CARE HOMES FOR OLDER PEOPLE
Ferfoot Care Homes Old and New House The Folly, Old Hardenhuish Lane Chippenham Wiltshire SN14 6HH Lead Inspector
Malcolm Kippax Unannounced Inspection 7th December 2005 09:20 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 Ferfoot Care Homes DS0000028628.V273035.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. Ferfoot Care Homes DS0000028628.V273035.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Ferfoot Care Homes Address Old and New House The Folly, Old Hardenhuish Lane Chippenham Wiltshire SN14 6HH 01249 658677 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) Ferfoot Limited Mrs Bridget Ann Barton Care Home 56 Category(ies) of Dementia - over 65 years of age (56), Mental registration, with number disorder, excluding learning disability or of places dementia (1) Ferfoot Care Homes DS0000028628.V273035.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. No more than 1 service user with Mental Disorder, under the age of 65. 21st June 2005 Date of last inspection 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 is 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 DS0000028628.V273035.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place between 9.20am and 3.50pm. Service users were met with in the communal areas of the two houses. The home specialises in the care of older people with dementia and mental health needs; direct conversation about their care and their experience of the home was limited. Interactions between staff and service users were observed. A relative who was visiting gave her opinions about the home. As part of the inspection process, the Commission has received 25 comment cards from relatives and visitors. There was an individual meeting with one member of staff. Other staff members were met with during the course of the inspection. A Team leader was in charge at the start of the inspection. Mrs T. Novik was also available for much of the time. Records, including care reports, health & safety, medication and social activities were looked at. The communal rooms were seen in both houses. This inspection focussed on a number of key standards that were not looked at during the previous inspection of the home. All the key standards have been looked at over the two inspections. A pharmacist inspector from the Commission examined the home’s medication arrangements. What the service does well: What has improved since the last inspection?
Ferfoot Care Homes DS0000028628.V273035.R01.S.doc Version 5.0 Page 6 It was reported at the last inspection that staffing levels were being increased, with the deployment of an additional carer in each house during the day. The team leader said that this higher staffing level was being maintained and that the extra staffing meant that carers had more time to spend with individual service users. The manager said that a recommendation made at the last inspection about record keeping was being followed up. This was in order to produce a more co-ordinated and user-friendly set of forms that reflects the homes person centred approach to care. At the time of the last inspection, some external factors were contributing to delays when particular service users had been assessed as needing nursing home care. The manager said that two service users had since moved to nursing homes and that following this experience, similar delays should not arise. 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
Ferfoot Care Homes DS0000028628.V273035.R01.S.doc Version 5.0 Page 7 contacting your local CSCI office. Ferfoot Care Homes DS0000028628.V273035.R01.S.doc Version 5.0 Page 8 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 Ferfoot Care Homes DS0000028628.V273035.R01.S.doc Version 5.0 Page 9 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): These standards were not looked at on this occasion. (Standard 3 was inspected and met at the last inspection). EVIDENCE: Ferfoot Care Homes DS0000028628.V273035.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): 9 Service users are protected by the homes policy and procedures for the safe handling of medication. (Standards 7, 8 and 10 were inspected at the last inspection. Standards 7 & 10 were met and standard 8 was almost met). EVIDENCE: Medication is stored securely and appropriate records maintained. Medication administration records are signed and checked and photographs of service users available. The home has a policy for the handling, administration and disposal of medicines. Staff involved in medication have all received training. Up to date information about medicines is available in both houses. District nurses take relevant blood tests and administer injections. Completed medication courses are sometimes printed on the medication administration record, these should be crossed through, dated and signed. Variable warfarin doses are recorded in the care plans, but not on the medication administration record; this is the primary source of information and should be kept current. Ferfoot Care Homes DS0000028628.V273035.R01.S.doc Version 5.0 Page 11 The details of standard 8 were not inspected on this occasion. However, there was discussion with Mrs Novik about the way in which pressure sore prevention and the involvement of staff are recorded. This had been looked at during the previous inspection. The recording format has changed since the last inspection and a single chart is now in use, for example to record when service users have received preventative care from staff. Care is recorded as having been given within a two-hour period, such as 2pm – 4pm, but the actual time is not shown. This is important because interventions need to be made within specific periods of time during the day. The records show that some people receive regular care throughout the day during periods of ‘bed rest’, although nothing is recorded at other times of day. For these people, an entry should be recorded within each two-hour period to avoid any uncertainty about what care was needed at that time and whether a period of bed rest had ended. Mrs Novik said that the current arrangements were successful in preventing pressure sores from occurring. Ferfoot Care Homes DS0000028628.V273035.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): 12 Daily life and the provision of social activities reflect the service users’ different needs and expectations. There is good range of social and therapeutic activities being provided. A change in the way that day to day activities are recorded would be beneficial. (Standards 13, 14 and 15 were inspected at the last inspection. Standards 14 and 15 were met and the home was commended in respect of standard 13). EVIDENCE: Dependency levels and the extent of a service user’s dementia were seen to be a major factor in determining how service users spend their time and what activities they take part in. Conversation with the more dependant service users was not possible. The majority of service users were using the lounges and were relatively active, whereas other people were in their rooms for periods of ‘bed rest’. Speaking of her husband’s situation, a visitor said that he was not able to be practically involved in activities himself, but there were a lot of different things happening in the home. The visitor also felt that staff members were considerate of people who could not take an active part but would benefit from observing what other people were doing and taking a passive role. One of service user met with said that she takes part in ‘anything that is going’ and particularly likes the music. It was evident that music plays a big part in the home, either in the background or as a more active pastime.
