CARE HOMES FOR OLDER PEOPLE
Ferfoot Care Homes Old and New House The Folly Old Hardenhuish Lane Chippenham SN14 6HH Lead Inspector
Malcolm Kippax Unannounced 21st June 2005 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. Ferfoot Care Homes D51_D01_S28628_FerfootCareHomes_V181374_210605_Stage4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Ferfoot Care Homes Address Old and New House The Folly Old Hardenhuish Lane Chippenham SN14 6HH 01249 658677 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) Ferfoot Limited Mrs Bridget Ann Barton Care Home 56 Category(ies) of DE (E) Dementia - over 65 registration, with number MD Mental Disorder (1) of places Ferfoot Care Homes D51_D01_S28628_FerfootCareHomes_V181374_210605_Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: No more than 1 service user with Mental Disorder, under the age of 65 Date of last inspection 28th January 2005 Brief Description of the Service: Ferfoot Care Homes is a care home consisting of two buildings, which are known as the Old House and the New House. The two buildings share the same grounds and are registered as a single establishment. Ferfoot Care Homes is located in a quiet residential area, although close to main roads and transport links. Ferfoot Care Homes is jointly managed by Mrs B. A. Barton and her daughter, Mrs Tina Novik. Mrs Barton and Mrs Novik are directors of Ferfoot Ltd that runs Ferfoot Care Homes. Other family members are also directors and have an active role in the running of the home. The Old House was the original building and the New House was developed later to provide purpose built accommodation. A permanent staff team provides 24 hour care and support to service users. Ferfoot Care Homes D51_D01_S28628_FerfootCareHomes_V181374_210605_Stage4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection started at 9.55am and took place over six hours. Service users from both houses were met in the lounges and in their own rooms. The home specialises in the care of older people with dementia and mental health needs; conversation with service users about their care and their experience of the home was very limited. However, three relatives were also spoken with, as well as staff members and members of the management team. The accommodation, other than for some of the bedrooms, was seen during a tour of the home. A number of the home’s records were looked at, including three of the service users’ care records. What the service does well: What has improved since the last inspection?
The home continues to assess its own performance and to have detailed plans in place for service improvement. Priorities have been identified for the current financial year. This pro-active response to improvement is very positive. A newsletter was shortly to be sent out to relatives with details of a new advocacy and helpline service that the home was supporting. Plans have now been finalised for a new staff roster, which includes a higher staffing level at particular times of day. This will have direct benefits for
Ferfoot Care Homes D51_D01_S28628_FerfootCareHomes_V181374_210605_Stage4.doc Version 1.30 Page 6 service users. A new recruitment drive is underway and this has been successful in attracting some of the additional staff who will be needed. 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. Ferfoot Care Homes D51_D01_S28628_FerfootCareHomes_V181374_210605_Stage4.doc Version 1.30 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 Ferfoot Care Homes D51_D01_S28628_FerfootCareHomes_V181374_210605_Stage4.doc Version 1.30 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) 3 Service users benefit from a regular assessment of their needs. There are good systems in place for identifying need and increased dependency. Changes in a service user’s needs are well responded to within the home, however external factors have contributed to some difficulties. EVIDENCE: The service user’s needs are monitored on a regular basis. Some checks are made on a daily basis. Staff used a form during the inspection to record how well the service users had eaten. This is a good way of monitoring food consumption and any lack of appetite that may indicate a change in well-being. ‘Waterlow’ and other assessments, including risk and moving & handling, had been regularly reviewed and recorded on separate forms. The relatives spoken with felt that the staff had a good understanding of the service users’ needs. Two service users have been assessed as in need of nursing home care. Mrs Novik said that delays have arisen in their moves to nursing homes as a result of external factors and that this was being discussed with the other parties involved.
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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 and 10 Individual care plans and other records are providing a good summary of the service users’ needs. Health and personal care are well monitored, however the guidelines for pressure sore prevention need to be clarified. Service users’ are treated in a respectful manner and benefit from the home’s philosophy of care. EVIDENCE: Service users have a main individual care plan. The plans seen had been written during the last year and last reviewed in May and June 2005. ‘No change’ is often recorded when the care plans and assessments are reviewed. A form of short-term care plan is also available for temporary conditions. Service users find it difficult to be involved in the care planning arrangements, although their relatives are consulted. Relatives receive a copy of the care plan and are invited to record their comments on a review form. The relatives spoken with confirmed that they were kept well informed of care related matters. The care plans for some service users include regular interventions by staff. Guidelines for pressure sore prevention have been produced in conjunction
Ferfoot Care Homes D51_D01_S28628_FerfootCareHomes_V181374_210605_Stage4.doc Version 1.30 Page 10 with the District Nurse. These specify the frequency of ‘turns’ for service users who spend time in bed. As good practice staff record when a service user has received this support. The records showed that sometimes the turns have not been as frequent as stated in the guidelines. Mrs Novik thought that it would be useful to review the guidelines on an individual basis (Also refer to the ‘Management and Administration’ section re: record keeping). Ferfoot Care Homes D51_D01_S28628_FerfootCareHomes_V181374_210605_Stage4.doc Version 1.30 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) 13, 14 and 15 Service users enjoy a relaxed and informal atmosphere. The involvement of relatives and other visitors is encouraged and very well supported by staff and managers. Good attention is being given to develop systems that promote the interests of very dependant service users. The meal arrangements are of a good standard. EVIDENCE: Service users were observed to have freedom of movement within the home, the only restrictions being to limit contact with the domestic areas and in consideration of other service users’ private spaces. Information of interest to relatives and visitors was well displayed in the home. This was updated during the inspection. A newsletter was shortly to be sent out to relatives with details of a new advocacy and helpline service that the home was supporting. The relatives were able to help out with the lunch meal, which looked like a nice way for the service users to have personal contact with their loved ones. Other service users received good attention from the care staff.
