CARE HOMES FOR OLDER PEOPLE
Fenwinds Rest Home 56 Doddington Road Wimblington, Nr March Cambridgeshire PE15 0RD
Lead Inspector Don Traylen Announced 22 May 2005 @ 10:00 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 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. Fenwinds Rest Home Version 1.10 Page 3 SERVICE INFORMATION
Name of service fenwinds Address 56 Doddington Road Wimblington Cambridgeshire PE15 0RD 01354 740418 01354 740508 ronald.bays@btopenworld.com Mrs Susan Joy Bays Mr Ronald Bays Mrs Susan Joy Bays Care Home 3 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Category(ies) of Dementia-over 65 years of age DE(E),3 places; registration, with number Old age, not falling into any other category, 3 of places places. Fenwinds Rest Home Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 10/03/2005 Brief Description of the Service: Fenwinds is a small home registered to provide for a total of 3 people who are elderly frail or affected by dementia. The home was first registered in 1995 under the Registered Homes Act 1984, as ammended in 1991. The home is managed and staffed by the registered providers, Mr & Mrs Bays. The home is a detached house that has been ammended for the purpose of providing care to three service users. The three service users live in the downstairs part of the house whilst the registered providers private accommodation is the upstairs part of the house. The home has an additional downstairs bedroom, a large kitchen-dining area, a conservatory and large rear garden. The home has a vehicle for service users transport arrangements. Fenwinds Rest Home Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place on Sunday 22/05/2005. The previous inspection report did not contain any requirements or recommendations. The three service users were known to the inspector from his previous visits and on this occasion spoke to the inspector for over an hour when sitting together in the lounge. The service users informed the inspector of their individual and group experiences and feelings about living in the home. Care Plans for the same three service users were read at previous inspections. On this occasion one service user’s Care Plan was read, the fire alarm was tested and medication storage and records were examined and lunch was observed being prepared. The interior and exterior of the building including the garden was inspected. The inspector discussed with the providers how they manage the home and how their philosophy of care and common sense approach to practice is achieved. What the service does well:
The registered providers are very person centred in their approach to giving care. Because the home has only three service users the home is staffed and managed by the registered providers. Discussions with both Mr and Mrs Bays demonstrated their awareness and understanding of the emotional needs of each service user as well as the service users’ combined needs as an interactive and dynamic group of people who live in close contact. The manager consult and listen to each service user and to carefully planning their care and to recording detailed care arrangements for each service user. The providers are able to respond rapidly to service users changing needs and to seek appropriate community health services when necessary. Mrs Bays is a registered nurse who takes care to ensure that each service user’s health needs are not overlooked. Both Mr and Mrs Bays are prepared to make immediate referrals to health services when necessary. The providers have made the service a friendly and open environment by their kindness and professional approach. Both of the registered providers are committed to providing care that centres on individual care needs and emotional wellbeing. The service user are consulted on all aspects of their care and are made to feel that the home is their home and are included in the daily arrangements of the home. Fenwinds Rest Home Version 1.10 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Fenwinds Rest Home Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Fenwinds Rest Home Version 1.10 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 standard(s) 1,2,3,4,5, Service users’ needs are met by attention and understanding of their individual needs. EVIDENCE: Standards 1-5 were satisfactorily met at the last inspection of the 10/03/2005. Each service user has a pre-admission assessment and contract agreed with their commissioning authority. Although no new service users have moved into the home since 2003, a trial period is insisted upon by the home and service users are invited to visit prior to deciding to move into the home. No intermediate care arrangements are made. Fenwinds Rest Home Version 1.10 Page 9 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 standard(s) 7,8,9,10,11, Service users are provided with excellent personal care by the two dedicated providers who are committed to a person centred manner of caring. EVIDENCE: Care Plans have been read during previous inspections and judged to contain all appropriate information required. During this inspection, one service user’s Care Plan was read that contained amendments because of a change in his health. Contacts with health professionals had been made and arrangements for regular visits to a specialist clinic had been organised by the home. One of the registered providers always transport and accompany this person to the specialist clinic so they are also informed of his care. The service user stated that he is very happy with this arrangement and is of his choice. One service user manages his regular insulin injections and blood sugar monitoring with the supervision of the manager and the guidance of a District Nurse. The care planning arrangement for one service user had been agreed and a signed agreement was kept in the Care Plan. The service user’s independence was maintained and he was encouraged to take responsibility and involvement in his health. Reassurance and supervision of this aspect of medication is managed by the home.
