CARE HOMES FOR OLDER PEOPLE
Fenwinds Rest Home 56 Doddington Road Wimblington, Near March Cambridgeshire PE15 0RD Lead Inspector
Don Traylen Unannounced Inspection 24th November 2005 15:30p 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 Fenwinds Rest Home DS0000015210.V269197.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. Fenwinds Rest Home DS0000015210.V269197.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Fenwinds Rest Home Address 56 Doddington Road Wimblington, Near March Cambridgeshire PE15 0RD 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) 01354 740418 01354 740508 susan.joybays@btinternet.com Mrs Susan Joy Bays Mr Ronald Bays Mrs Susan Joy Bays Care Home 3 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (3) of places Fenwinds Rest Home DS0000015210.V269197.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 22nd May 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 amended in 1991. The home is managed and staffed by the registered providers, Mr & Mrs Bays. The home is a detached house that has been amended 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 DS0000015210.V269197.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place in the afternoon of 24 /11/2005. The previous inspection report did not contain any requirements or recommendations. No requirements or recommendations have been made in this report. The three service users were known to the inspector from previous inspection visits and all spoke with the inspector during this visit. The medication records and contents were checked. The inspector discussed with the providers the arrangements and support provided for administering medication. Bedrooms and the bathroom were inspected. What the service does well: What has improved since the last inspection?
Fenwinds Rest Home DS0000015210.V269197.R01.S.doc Version 5.0 Page 6 The continuity of evidence from the previous inspection report and the positive comments made by service users repeated again in this report indicates a satisfactory care service. One service user’s needs that had been identified as having changed in the last report have been met in a thorough and comprehensive manner; the Care Plan had been amended and the details had been recorded of all the events and arrangements necessary to meet that person’s changed needs. The garden had been maintained to a high standard and was very neat and tidy, including a sloped access area for wheelchairs. The manager has undertaken a refresher training course in administering medicines. 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. Fenwinds Rest Home DS0000015210.V269197.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 Fenwinds Rest Home DS0000015210.V269197.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): 1,2,3,4,5, Service user’s needs are verified and agreed if they can be met prior to their admission being arranged. EVIDENCE: Standards 1-5 were satisfactorily met at the last two inspection made on the 10/03/2005 and 22/05/2005. 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, the manager stated a trial period would be insisted on. Service users would be invited to visit prior to deciding to move into the home. No intermediate care arrangements are made. Fenwinds Rest Home DS0000015210.V269197.R01.S.doc Version 5.0 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 the following standard(s): 7,8,9,10,11, Service users’ care is considerately planned and is provided in full. EVIDENCE: Care Plans were read during previous inspections and judged to contain all appropriate information required. Care plans have recently started to include nutritional and dietary screening records after the involvement of the East Cambridgeshire and Fenland PCT nurse with responsibility for this service. The manager had written a letter, dated 04/11/2005, to the GP to requesting a review of one service user’s Care Plan. Specific concerns and increasing needs and a request for a wheelchair had been indicated. The telephoned reply from the District Nurse was recorded in the Care Plan. The same Care Plan also contained weight charts, nutritional screening and a contract record. The Care Plans are excellent working documents; they are very neat written, clearly signposted and contain concise details of care. Contacts with health professionals are made on behalf of all service users when considered necessary by the providers. Both providers are diligent and confident about requesting service s from health personnel. Arrangements have been made for one service user to attend 6 monthly checks at a diabetic
Fenwinds Rest Home DS0000015210.V269197.R01.S.doc Version 5.0 Page 10 clinic. One of the registered providers always transports and accompanies any service users to health surgeries or clinic so they are informed of any changes in the service users care. One service user who manages his regular insulin injections and blood sugar monitoring does so with the supervision of the manager and the guidance of a District Nurse. The care planning arrangement for this service user had been agreed in a signed agreement kept in his Care Plan. Thus his independence was maintained and he was encouraged to take responsibility and involvement in his health. Medication Administration Record (MAR) sheets for the three service users were checked and found to have been accurately recorded and accounted. The records allowed for blood pressure and pulse to be included. Support and visits from a nominated pharmacist is regular and have been recorded. Threemonthly visits have been a feature of this support and an annual audit. Training in the control of medicines have been provided by the pharmacist and an NHS study day for, “Medicines Course for Carers” was held on the 21/09/2005, was attended by Mrs Bays. Anglia Support Partnership have written a letter to