Ferfoot Care Homes D51_D01_S28628_FerfootCareHomes_V181374_210605_Stage4.doc Version 1.30 Page 12 The main course for lunch was pork with mashed potatoes and fresh vegetables. This food was served in blended form for many service users. Since the last inspection, special plates have been bought which keep the blended items separate. Ferfoot Care Homes D51_D01_S28628_FerfootCareHomes_V181374_210605_Stage4.doc Version 1.30 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 standard(s) 16 The service users’ representatives have information about what to do if they have a complaint and are encouraged to raise any concerns on an informal basis. EVIDENCE: Information about the home’s complaints procedure is given to relatives and available in the home. Relatives and others are encouraged to raise any concerns with one of the senior staff or management team who are readily on hand. Ferfoot Care Homes D51_D01_S28628_FerfootCareHomes_V181374_210605_Stage4.doc Version 1.30 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 standard(s) 19 and 20 The home environment is meeting the service users’ needs. Service users benefit from the home’s layout and the upkeep of the surroundings. Service users make good use of the communal areas. EVIDENCE: The home has well maintained grounds and parking spaces between the two houses. The service users’ use of the grounds is limited to an attractive inner garden area, which has been enclosed for safety. The overall impression is one of a tidy and organised environment. Internally, refurbishment has focussed on the Old House during the last year. The priority for the current year is on routine decoration. The main activities were centred around the large communal rooms in each house. Smaller lounges were also available. During the morning a visitor played familiar tunes on an electric organ and this was enjoyed by several service users.
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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 and 30 The service users’ care needs are met by a competent and well qualified staff team. Service users benefit from having staff who understand their roles and from the high priority that is given to staff training and development. The recruitment procedures help to protect service users from unsuitable staff. EVIDENCE: The written roster provided a clear record of the management, care and ancillary staff on duty. There is a single staff team, with carers and senior staff allocated to work in one of the houses. Staff deployment at the time of the inspection was as shown on the roster and the staff members were met with during the day. Numbers of care staff are higher in the New House to take account of the higher dependency levels. The roster also showed the future deployment of staff, which is to include an increase in staffing levels at particular times of day. New staff were being recruited because of this. The recruitment process was looked at in respect of two staff members who have been appointed since the last inspection. Their recruitment included the appropriate checks and references that help to protect service users from unsuitable staff. Staff members were seen to be responding to service users in a caring manner. The relatives spoken to said that staff are friendly and helpful.
Ferfoot Care Homes D51_D01_S28628_FerfootCareHomes_V181374_210605_Stage4.doc Version 1.30 Page 16 The annual staff training plan for 2004 had been appraised and a new plan produced for 2005. This includes a mix of external and in-house training events. Training activities are varied and relevant. Induction and foundation training for new staff is followed by N.V.Q. at Level 2. At the time of the inspection, 75 of the care staff had achieved their N.V.Q. Each employee has an individual training record. Ferfoot Care Homes D51_D01_S28628_FerfootCareHomes_V181374_210605_Stage4.doc Version 1.30 Page 17 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) 32, 33 and 37 There is an open and inclusive management approach that produces positive outcomes for service users. The home’s development plans and quality assurance systems help to ensure that good standards are maintained and improved upon. Recording systems are well established. However, their effectiveness is reduced by the method of recording in some areas. EVIDENCE: Senior staff and the members of the management team are readily on hand to deal with any issues that arise. Relationships between service users, staff and management during the inspection were seen to be friendly and respectful. Systems are in place for gaining feedback from relatives and interested parties about the home. This contributes to improvement and developmental plans
Ferfoot Care Homes D51_D01_S28628_FerfootCareHomes_V181374_210605_Stage4.doc Version 1.30 Page 18 that are produced on a regular basis. There is a five-year business plan that identifies the longer term aims. Records generally show a good awareness of risk and care matters. The system for the recording of care and assessments has developed over time, however it does not provide a well co-ordinated and user-friendly set of forms. The lay out and content of some forms vary and do not always include a good section for comment when care and assessments are reviewed. A new and different format would be beneficial by encouraging a more ‘person centred’ approach to what is reported. Ferfoot Care Homes D51_D01_S28628_FerfootCareHomes_V181374_210605_Stage4.doc Version 1.30 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 4 14 3 15 3
COMPLAINTS AND PROTECTION 3 3 x x x x x x STAFFING Standard No Score 27 3 28 4 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x 3 3 x x x 3 x Ferfoot Care Homes D51_D01_S28628_FerfootCareHomes_V181374_210605_Stage4.doc Version 1.30 Page 20 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 8 Regulation 17 Requirement That care is delivered by staff in accordance with the guidelines identified in the service users pressure sore prevention plans Timescale for action FROM 22/06/05 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 3 Good Practice Recommendations That a policy and procedure is drawn up concerning the action that needs to be taken to ensure that service users who are in need of nursing home care can move without undue delay That the system used for the recording of care and assessment information is reviewed in order to produce a more co-ordinated and user-friendly set of recording forms that better reflects the homes person centred approach to the provision of care That recording in the Bath section of the Bowel, Bath and Sleep form is expanded to give fuller details of the support that service users receive with their personal hygiene 2. 37 3. 37 Ferfoot Care Homes D51_D01_S28628_FerfootCareHomes_V181374_210605_Stage4.doc Version 1.30 Page 21 Commission for Social Care Inspection Avonbridge House Bath Road Chippenham Wiltshire SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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