Ferfoot Care Homes DS0000028628.V273035.R01.S.doc Version 5.0 Page 13 This included an organist who plays in the home each week and other spontaneous ‘singalongs’ and movement sessions involving staff and service users. A staff member in the role of activities organiser was met with during the inspection. She spends ‘hands-on’ time with service users for a two-hour period in the morning and in the afternoon. The activities organiser said that families provided useful information when service users could not express their own views about their interests and preferences. Good attention has been given to drawing up a list of different activities. These are defined under various headings such as ‘Sensory’, ‘Spiritual’, ‘Musical’ and ‘Horticultural / Outdoor’. A Methodist service takes place in the home every two months. An art therapist also visits the home every Wednesday and was doing individual work with a service user on the afternoon of the inspection. Information was well displayed in the home about activities and social events, although a notice about bingo suggests that this is happening each day, rather than on each Thursday. A record is kept of the activities that have taken place each day. In the last few days this has included Christmas related activities and the home was looking very festive at the time of the inspection. A pantomime and family party had taken place on the day before. The activities organiser said that efforts were made to provide activities that would be appropriate for the more dependant service users. In some cases, the names of service users attending group activities have been recorded. Other more individual activities such as ‘chatting’, do not identify a particular service user. This means that it is difficult to assess the involvement of some service users and the frequency of activities. In a comment card, one relative said that Ferfoot is one of the best homes ‘with regard to personal care, health & hygiene matters, meals and the personal qualities of the carers’ The relative felt that one are in which the home could improve would be the provision of more activities, but added that this was being addressed. Ferfoot Care Homes DS0000028628.V273035.R01.S.doc Version 5.0 Page 14 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): 18 The arrangements in the home are helping to safeguard service users from abuse. (Standard 16 was inspected and met at the last inspection). EVIDENCE: The home has a policy and procedure about vulnerable adults and the prevention of abuse. Other guidance for staff has been produced in related areas such as risk taking, the use of restraint and the reporting of bad practice, including ‘whistle blowing’. The management team have had experience of the adult protection referral system. A staff member met with confirmed her awareness of the vulnerable adults procedure. The protection of vulnerable adults was included as a subject within the home’s training plan for 2006. Abuse is covered in the home’s induction programme and the 2006 training plan includes the involvement of 18 staff in a new VRQ in dementia care, which is reported to include an element on abuse. The staff training records showed attendance on a number of courses in which good practice in respect of abuse would be a component. Mrs Novik said that it was not the intention for all staff to receive the same training in abuse and adult protection. It is however the intention for staff members and the management team to receive the information and training which is appropriate for the position and responsibilities held. Mrs Novik was recommended to detail this within the home’s training plan. Ferfoot Care Homes DS0000028628.V273035.R01.S.doc Version 5.0 Page 15 During the inspection, staff members were seen to be dealing with service users in a positive and friendly manner. Service users were able to move around within the accommodation, with prompting and encouragement from staff to maintain safety and prevent disorientation. Ferfoot Care Homes DS0000028628.V273035.R01.S.doc Version 5.0 Page 16 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): 26 Service users benefit from cleaning arrangements in the home and the involvement of ancillary and care staff. (Standards 19 and 20 were inspected and met at the last inspection). EVIDENCE: A laundry person was working during the day and there are separate laundry facilities in each house. There were two housekeepers deployed at the time to carry out the main cleaning tasks. Some service users have continence problems and behaviour that can have an impact on hygiene and cleanliness within the home. During the inspection, staff members were readily on hand and responded positively to one incident in a lounge in which a service user was in need of assistance. A visitor met with was familiar with the challenges that staff face and thought that although there were some occasional incidents, hygiene and cleanliness are generally well maintained. There were no unpleasant odours at the time and the home looked tidy.
