CARE HOME ADULTS 18-65
Fiennes House Drakes Park North Wellington Somerset TA21 8TB Lead Inspector
Sue Hale Unannounced Inspection 15th November 2005 08:30 Fiennes House DS0000038170.V257140.R01.S.doc Version 5.0 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 Fiennes House DS0000038170.V257140.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 Adults 18-65. 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. Fiennes House DS0000038170.V257140.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Fiennes House Address Drakes Park North Wellington Somerset TA21 8TB 01823 661529 01823 662319 fienneshouse@seeability.org 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) SeeAbility Mr Stephen Rowland Mudway Care Home 7 Category(ies) of Learning disability (0), Physical disability (0), registration, with number Sensory impairment (0) of places Fiennes House DS0000038170.V257140.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Registered for 7 persons in categories LD, PD and SI. Date of last inspection 16th June 2005 Brief Description of the Service: Fiennes House is registered with the Commission for Social Care Inspection to provide personal care for up to seven people under the age of 65. It is registered in the categories of sensory impairment, physical disability and learning disability. The providers are See Ability, a registered charity. The home is purpose-built and situated close to all the amenities of Wellington. All bedrooms are single occupancy, five residents have full en suite facilities and two residents share an assisted bathroom. The home is surrounded by well maintained landscaped gardens, including a ‘sensory’ garden. The gardens are fully accessible for wheelchair users. In addition to the home, there is an activity and resource centre adjacent to the home that residents can access this is known as the Bill Cooke Centre. Fiennes House DS0000038170.V257140.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over the course of one day in November 2005. The inspector viewed all parts of the home, checked all records relating to three individual residents including care and support plans and the accident book. Selected staff files were examined. The inspector spoke to the manager and four members of staff on duty. The inspector met some of the residents that were at home on the day of the inspection. There were no relatives or friends of residents visiting the home on the day of the inspection. As a result of this inspection, two requirements were identified and three recommendations made. What the service does well: What has improved since the last inspection?
All staff has received training in fire safety. The staff roster had been reviewed and an extra part time member of staff is available during the weekend to ensure that residents are able to access social and leisure opportunities.
Fiennes House DS0000038170.V257140.R01.S.doc Version 5.0 Page 6 A washbasin in one resident’s room had been replaced to provide better access to this area. The menu had been reviewed and healthy eating promoted. The homes financial procedures had been reviewed and two staff signatures are now obtained for service user’s financial transactions. 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. Fiennes House DS0000038170.V257140.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Fiennes House DS0000038170.V257140.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 A thorough pre-admission process was in place to ensure the home could meet residents’ needs. EVIDENCE: There have been no new admissions since March 2001. However, the inspector viewed three care plans and there was evidence that detailed assessments took place prior to residents being admitted to the home. Relatives had been involved with the pre admission process and the home had obtained information from the local authorities that were funding placements. Staff told the inspector that the pre-admission process would be well planned, takes approximately 12 weeks and would involve visiting the prospective residents in their own environment and arranging for trial periods to be spent at the home. The needs of existing residents would be taken into account when any new admission was being considered. Fiennes House DS0000038170.V257140.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,9 Residents care plans are user-led, detailed and are reviewed on a regular basis. Detailed risk assessments are conducted where needed. EVIDENCE: The inspector viewed three care plans both of which were very well maintained, detailed, signed and dated. They had been reviewed on a monthly and basis and are formally reviewed on an annual basis in a multi-disciplinary type review. A plan of action clearly sets out the needs identified and person/s responsible. There was evidence to demonstrate that the residents, their families and care managers are involved in the care planning process. Each of the care plans viewed had risk assessments where needed. Fiennes House DS0000038170.V257140.R01.S.doc Version 5.0 Page 10 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15,17 The home encourages residents’ families and friends to maintain contact and they are able to freely visit the home. The home has a healthy eating planned menu with choices offered. EVIDENCE: The home encourages contact with residents’ family and friends. Records were kept in residents care files of significant events such as families’ birthdays and contact with family was recorded. The home has a kitchen/dining area that is domestic in style and conducive to a family type environment so that everyone can sit around the table for meals. It is a pleasant area where residents can actively or passively be involved in meal preparation according to their assessed need. The home has a planned menu that is based on known likes and dislikes of the service users. This has been recently reviewed to further promote healthy eating options.
