Inspection on 09/05/06 for Fewcott House Nursing Home

This inspection was carried out on 9th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Fewcott House Nursing Home 25/09/07

Fewcott House Nursing Home 22/12/05

Fewcott House Nursing Home 02/06/05

Fewcott House Nursing Home 27/01/05

Fewcott House Nursing Home 22/06/04

Fewcott House Nursing Home 18/02/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Fewcott House Nursing Home Fritwell Road Fewcott OX27 7NZ Lead Inspector Kate Harrison Unannounced Inspection 9th May 2006 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 Fewcott House Nursing Home DS0000043201.V292970.R01.S.doc Version 5.1 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. Fewcott House Nursing Home DS0000043201.V292970.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Fewcott House Nursing Home Address Fritwell Road Fewcott OX27 7NZ 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) 01869 345501 01869 345502 admin@fewcott.com Fewcott Healthcare Limited Mrs Fairus Harrison Care Home 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 DS0000043201.V292970.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The total number of persons that may be accommodated at any one time must not exceed 35. Admittance of two named service users under the age of 65. Date of last inspection 22nd December 2005 Brief Description of the Service: Fewcott House is a small manor house (the original building dates from 1680), set in 2½ acres of gardens, with an ornamental lake. Situated in the small village of Fewcott, in an attractive rural setting, it 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, Mr Neeraj Harrison and their 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. 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. Fees range from £620 to £720 per week. Fewcott House Nursing Home DS0000043201.V292970.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the service was an unannounced ‘Key Inspection’. The inspector arrived at the service at 09.20 and was in the home for 8.5 hours. It was a thorough look at how well the service is doing. It took into account detailed information provided by the service’s deputy manager and owners, and any information that CSCI has received about the service since the last inspection. The deputy manager was the nurse in charge of the home, and the inspector discussed care issues with him, with other staff and with the owners. Records and other documents were also seen, and the inspector saw all areas of the home. The inspector asked the views of the people who use the services and other people seen during the inspection, and the Commission sent out questionnaires regarding the care provided at the home. Twelve replies were received from residents and relatives. From the evidence seen by the inspector and comments received, the inspector considers that this service would be able to provide a service to meet the needs of individuals of various religious, racial or cultural needs. The inspector looked at how well the service was meeting the standards set by the government and has in this report made judgements about the standard of the service. What the service does well: What has improved since the last inspection? An independent consultant has been advising the home on how to improve the care services, and as a result a new post of deputy manager has been created. A deputy manager has been recruited and is gradually improving the care services. Fewcott House Nursing Home DS0000043201.V292970.R01.S.doc Version 5.1 Page 6 A new format of care plans is being introduced to make it easier for staff to record residents’ needs and care appropriately. Regular times for relatives to meet with the home’s managers have started, and communications between relatives and management are improving through the use of questionnaires and a suggestions box. A new maintenance person is in post and is improving the management of maintenance issues. The introduction of regular audits has improved the recording of the administration of medicine. 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. Fewcott House Nursing Home DS0000043201.V292970.R01.S.doc Version 5.1 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 Fewcott House Nursing Home DS0000043201.V292970.R01.S.doc Version 5.1 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): 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The pre-admission information available about prospective residents is good. Standard 6 does not apply. EVIDENCE: The inspector saw the pre-admission information for some of the residents and assessed two personal files in detail. A registered nurse conducts the assessments and visits the prospective resident. All the necessary information was available from the discharging hospitals, and sufficient detail was available so that appropriate care plans were developed. Fewcott House Nursing Home DS0000043201.V292970.R01.S.doc Version 5.1 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 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The health and personal care arrangements are adequate, but the recording of medication is poor. EVIDENCE: A new format of care plans is being introduced to make it easier for staff to record residents’ needs and care appropriately. Residents are seen regularly by their GP, and one GP was in the home on the day discussing the needs of residents. Records seen show that the care plans are initially good, but that information from the daily recordings is not always used to update the care plans. A better system of updating the care plans should be in place, so that the changing needs of the residents are recorded and acted on. The evidence base of the home’s nutritional and falls risk assessments are not clear. It is recommended that the MUST nutritional risk assessment and the falls risk assessment recommended by the Oxfordshire Falls Service be used instead, as they are both strongly evidence based. Fewcott House Nursing Home DS0000043201.V292970.R01.S.doc Version 5.1 Page 10 Although some steps are being taken to improve daily life at the home, it is not clear that the emotional needs of the residents are met, as some residents with dementia were distressed during the day as they could not move about as they wished, and residents are not being provided with sufficient stimulation during the day. The registered