CARE HOMES FOR OLDER PEOPLE
Fewcott House Nursing Home Fritwell Road Fewcott Oxfordshire OX27 7NZ Lead Inspector
Delia Styles Unannounced 02 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. Fewcott House Nursing Home H57-H08 S43201 Fewcott House V230229 020605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Fewcott House Nursing Home Address Fritwell Road, Fewcott, Oxfordshire, OX27 7NZ 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) 01869 345501 01869 345502 admin@fewcott.com Fewcott Healthcare Limited Mrs Fairus Harrison Care Home with Nursing 35 Category(ies) of Dementia - over 65 years of age(8), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age(4), Old age, not falling within any other category(35). Fewcott House Nursing Home H57-H08 S43201 Fewcott House V230229 020605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Admittance of one named under age service user. Date of last inspection 27 January 2005 Brief Description of the Service: Fewcott House is a small manor house (the original building dates from 1690) set in 2.5 acres of gardens with an ornamental lake. It is situated in the small village of Fewcott, in an attractive rural setting and is conveniently accessible from the motorway and major road routes from Bicester, Oxford and Banbury. The home was originally registered as a nursing home in 1985, with 14 beds. A purpose built extension was added and the home was registered to accommodate a total of 37 residents in 1987. The present registered owner and co-directors, Ms Neeru Harrison and her parents, Mr H and Mrs F Harrison, bought Fewcott House in March 2003. The home offers care to physically and mentally frail older people with nursing needs. Accommodation is in either single or shared rooms. There are nine single rooms and 13 shared rooms. First floor rooms are served by a passenger lift and two stairways. Most rooms are equipped with small en-suite shower/toilet cubicles. There are four communal bathrooms, two of which have bath hoists, and 3 communal toilets. Fewcott House Nursing Home H57-H08 S43201 Fewcott House V230229 020605 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place over four hours during an afternoon. The inspector spoke to six residents, two visitors, the manager and co-directors of the home (Mrs Harrison, Mr Harrison and Ms Harrison), senior nurse, Ms Jackson, and two nursing staff. A partial tour of the building was done, visiting the lounges, dining room, communal bathrooms and toilets and two individual resident’s rooms. What the service does well: What has improved since the last inspection? What they could do better:
The home should have more daily activities for residents to give them more opportunities to share time together and to enjoy different types of individual and group activities that suit them. Assessment of residents’ needs and care planning should continue to be improved to ensure that staff are able to know what to do for each person and for the records to show that the care has been carried out satisfactorily. The care assessments should include detailed information about each person’s physical, mental and social needs. The recommendation made at previous inspections - that the proprietor fits special valves to pipes under the basins to control the temperature of the hot water - has not been carried out. The hot water temperature to some washbasins in residents’ rooms and communal bathrooms and toilets is too high and must be reduced to lessen the risk of residents scalding themselves. Although maintenance staff do check hot water temperature regularly, this is done in the early mornings and so this may not show that the water can get too hot at
Fewcott House Nursing Home H57-H08 S43201 Fewcott House V230229 020605 Stage 4.doc Version 1.30 Page 6 other times of the day. Testing of the hot water temperature should be done at different times of the day and adjustments made at the boilers and valves if necessary, to make sure the hot water never reaches a temperature likely to cause injury to residents. The hot water to the baths is controlled, so that the water was not too hot. There is still no formal system of supervision of staff in place. All staff should have time set aside to meet individually with a senior member of staff at least 6 times a year to discuss their work and any problems, their progress, and training needs they may have. A record should be kept of these ‘supervision’ sessions, so that both staff members know what has been discussed and any action to be taken. This is good employment practice and helps staff to feel valued and to know that they have regular opportunities to have time set aside from their work to share their opinions. Staff have not had specific training in how to care for people who have dementia. The home is registered to admit older people who are confused and who need care that helps them to feel comfortable and ‘at home’. Staff should have extra training to help them gain the skills needed to care for this resident group and to help lessen the problems residents might have because of their memory loss. 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. Fewcott House Nursing Home H57-H08 S43201 Fewcott House V230229 020605 Stage 4.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 Fewcott House Nursing Home H57-H08 S43201 Fewcott House V230229 020605 Stage 4.