Fenwinds Rest Home Version 1.10 Page 10 Medication Administration Record sheets were accurately recorded and safe storage of medication and the correct temperature for insulin storage were maintained. A pharmacist supports the home by regular 3 monthly visits and offers advice and support as well as carrying out annual audits. The pharmacists last visit was recorded for the 07/03/2005. This arrangement has been approved by the Anglia Support Partnership, who have written a letter to the home, dated the 23/04/2004, informing them of this contractual arrangement. The manager stated that service users are sensitively consulted about the arrangements they wish to make in the event of their death. The manager stated that this subject was openly discussed at one of the three monthly meetings with service users. Fenwinds Rest Home Version 1.10 Page 11 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 standard(s) 12,13,14,15, Service users are assisted to maintain family connections and are afforded total freedom of choice in all aspects of their lives. EVIDENCE: Each service user informed the inspector about their families and their relationships with them and who they keep contact with. One service user was awaiting an imminent visit from her niece who lives abroad and who telephoned during the inspection. All the service users stated they felt assisted in every aspect of their lives by the manager and Mr Bays. They each stated that the home is excellent and they felt safe and secure in their social arrangements. The evening before the inspection the service users and visitors enjoyed a barbeque in the garden of the home despite a thunder and rain. During the inspection a traditional and nutritious roast meal with fresh vegetables was observed being prepared. Service users stated they were very satisfied and pleased with the quality and amount of food and drink provided. One service user was drinking a glass of sherry that she stated she regularly enjoys before a meal. Fenwinds Rest Home Version 1.10 Page 12 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 standard(s) 16,17,18, Service users rights are upheld and they are protected from abuse. EVIDENCE: The home has a complaints log book and a compliments book, a complaints policy and an adult abuse policy that follows the Cambridgeshire Local Authority guidelines. Training in preventing adult abuse has been received by Mr and Mrs Bays. Service users stated they would make a complaint at any time if they if they wanted. Each service user was asked if they had anything to complain about and unanimously informed the inspector they felt safe living at the home and did not have anything to complain about. The manager stated that she speaks to each service user on a regular arrangement and kept records of this method of contact where opportunities to raise concerns are encouraged. Fenwinds Rest Home Version 1.10 Page 13 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 standard(s) 19,20,21,22,23,24,25,26, Fenwinds is a well maintained and clean home where service users benefit from a safe and comfortable environment. EVIDENCE: The last report stated that service users have sufficient personal space and privacy. Rooms are personalised with private possessions. Nothing has declined since the last inspection but the home have improved and maintained the garden and outside areas so that one service user can have easier wheelchair access. Each bedroom has a window. The fire alarm was tested during the inspection. Hot water is tested for the bath and the temperatures are recorded at the time of use. No service takes a bath without assistance from the manager or Mr Bays. A separate laundry room contains washing and drying machines. Service users confirmed they did not want their bedroom doors locked during the day or night time, but were aware that they could have a key to the locks of their rooms if they chose to. Fenwinds Rest Home Version 1.10 Page 14 The bathroom is fitted with grab rails and a raised toilet seat. The bath has a manual operated hoist. All internal doorways and corridors are suitable for wheelchair access. All radiators are fitted with heat guards. Fenwinds Rest Home Version 1.10 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29,30, The staffing ratio to service users is higher than in most other care homes. The quality and staffing arrangements for care provided by trained staff is also better in this home than in most care homes. EVIDENCE: There are two care workers for the majority of the time. Mr and Mrs Bays are both ready to be alerted during the night and there is at least one carer during the daytime but most often both the manager and Mr Bays are working. Service users stated that the ratio of 2 care staff to 3 service users made them feel safe. The manager, Mrs Bays is a registered nurse and has appropriate training including dementia care. Mrs Bays passes on her skills to Mr Bays and trains him in methods of moving and handling safe, first aid and personal hygiene. The pharmacist provides training and support to Mr and Mrs Bays and has a contractual responsibility to Anglia Support Partnership to provide this service to the home. Fenwinds Rest Home Version 1.10 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32, 33, 37, 38, Service users live in a well-managed care home where their interests are paramount. EVIDENCE: The home has a set of policies and procedures appropriate to the size of the home including emergency procedures, the protection of vulnerable adults, a complaints policy, service users’ rights and admissions to the home procedures. Care Plans provided evidence of care provided and care planned and when changes in need had been noticed. Observations made of the relaxed yet attentive attitude of the registered providers demonstrated their commitment to giving high quality and individually tailored care. The inspector discussed with the proprietors their views and principles of care that demonstrated their eagerness to maintain service users independence and to provide a homely and caring place to live.
Fenwinds Rest Home Version 1.10 Page 17 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 3 3 x x x 3 3 Fenwinds Rest Home Version 1.10 Page 18 no Are there any outstanding requirements from the last inspection? 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 Regulation None Requirement Timescale for action 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. Refer to Standard None Good Practice Recommendations Fenwinds Rest Home Version 1.10 Page 19 Commission for Social Care Inspection CPC1, Capital Park Fulbourn Cambridge CB1 5XE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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