manager should consider how the home could better meet the emotional needs of all the residents. Medication is kept securely and the introduction of regular audits has improved the recording of the administration of medicine. However, the recording of medication received into the home is not appropriate, as nurses do not record the receipt of all medication received. The registered manager must take action to ensure that all medication received into the home is recorded. An error by two nurses was also noted in the controlled drugs book, and the registered manager must ensure that all nurses attend appropriate medication training, so that residents’ health and welfare are protected. The drugs policy should be amended to show that all medication, from whatever source, received into the home must be recorded. The inspector noted that staff treated residents with respect during the day, and residents and visitors said that staff are respectful. Fewcott House Nursing Home DS0000043201.V292970.R01.S.doc Version 5.1 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 and 15. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The arrangements regarding daily life and social activities for the residents are poor, though the food provided is good. EVIDENCE: Visitors are welcome at the home, and some were in the home on the day of inspection. The home’s activities organiser works part time and during the week of inspection provided approximately 4 hours of activities for residents, spread over two days. The activity plan for the month shows some activities that are not suitable for all the residents, so many residents would not be able to participate in the few activities provided. No trips outside the home were planned. The home’s owners told the inspector that staff provide activities at other times, but one visitor said that he/she had arranged for a charity to provide an activity for his/her relative, as staff did not have enough time to have conversations with the resident. Another comment from a visitor concerned the quality of English language shown by some staff, saying that it is ‘incomprehensible’ for some elderly people to fully understand all that is being said. On the day of inspection several of the residents spent most of the day sitting in the lounge areas with little stimulation, and others spent long periods knocking on the locked doors wanting to get out. Fewcott House Nursing Home DS0000043201.V292970.R01.S.doc Version 5.1 Page 12 A recommendation from the previous inspection regarding activities has not been met, and remains in this report. The dining room is kept locked during the day, apart from the meal times, and this reduces the amount of space in the home that residents can use, as well as reducing their choice and control over where they spend their day. The home has very good outdoor space but access for residents is limited, though a few have access to the small courtyard garden. Daily life could be improved for all the residents, especially for the individuals with dementia, if risk assessed and planned access to the grounds was available. The tables in the dining room are arranged refectory style, and the tablecloths are covered by plastic, giving an institutional appearance to the room. To improve daily life for residents, and to meet all details of the home’s Statement of Purpose and Charter of Rights, the registered manager should consider how best to arrange access for residents to all parts of the home and grounds, and how the dining room can be made more homely for the benefit of residents. The chef has been at the home for several years and has a good understanding of the needs of the residents. Several residents said that the food was good, and one said that it was ‘very good’. Fewcott House Nursing Home DS0000043201.V292970.R01.S.doc Version 5.1 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 the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements regarding complaints and the protection of vulnerable adults are good. EVIDENCE: The complaints procedure is available to residents and relatives, and the deputy manager has improved the reporting and monitoring of complaints, following the previous inspection. One complainant has contacted the Commission with information concerning a complaint made to the service since the last inspection, and the home is currently dealing with the complaint. The home has an adult protection policy and staff have training in protecting vulnerable adults from abuse. Fewcott House Nursing Home DS0000043201.V292970.R01.S.doc Version 5.1 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 the following standard(s): 19 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management of the environment in general is adequate, but the arrangements in the laundry are poor. EVIDENCE: The home has good gardens, including a pond, though access is limited for residents. A new maintenance person has been in post for several months and is improving the maintenance systems at the home so that the environment is kept safe for residents. Few of the beds are adjustable and to protect staff from injury, the registered manager should work to increase the number of adjustable beds as soon as possible. The laundry is situated in the basement, and as the lift does not descend, staff bring the laundry down manually. Clothes awaiting washing were strewn on Fewcott House Nursing Home DS0000043201.V292970.R01.S.doc Version 5.1 Page 15 the stairs and were being sorted on the floor. Clean laundry was stored on top of the washing machine. The registered manager should improve the management in the laundry so that the risk of infection is minimised. Fewcott House Nursing Home DS0000043201.V292970.R01.S.doc Version 5.1 Page 16 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 and 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home’s staffing arrangements are poor. EVIDENCE: The home’s staffing statement shows the minimum numbers of staff needed for each shift. The staff rota for the three weeks around the inspection date show that for the 32 residents at the home the minimum numbers of staff were not usually available. Between 8am and 10pm the minimum numbers of carers should be six, as well as one nurse. Although the minimum numbers of nurses were always met, and most times two or more nurses were available, the number of carers overall did not