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) 3,4 and 5 The home provides written information for prospective residents in the form of the Statement of Purpose and Service User Guide. People are given the opportunity to visit the home with their representatives before admission so that they can be clear about the services the home provides. EVIDENCE: Visitors said that they had consulted with the home’s managers and care managers before their relative had been admitted to Fewcott House and had visited the home in person to see the facilities for themselves. They were able to visit frequently and confirmed that their relatives’ care needs were being met. The residents’ care plans showed that their needs had been assessed by a senior nurse or manager, before they came into the home. Fewcott House Nursing Home H57-H08 S43201 Fewcott House V230229 020605 Stage 4.doc Version 1.30 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 Since the last inspection there have been some improvements made to the care planning system. Further work is needed to make sure that the care plan instructions are up to date, and detailed enough to provide staff with the information to carry out the care, and to demonstrate that the care given meets the residents’ needs. EVIDENCE: The residents’ care record is a computer-generated list of each person’s care needs and the action to be taken by staff. This is updated and reviewed monthly after discussion with the nursing staff in the home, the home manager and administrator (also a nurse). There were some instances where the printed information did not match more recent care needs of the resident which had been written into a handwritten daily care plan sheet for listing any changes. This was confusing and could result in out of date care instructions being followed by staff. The amount of information about resident’s social care needs was minimal. There was a variety of assessment measures to show people’s risk of skin damage, their nutritional status, general dependency (for staff assistance), but a lack of detailed information about the action that is taken by staff to reduce any identified risk. This resulted in some duplication
Fewcott House Nursing Home H57-H08 S43201 Fewcott House V230229 020605 Stage 4.doc Version 1.30 Page 10 and no clear plan of action for staff to follow to show how the individual risk factors were being dealt with. The care needs should be developed into care plans, showing in more detail the actions to be taken by staff, and with a section evaluating the care, to show whether the care need or problem has been improved as a result of the care given. There was insufficient information in care plans about how staff should provide care for residents with confusion and short-term memory loss. There was evidence of regular visits from local doctors, community mental health nurses and social workers. Fewcott House Nursing Home H57-H08 S43201 Fewcott House V230229 020605 Stage 4.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) 12 & 13 There has been limited progress in addressing the need for daily activities and social opportunities for residents, in particular for those residents with mental health needs. EVIDENCE: The home employs a part-time activities helper for 2 afternoons in the week. Care staff do try to involve residents in ad hoc activities, for example, taking people out in the grounds and to see the horses in the adjacent fields. The senior nurse spoken with had an understanding of individual resident’s interests and hobbies, though specific plans of care did not record these or show how these would be addressed in practice. Staff were seen to welcome visitors to the home. One visitor said that they have to rely on taxis for transport as local public transport is poor, but that they come most days. Most residents were sitting in the conservatory and sitting rooms, with the radio, music centre or t.v on during the afternoon. The t.v reception was poor and needed adjustments in one sitting room and a resident’s room, to improve the picture. Staff should ensure that residents make a positive choice about the television (or radio/music) programme, and that there is satisfactory sound and picture quality to help them enjoy this activity. The home has piped music playing that is audible in the reception and corridor areas, but was not obtrusive in the communal sitting rooms.
Fewcott House Nursing Home H57-H08 S43201 Fewcott House V230229 020605 Stage 4.doc Version 1.30 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 The home has a satisfactory complaints system with evidence that residents’ and their representatives concerns are investigated and responded to promptly. EVIDENCE: The home had received one formal complaint since the last inspection. This related to an incident of aggression between two residents with mental health needs. The registered manager had investigated the concerns and responded to the family of one resident within the timescale set out in the home’s complaints procedure. It was not known whether the family was satisfied with the home’s response at the time of this inspection. Fewcott House Nursing Home H57-H08 S43201 Fewcott House V230229 020605 Stage 4.doc Version 1.30 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) 25 & 26 The standard of the environment within the home is good and provides an attractive, clean and homely place to live. The hot water temperature to several wash basins was excessive and poses a danger of scalding to residents and action must be taken to prevent this. EVIDENCE: The home is very clean and the lounges and conservatory area, and individual’s rooms visited during this inspection were well decorated, comfortable and smelled fresh. The proprietor has not yet acted on recommendations made at previous inspections to install a sluice disinfector machine in the sluice room. A sluice machine would provide a more effective means of cleaning and disinfecting used commode inserts and other used sanitary equipment. It also is safer for staff and residents than using the current method of using disinfecting sprays and soaking utensils in bleach solutions. The proprietor said that he is still considering undertaking this work.