Fiennes House DS0000038170.V257140.R01.S.doc Version 5.0 Page 11 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 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 Residents receive support in the manner they prefer and have access to appropriate health care professionals as necessary. EVIDENCE: The care plans that the inspector viewed indicated the way in which residents preferred to receive their personal care. All residents have a key worker. Staff will are proactive in involving multi-disciplinary healthcare professionals, including appointments with physiotherapists, GPs, speech and language therapists in addition to consultant specialists. Records are kept of all contact with healthcare professionals and any advice or treatment recommended. The home has a mobility officer who works with staff to ensure that current and developing mobility needs are addressed. Care staff assist residents with personal care in the privacy of en-suites or the communal bathroom. Appropriate equipment is in place to allow people to be as independent as possible and to be assisted in a dignified manner. Staff spoken to were familiar with the needs and preferences of individual residents. Fiennes House DS0000038170.V257140.R01.S.doc Version 5.0 Page 12 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23 Appropriate measures to safeguard residents and investigate allegations of abuse were not taken. EVIDENCE: The home had a detailed complaints policy and procedure. The home had received one allegation of abuse since the last inspection; this had been dealt with using the complaints procedure, and not the homes protection of vulnerable adults policy and procedure or the Somerset Safeguarding Vulnerable Adults policy. This had been dealt with by the homes head office as the manager had been on leave. The inspector noted that the allegation referred to an incident that occurred some months previously. The home should ensure that all allegations of abuse are recorded and investigated in line with the Somerset Safeguarding Vulnerable Adults policy and in conjunction with other agencies as appropriate including the Police, Social Services and the Commission for Social Care Inspection. The Commission for Social Care Inspection must be informed of any such incident. This will be addressed separately to this report. The homes policy and procedure in relation to abuse should be revised to reflect good practice and guidance contained within the Department of Healths ‘No Secrets’ document. All staff should be made aware of the correct procedure to follow should an allegation of abuse be received. The manager was unaware if the home had a copy of the Somerset Safeguarding Vulnerable Adults policy or the Department of Healths guidance ‘No Secrets’.
Fiennes House DS0000038170.V257140.R01.S.doc Version 5.0 Page 13 The home has a number of systems to safeguard vulnerable people which include a whistle blowing policy for staff and recruitment policies that mean that new staff do not start work at the home until a satisfactory enhanced Criminal Records Bureau clearance has been obtained. Fiennes House DS0000038170.V257140.R01.S.doc Version 5.0 Page 14 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 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 assessed; the home was clean, tidy and free from odours on the day of the inspection. EVIDENCE: Reference to these standards can be found in the previous inspection report of the 16th June 2005. Fiennes House DS0000038170.V257140.R01.S.doc Version 5.0 Page 15 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33,34 The home has a robust recruitment process designed to protect residents from abuse. Staffing levels at weekends had improved since the last inspection. EVIDENCE: The inspector viewed the staff file for one recently appointed member of staff. It contained the appropriate documentation as detailed in Schedule 2 of the Care Homes Regulations so as to protect vulnerable adults. A part time member of staff had been allocated to work at weekends to increase the staffing numbers and to enable the residents to become involved with leisure and social activities in line with their choices and preferences. This was recommended in the previous report. A member of staff spoken to said that at weekends there was ‘enough staff for residents to go out if they wanted to’. All staff spoken to said that there was a wide variety of training available and encouragement and support from management to ensure that they could obtain the skills and experience necessary to provide a good quality of care for residents.
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The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 43 Residents’ benefit from living in a well run and well managed home. EVIDENCE: The manager of the home draws up an annual development plan that is forwarded to head office and considered in the development of See Abilities financial and business plan for the home. Appropriate insurance cover was in place including for business interruption costs. See Ability has systems in place in relation to financial planning, budget monitoring, human resources, training and quality monitoring. Staff spoken to confirmed that the lines of accountability within the home are clearly understood. Fiennes House DS0000038170.V257140.R01.S.doc Version 5.0 Page 17 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 3 X X X Standard No 22 23 Score X 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 X X 3 X Standard No 24 25 26 27 28 29 30
STAFFING Score X X X X X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 3 16 X 17 Standard No 31 32 33 34 35 36 Score X X 3 3 X X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Fiennes House Score X 3 X X Standard No 37 38 39 40 41 42 43 Score X X X X X X 3 DS0000038170.V257140.R01.S.doc Version 5.0 Page 18 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA23 Regulation 37 (1) (e) (g) Requirement The registered person must give notice to the Commission for Social Care Inspection without delay of the occurrence of any event in the care home which adversely affects the well being or safety of any service user, and any allegations of misconduct by any person who works at the care home. Robust procedures for responding to suspicion or evidence of abuse or neglect specific to Fiennes House and reflecting guidance from the Department of Health document No Secrets must be developed. Timescale for action 31/12/05 2 YA23 12(1)(a) 13(6) 31/01/06 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 YA23 Good Practice Recommendations The home should obtain a copy of the Department of Health guidance ‘No Secrets’.
DS0000038170.V257140.R01.S.doc Version 5.0 Page 19 Fiennes House 2 3 YA23 YA23 The home should obtain a copy of the Somerset Safeguarding Vulnerable Adults policy. The home should ensure that all staff are aware of the correct procedure to follow should an allegation of abuse be received. Fiennes House DS0000038170.V257140.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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