meet the minimum staffing statement. At times only four carers were available. At night the minimum number of staff should be one nurse and four carers, but the rota shows that only two carers are usually on duty from 10pm until 8am, with one nurse. The registered manager must ensure that at all times appropriate numbers of competent carers are available for residents. Comments from relatives reflected concerns that sufficient numbers of staff were not always available, and coupled with the findings under ‘Daily Life and Social Activities’ it is not clear that the residents’ needs are met under the current staffing arrangements. The registered manager should improve the staffing arrangements so that all the assessed needs of the residents are met. Fewcott House Nursing Home DS0000043201.V292970.R01.S.doc Version 5.1 Page 17 The home has ten care staff including staff who are undertaking the registered nurse conversion course. Eight care staff hold NVQ Level 2 qualifications or above, so the home meets the standard of having 50 trained care staff. The home’s recruitment procedures were checked through three staff files. The home uses one agency and should have confirmation from the agency that all necessary information to meet regulation is available about staff working at the home. The home has an induction and on going training programme, and training such as basic dementia training and updates on medication training have recently been delivered for staff, though staff do not show evidence in performance that the training has been successful. Fewcott House Nursing Home DS0000043201.V292970.R01.S.doc Version 5.1 Page 18 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, 33, 35 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management arrangements are adequate. EVIDENCE: The registered manager, with support from the newly appointed deputy manager, manages the home, and is working towards her NVQ 4 in management. One relative noted that communications between relatives and management are ‘poor’, though the deputy manager has now started relatives ‘surgeries’, and intends to start regular relatives meetings soon. Annual questionnaires to relatives as part of the home’s improved quality assurance have started, and it is intended to inform relatives and residents of the outcome. A suggestion box is also available in the hall for comments from visitors. Fewcott House Nursing Home DS0000043201.V292970.R01.S.doc Version 5.1 Page 19 Residents who need help with managing petty cash contribute to the home’s account held on behalf of the residents. Services delivered at the home for residents, such as chiropody and hairdressing, are invoiced to the provider, who pays from the account. Since the last inspection the named nurses are responsible for ensuring that a record is kept of residents’ personal property. The home has a written health and safety policy statement and moving and handling training is provided for staff to protect them from injury. Health and safety audits have recently started, though on the day of inspection the hot water temperature in one resident’s wash-basin measured 46.6 degrees Fahrenheit, higher than the recommended temperature of around 43 degrees. The registered manager should ensure that the hot water available to residents is delivered at the appropriate temperature. The written risk assessments regarding control of substances hazardous to health have started and should be completed. Fewcott House Nursing Home DS0000043201.V292970.R01.S.doc Version 5.1 Page 20 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 Fewcott House Nursing Home DS0000043201.V292970.R01.S.doc Version 5.1 Page 21 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. 1 Standard OP9 Regulation 13 Requirement The registered manager must take action to ensure that all medication received into the home is recorded. The registered manager must ensure that at all times appropriate numbers of competent carers are available for residents. Timescale for action 31/05/06 2 OP27 18 16/06/06 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 OP7 Good Practice Recommendations A better system of updating the care plans should be in place, so that the changing needs of the residents are recorded and acted on. This recommendation remains from the previous inspection. Evidence based risk assessment formats, such as the MUST nutritional risk assessment and the Oxfordshire Falls Service falls risk assessment should be used. DS0000043201.V292970.R01.S.doc Version 5.1 Page 22 2 OP7 Fewcott House Nursing Home 3 4 5 6 OP8 OP9 OP9 OP12 7 8 9 10 11 12 13 14 OP14 OP15 OP19 OP26 OP27 OP29 OP38 OP38 The registered manager should consider how the home could better meet the emotional needs of all the residents. The drugs policy should state that all medication received into the home must be recorded. The registered manager should ensure that all nurses attend appropriate medication training so that residents’ interests are protected. 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. This recommendation remains from the previous inspection. To improve daily life for residents the registered manager should arrange access for residents to all parts of the home and grounds. The registered manager should consider how the arrangements in the dining room could be improved. The registered manager should work to increase the number of adjustable beds at the home as soon as possible. The registered manager should improve the management in the laundry so that the risk of infection is minimised. The registered manager should improve the staffing arrangements so that all the assessed needs of the residents are met. The home should have confirmation from agencies supplying staff that all the necessary information to meet regulation is available about staff working at the home. The registered manager should ensure that the hot water available to residents is delivered at the appropriate temperature. The written risk assessments regarding control of substances hazardous to health should be completed. Fewcott House Nursing Home DS0000043201.V292970.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Oxford Area Office 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 DS0000043201.V292970.R01.S.doc Version 5.1 Page 24 - 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. 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