Fewcott House Nursing Home H57-H08 S43201 Fewcott House V230229 020605 Stage 4.doc Version 1.30 Page 14 The temperature of the hot water from the taps at basins in some ground floor rooms was excessively hot. There is a risk of scalding to residents who are confused or who are unable to move their hands out of the flow of water quickly. The inspector raised this with the proprietors at previous inspections when it was agreed that a programme of work to fit temperature regulating valves to the basin pipes would be started. This work must be completed by the end of June 2005. Fewcott House Nursing Home H57-H08 S43201 Fewcott House V230229 020605 Stage 4.doc Version 1.30 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 & 30 The numbers of staff appear to meet the physical care needs of residents, but there should be more allocation of staff to attend the recreational and social aspects of care. EVIDENCE: The home employs four staff through an agency: these staff live in a house owned by the proprietors and are familiar with the home and residents. The home also has 2 staff who are registered nurses undertaking an adaptation course to enable them to register to practice as nurses in the UK. There was evidence that agency staff have appropriate training in health and safety topics. Six of the current care staff are undergoing National Vocational Qualifications (NVQ) Level 2 training in care. The activities worker is part-time and works for two afternoons per week. Care staff have not had specific training in caring for people with dementia. Many of the residents have dementia-type illnesses and staff should have additional training to further develop their abilities to care for this client group. As noted at earlier inspections, many of the care staff, particularly the agency staff, work long hours and undertake a range of care and domestic work in the home. There is a risk that staff who work long hours and a variety of day and night shifts, will become overtired and put themselves and residents at risk because they are more likely to make mistakes or have accidents. This was
Fewcott House Nursing Home H57-H08 S43201 Fewcott House V230229 020605 Stage 4.doc Version 1.30 Page 16 discussed with the proprietors who said they do monitor the duty rosters and would limit staff member’s hours if it was apparent that they were working excessively. Fewcott House Nursing Home H57-H08 S43201 Fewcott House V230229 020605 Stage 4.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) 36 There is still no system in place for regular formal supervision of care staff: this has been raised at previous inspections. EVIDENCE: The proprietors said that the supervision paperwork was now ready and that the programme of regular meetings with each individual staff member would be implemented. It is good employment and training practice for employees to have time set aside with their manager to discuss their work, progress and training needs. The meetings should have a formal record, with copies held by the employee and their supervisor so that they can refer to the content of previous supervision meetings and the actions taken as a result of their discussions. Fewcott House Nursing Home H57-H08 S43201 Fewcott House V230229 020605 Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 x
COMPLAINTS AND PROTECTION x x x x x x 2 2 STAFFING Standard No Score 27 3 28 x 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x x x x 2 x x Fewcott House Nursing Home H57-H08 S43201 Fewcott House V230229 020605 Stage 4.doc Version 1.30 Page 19 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 25 Regulation 13:4(a) Requirement Hot water temperatures are maintained within recommended safe limits by fitting pre-set valves with fail-safe devices to all outlets accessible by residents. Timescale for action 30/06/05 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. 2. Refer to Standard 3.3 2 Good Practice Recommendations Include more detail in the needs assessment for all aspects of care, including mental state and cognition, social interests, hobbies and religious and cultural needs etc Ensure that the services for residents with dementia are based on current good practice and that staff individually and as a team have the skills and experience to deliver care to this client group. Ensure that residents care plans are sufficiently detailed, updated to show their current care needs, and evaluated to show whether the care given has been appropriate to meet their needs. Implement the MUST nutritional assessment tool, to be undertaken on admission and reviewed, updated and showing that appropriate action has been taken in relation to nutritional needs.
H57-H08 S43201 Fewcott House V230229 020605 Stage 4.doc Version 1.30 Page 20 3. 7.2 4. 8.9 Fewcott House Nursing Home 5. 6. 12.3 25.8 and 38.3 7. 8. 26.6 36.2/3/4 Increase the opportunities for residents to be involved in individual and group activities both inside and outside the home, to suit their needs, preferences and capacities. Vary the times of testing the hot water temperature at all outlets accessible to residents and take prompt action to adjust where necessary, to ensure that the temperature range is kept close to the recommended maximum and reduce the risk of scald injuries to residents. Install a sluicing disinfecting machine. Staff receive individual formal supervision at least 6 times a year and written records are maintained of the supervision sessions. Fewcott House Nursing Home H57-H08 S43201 Fewcott House V230229 020605 Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection Burgner House, 4630 Kingsgate, Cascade Way, Oxford Business Park South, Cowley, Oxford OX4 2SU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© 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 Fewcott House Nursing Home H57-H08 S43201 Fewcott House V230229 020605 Stage 4.doc Version 1.30 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