Ferfoot Care Homes DS0000028628.V273035.R01.S.doc Version 5.0 Page 17 Cleaning schedules have been produced and there are rotas for particular jobs, such as shampooing the carpets. Ferfoot Care Homes DS0000028628.V273035.R01.S.doc Version 5.0 Page 18 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): These standards were not assessed on this occasion. (Standards 27, 28, 29 and 30 were inspected at the last inspection. Standards 27 and 29 were met and the home was commended in respect of standards 28 and 30). EVIDENCE: The deployment of staff during the confirmed with the team leader at the start of the inspection. There were no changes to the written staff roster. During the last year the staffing levels during the day have increased by one carer in each house. Ferfoot Care Homes DS0000028628.V273035.R01.S.doc Version 5.0 Page 19 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, 35 and 38 Services users benefit from an experienced management team. Service users are not able to safeguard their own financial interests and this is the responsibility of people outside the home. Safety is well promoted within the home. (Standards 32, 33 and 37 were inspected and met at the last inspection). EVIDENCE: The managers are suitably qualified and experienced. Mrs Novik’s qualifications include the Registered Managers Award and NVQ level 5 Operational Management. Members of the management team continue to undertake further training in support of their roles. Ferfoot Care Homes DS0000028628.V273035.R01.S.doc Version 5.0 Page 20 Service users have dementia and related needs, which reduces their capacity to manage their own financial affairs. Mrs Novik said that the home had no involvement with the service users’ personal money and that this was dealt with by relatives or by an appointee from Wiltshire County Council. Mrs Novik said that the fees now covered all of the service users’ day to day needs, other than for the cost of clothes. The home has several health & safety related policies and procedures. These cover such areas as the kitchen, fire safety, accident reporting and environmental hazards. Guidance had been produced about maintaining safety in icy weather. Problems and items in need of repair are reported in a book for the attention of the maintenance person. The records showed that jobs are promptly responded to. A daily handover sheet is filled in by the shift leader and this includes the completion of a security checklist. There was a fire risk assessment, which was dated 16 February 2005. Other risk assessments are being carried out in relation to specific hazards. In some cases, reviews were shown by changing the original date of an assessment, rather than by adding a new date. The home’s fire log book was up date. The time at which fire drills take place should be added to the record, together with the names of all staff who have participated. There are arrangements in place for the servicing of specialist facilities and items of equipment. The hoists were last serviced in during June and July 2005. Ferfoot Care Homes DS0000028628.V273035.R01.S.doc Version 5.0 Page 21 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 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 X X X X X X X 3 STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 X X 3 Ferfoot Care Homes DS0000028628.V273035.R01.S.doc Version 5.0 Page 22 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. Standard Regulation 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 OP8 Good Practice Recommendations That further details are included on the record of pressure sore prevention care. This would include for example the time at which care was given and the recording of an entry within each two-hour period to avoid any uncertainty about what care was needed at that time and whether a period of bed rest had ended. Medication administration records should reflect all current drug treatments and doses in addition to any information kept elsewhere. That further information about the involvement of individual service users is included in the record of activities. This will make it easier to assess how well the activities programme is meeting the needs of all the service user and to what extent each service user has participated. This is particularly relevant in respect of the more dependant service users. That the home’s training plan includes details of how the
DS0000028628.V273035.R01.S.doc Version 5.0 Page 23 2 3 OP9 OP12 4 OP18 Ferfoot Care Homes 5 6 OP38 OP38 subject of abuse is covered within the different training events and which events different members of the staff and management team are expected to attend. That the original date on which a risk assessment took place is not altered. That the time of day and the names of all staff members involved are added to the record of fire drills. Ferfoot Care Homes DS0000028628.V273035.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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