the home, dated the 23/04/2004, informing them of their contractual agreement to provide support to the home. The home has a clear and appropriate medications policy. Service users are sensitively consulted about the arrangements they wish to make in the event of their death. This subject has been discussed at one of the three monthly meetings with service users. Fenwinds Rest Home DS0000015210.V269197.R01.S.doc Version 5.0 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 the following standard(s): 12,13,14,15, Service users are assisted to maintain family connections and are afforded freedom of choice in all aspects of their lives. EVIDENCE: The weekly menu was read and service users stated they enjoyed all their food and they were supplied with plenty of drinks snacks and main meals that were to their liking. The service users decide and make choices about food and meals. The providers are very flexile about making alterations or changes to meal \times and diet whenever service users decide. The food supplied on the 23/11/200 included porridge, sausages, eggs for breakfast; roast lamb with vegetables for lunch, and ham salad for tea. Each service user stated they felt assisted in every aspect of their lives by the manager and Mr Bays Fenwinds Rest Home DS0000015210.V269197.R01.S.doc Version 5.0 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 the following standard(s): 16,18, Service users 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 adheres to 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. As a standard question, the inspector asked each service user if they had anything to complain about and each person stated they felt safe living at the home and would raise any concern with Mr & Mrs` Bays. 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 DS0000015210.V269197.R01.S.doc Version 5.0 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 the following standard(s): 19,20,21,22,23,24,25,26, Service users benefit from a pleasant home with a family atmosphere that is environmentally suited to their needs and is clean and well maintained. EVIDENCE: The last two reports stated that, “service users have sufficient personal space and privacy. Rooms are personalised with private possessions.” Nothing has declined since the last inspection. In the summer of 2005 the owners improved and maintained the garden and outside areas so that one service user can have easier wheelchair access. Each bedroom has a window. 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 have decided they do not want to lock their bedroom doors during the day or night time, but are aware that they can have a key to the locks of their rooms if they chose. Service user enjoy the accommodation of a lounge, a large dining area, a large open plan kitchen, a large conservatory
Fenwinds Rest Home DS0000015210.V269197.R01.S.doc Version 5.0 Page 14 overlooking the rural landscape plus the use of a very large garden to the rear of the house. Fenwinds Rest Home DS0000015210.V269197.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): 27,28,29,30, The providers consider service users needs are paramount and meet these needs through their very adequate care skills. EVIDENCE: The arrangements for staffing are provided by the two registered providers and these have been assessed as being adequate at previous inspections. There are two care workers for the majority of the time who are Mr and Mrs Bays and they are ready to be alerted during the night should service users call for their assistance. 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. The Care Plans provided evidence of how well organised and how thoroughly care is provided. Observations were made of the relaxed yet attentive attitude of the registered providers who continued to demonstrated their commitment to giving high quality and individual care. The inspector was satisfied the providers have high standards and principles of care who demonstrated their eagerness to maintain service users independence and to provide a homely and caring place to live. Fenwinds Rest Home DS0000015210.V269197.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): 31,32,35,37,38, Service users enjoy a well managed home. EVIDENCE: The registered manager, Mrs Bays is a registered nurse and has appropriate training including dementia care. Mrs Bays passes leads by example and passes on her skills to Mr Bays and trains him in methods of moving and handling safe, first aid and personal hygiene. The home has a set of policies and procedures that are appropriate to the size of the home. These include a medications policy, emergency procedures, the protection of vulnerable adults, a complaints policy, service users’ rights and admissions to the home procedures. Care Plans and MAR sheets provided evidence of a good approach to care planning especially when changes in need had been noticed. Fenwinds Rest Home DS0000015210.V269197.R01.S.doc Version 5.0 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. 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 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 Standard No Score 16 3 17 X 18 3 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 3 3 X X 3 N/A 3 3 Fenwinds Rest Home DS0000015210.V269197.R01.S.doc Version 5.0 Page 18 Are there any outstanding requirements from the last inspection? No 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. N/A Standard N/A Regulation N/A None Requirement Timescale for action 01/01/99 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. N/A Refer to Standard N/A Good Practice Recommendations None Fenwinds Rest Home DS0000015210.V269197.R01.S.doc Version 5.0 Page 19 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office 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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