Inspection on 03/09/07 for Fistral House

This inspection was carried out on 3rd September 2007.

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

Fistral House 01/09/08

Fistral House 30/05/06

Fistral House 07/03/06

Fistral House 22/09/05

Fistral House 03/03/05

Fistral House 07/09/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Fistral House 3 Esplanade Road Pentire Newquay Cornwall TR7 1PY Lead Inspector Alan Pitts Key Unannounced Inspection 3rd September 2007 10:00 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 Fistral House DS0000008927.V340651.R01.S.doc Version 5.2 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. Fistral House DS0000008927.V340651.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fistral House Address 3 Esplanade Road Pentire Newquay Cornwall TR7 1PY 01637 878423 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) Mr Geoffrey Ernest Dowling Mrs Rita Gladys Dowling Mr Geoffrey Ernest Dowling Care Home 13 Category(ies) of Old age, not falling within any other category registration, with number (13) of places Fistral House DS0000008927.V340651.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To include accommodation for two named persons only outside of the age range and other category of the home. Date of last inspection Brief Description of the Service: Fistral House is a care home providing personal care and accommodation for up to thirteen older people. The home is located in a residential area of Newquay directly opposite Fistral beach. The home provides a conservatory for service users to enjoy the views. The home has all en suite (toilet and wash hand basin) bedrooms on the ground and first floor. There is a stair lift facility to all the bedrooms on the first floor. Communal accommodation is on the ground floor and consists of a lounge, dining room and conservatory. The home has a spacious level back garden and car parking is available at the front of the home. Fees range from £300 to £500 per week. Fistral House DS0000008927.V340651.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection of care standards at Fistral House, which took place over a period of approximately 5 hours commencing at 9am on 3rd September 2007. The inspector met with 5 residents, a number of staff and the son of the registered providers, and toured the premises. The residents were complimentary about the home generally, and the kindness and consideration of the care staff. The requirements and recommendations made in this report should not detract from the overall high standard of care provided at this small, ‘homely’, care home, but the home’s management systems are undermining the efforts and hard work of the staff. What the service does well: What has improved since the last inspection? What they could do better: As was mentioned in the previous inspection the registered provider must ensure that all residents have a care plan. Standards relating to staff training have fallen, as has the home’s commitment to staff supervision and a robust recruitment policy. There is some conflict over roles at management level, which has undoubtedly resulted in the fall in staff/managerial standards. Please contact the provider for advice of actions taken in response to this Fistral House DS0000008927.V340651.R01.S.doc Version 5.2 Page 6 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Fistral House DS0000008927.V340651.R01.S.doc Version 5.2 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 Fistral House DS0000008927.V340651.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 6 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Potential residents care needs are assessed prior to admission. The home does not provide intermediate care. EVIDENCE: Pre-admission information and assessments were seen to be evident for residents admitted to the home. The registered provider must ensure that a pre-admission care needs assessment is completed prior to accepting any admission to the home. One resident admitted to the home in the previous 1-3 months had had an assessment, but did not have a plan of care. The home does not provide intermediate care. Fistral House DS0000008927.V340651.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans are generally excellent, though this impression was spoilt by the lack of a care plan for the most recent admission to the home. Care plans were seen to be informative and comprehensive, indicating residents’ health care needs being met as appropriate. Medicines are handled properly, and stored securely. Residents confirmed that all the staff protected their privacy and were respectful. EVIDENCE: The home would have gained ‘top marks’ from the inspector for the quality of the care plans in use, had it not been for the one resident who did not have a care plan. The same comment was made at the previous inspection in May 2006. The home’s Statement of Purpose states that each resident will have a care plan. Care plans are generally informative and comprehensive, providing clear instruction to the care provider. Care plans are reviewed monthly with the Fistral House DS0000008927.V340651.R01.S.doc Version 5.2 Page 10 respective resident, who signs the care plan where possible. The care plans are supported by generally detailed daily records, which prompt the writer to make an entry about a number of criteria, such as mobility, diet, etc. The involvement of other healthcare professionals is recorded in detail. Residents are given the opportunity for exercise and a session was planned for the afternoon of the inspection. Medicines are appropriately stored and administered, in line with the medicines policy in use. A Control Drug book is kept and was seen to be in order. Medicines are stored securely. A record is kept for the receipt and return of medication. Medicine Administration Records were seen to be accurate and current. The supplying pharmacist regularly inspects the home’s medicine systems. The residents spoken with could not speak highly enough of the consideration of the staff, and confirmed that they were respected and their privacy upheld. Some residents have their own telephone, but all have access to one. Mail is delivered unopened to residents, though assistance is given as needed. Residents’ preferred term of address is known and used. Fistral House DS0000008927.V340651.