visit report must demonstrate that the owner is aware of any concerns in the home and any environmental issues that need addressing. Fenwick House DS0000063121.V270751.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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