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents confirmed that the home meets their social/recreational needs, that they are free to determine their daily lives, and that there is no restriction on receiving visitors. A wholesome, diet is provided, and residents said that the standard of food provided was very good. EVIDENCE: There is a list of activities that the home can provide, and the inspector was advised that an activity is offered every day. The residents said that they had enough to keep themselves occupied, and there was an activity planned later that day. Although there has been improvement, there is still a tendency to say where a resident was in the home rather than what they were doing. Similarly, when a resident declines an option, the entry should say what was declined. The inspector does not doubt that the residents have appropriate recreational/social opportunities, but the daily records could better reflect this. The daily records are otherwise very informative about the residents’ daily life at the home. The outcome for residents in terms of health and wellbeing, and lifestyle, is generally very good. Only the record keeping prevents the home from achieving ‘top marks’. Fistral House DS0000008927.V340651.R01.S.doc Version 5.2 Page 12 There is a visitor’s book in the entrance, which shows regular and frequent visitors to the home. Residents and staff confirmed that there are no restrictions on visitors. A number of residents have their own telephone lines in their bedrooms, but calls can be made and received in private without this facility. All the residents have relatives or representatives available to act in their interests. The residents also said that their right to make choices was respected. Staff were seen to interact with residents in a comfortable, familiar and caring, but professional manner. There is an excellent monthly newsletter sent to all the residents with articles about recent events or outings, news and competitions. A 2-week menu is used as a guideline, though meals may vary from this according to what has been locally available to the cook. There is a record of food provided. A wide choice of options is offered at the evening meal, though this is not shown on the records. The menu does demonstrate that a lunchtime choice is available, and the record of food provided shows that residents make use of this. The residents were complimentary about the quality of the food provided. The lunchtime menu on the day of the inspection was seen to be well presented and appetising. Fistral House DS0000008927.V340651.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a new complaints policy, which will be circulated to residents and their representatives with the new Statement of Purpose in the next few weeks. There is a comprehensive adult protection policy in place, but more could be done to ensure the protection of residents. EVIDENCE: The home has recently purchased an external reference from which they can develop new policies and procedures. There is a new complaints policy included in the, also new and comprehensive, Statement of Purpose. The head of care advised the inspector that this would be circulated to all the residents and/or their representatives in the next few weeks. Residents said they were very happy at the home and were seen to enjoy good relations with the staff. Residents said they would feel able to voice concerns. There is a comprehensive adult protection policy in place. The protection of the residents could be improved with a clear adult protection procedure for staff to follow in the event of an allegation of abuse, and a commitment to adult protection training as only two of eleven staff have undertaken this. Fistral House DS0000008927.V340651.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Fistral house is a large domestic dwelling, which is suitable to its stated purpose. The property is well maintained and provides a safe environment for service users. The home is clean, pleasant, and hygienic. EVIDENCE: All service user rooms are en-suite, and all but three offer a shower or bath. There is one communal lavatory and one communal bathroom. The baths have mixing valves to control the supply of hot water, though these haven’t been checked for some time and the head of care said this would be arranged. The home generally offers level access, with stair lifts, pressure relieving equipment, call bell system, moving and handling aids and a variety of grab rails are provided. Access between floors is aided by the provision of a stairlift. Bedrooms are regularly redecorated and the gardens are well maintained. Fistral House DS0000008927.V340651.R01.S.doc Version 5.2 Page 15 The heating is provided through radiators in each room with individual controls and protective guards. Appropriate ventilation and window restrictors in bedrooms are provided. The home is clean, well decorated and furbished throughout. Residents have personal possessions in their rooms. There are double-glazed windows fitted throughout the home, including a porch to the front of the building. New carpet has been fitted in the hall, landing, staircase, and lounge. There are beautiful views over Newquay beach from some bedrooms and from the main lounge and conservatory. Residents were very happy with the accommodation provided. Communal bathing and lavatory areas are provided with liquid soap and paper towels, and all the staff carry their own alcohol solution for hand washing. All areas of the home were seen to be clean, and there were no undue odours evident. Fistral House DS0000008927.V340651.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a high staff to resident ratio, ensuring that residents’ needs are met. Residents could be better safeguarded with a commitment to ongoing training and adherence to a robust employment procedure. EVIDENCE: At the time of the inspection there were 5 care staff, and a cook on duty, with 11 residents. Residents said that they were well cared for. A duty rota is used, which accurately reflects the staff numbers on duty. Residents’ comments and care documentation (with the exception of the missing care plan) show that care needs are well met. There are sufficient waking night staff on duty. There is 12 care staff employed by the home, of which 4 have achieved NVQ Level 2 or above (33 ). The home maintains a training record, which includes: 1st Aid (4 staff); Moving and Handling (6 staff); Food Hygiene (6 staff); Protection Of Vulnerable Adults (2 staff); Medication (6 staff); and Health & Safety (4 staff); Infection Control (0 staff); Care Planning and Record Keeping (0 staff); Death and Dying (0 staff); Risk-Assessment (0 staff); Dementia Awareness (1 staff). Levels of training generally have fallen since the last inspection in May 2006. Fistral House DS0000008927.V340651.R01.S.doc Version 5.2 Page 17 The home generally enjoys a low staff turnover, which benefits the residents, though as in any home there are peaks and troughs of staff movement. One staff personnel file was inspected. This showed that whilst two references had been obtained the primary reference did not cross-reference with the referee named on the job application form. The application form in use is insufficient to safely ascertain an applicants past work/education history, experience or qualifications. The head of care did produce an alternative format, which whilst not in use, would provide greater information from applicants. The home has obtained the necessary resources in order to implement a National Training Organisation compliant induction programme, though at the time of the inspection this was not in operation. The head of care confirmed that it was the intention to ensure that all the staff undertook this training. Fistral House DS0000008927.V340651.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38 - Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The registered provider is in day-to-day control, and there is a clear hierarchy in place at the home. The home is run in the best interests of residents, as evidenced by their comments during the inspection, but the registered provider needs to do more to ensure their safety and the effective management of the home. Residents’ financial interests are safeguarded, and the home has minimal involvement with their monies. EVIDENCE: The registered provider is in day-to-day control and is supported in her duties by the Head of Care and a Senior Carer. The Head of care has achieved the Registered Managers Award. Residents were aware of who was in charge at the home. The registered provider is well experienced in care and in meeting the needs of the residents, but requirements and recommendations identified in Fistral House DS0000008927.V340651.R01.S.doc Version 5.2 Page 19 this report show that the home needs a manager to ensure standards of record keeping, training and safety do not fall below that required. It is important that the manager has a clearly defined role that enables him/her to take responsibility for fulfilling their duties. The registered provider has reviewed and amended the home’s Statement of Purpose, and the inspector was advised by the Head of Care that it is planned that quality assurance questionnaires will be included when the new Statement of Purpose is posted/distributed to residents and their representatives. The home handles only a small amount of money for residents, and this is kept secure. The registered provider has no involvement with residents’ pensions or benefits. A record is kept for each resident, which includes the money received and the money spent (e.g. hairdresser), and is supported by a receipt wherever possible. Although there is some evidence of staff supervision happening in January of this year, there is no evidence since then to show that staff are receiving supervision at least 6 times per year. The home is well maintained, and records of regular maintenance work and other records were inspected, including: • Environmental Health Officer – February 2007 • Gas Safety certificate – February 2007 • Electrical Inspection report – July 2007 • RIDDOR • COSHH • Accident Book The home was seen to be clean, and in good order throughout. Fire training for staff has been neglected, with only one staff member receiving any training this year. An immediate requirement was made in respect of this at the time of the inspection. At the time of preparing this report, the home has confirmed in writing that arrangements for staff fire training have now been made. In addition, the home has recently been inspected by the fire authority and the Head of Care advised the inspector that work is underway to provide suitable fire risk-assessments (remedial work to the premises has been done). Fistral House DS0000008927.V340651.R01.S.doc Version 5.2 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 N/A DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Fistral House DS0000008927.V340651.R01.S.doc Version 5.2 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 OP7 Regulation 15 Requirement The registered provider must ensure that there is a current and accurate care plan for each resident. The registered provider must make arrangements to ensure that staff receive training appropriate to the work they are to perform, and to ensure the safety of themselves and others. The registered provider must adhere to a robust employment procedure in order to protect the residents. The registered provider must make arrangements for reviewing the quality of the service provided, making a copy of the results available to residents and the Commission for Social Care Inspection. The registered provider must ensure that staff are appropriately supervised. Timescale for action 01/10/07 2. OP28 OP30 OP38 13, 18 01/04/08 3. OP29 19 01/10/07 4. OP33 24 01/04/08 5. OP36 18 01/04/08 Fistral House DS0000008927.V340651.R01.S.doc Version 5.2 Page 22 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 OP12 Good Practice Recommendations The registered provider should ensure that residents’, generally very good, daily records show how they spent their day and what options were available to them (e.g. “declined playing cards in the lounge”). The registered provider should review and amend the food records to better show the choices available to residents at the evening meal. There is a Protection Of Vulnerable Adults policy in place, though the registered provider should also provide a procedure that includes clear instruction as to the steps to take in the event of an allegation of abuse, relevant contact details (Adult Social Care office), and to show adherence to the Cornwall Protection Of Vulnerable Adults procedure. The registered provider should make arrangements for staff training in adult protection. The registered provider should implement a staff training and development programme, including National Training Organisation compliant induction training. The registered provider should ensure that staff receive a minimum of 3 days paid training per year (including in-house training) and have an individual training and development assessment profile. 2. 3. OP15 OP18 4. OP30 Fistral House DS0000008927.V340651.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Devon Area Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Fistral House DS0000008927.V340651.R01.S.doc Version 5.2 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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