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Inspection on 11/04/05 for Flowerdown Nursing Home

Also see our care home review for Flowerdown Nursing Home for more information

This inspection was carried out on 11th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Procedures followed by trained staff for handling medicines are very good ensuring residents` medication needs are met. Meals are varied, offered choice and were well presented. All residents spoken to said that they enjoyed the food provided. Visitors were made to feel welcome at any time.

What has improved since the last inspection?

A refurbishment programme has stared with new carpets and light switches fitted in some rooms in the old house wing and the home looked cleaner and more homely than on a previous visit.

What the care home could do better:

Written contracts for residents admitted to the home are still not available. This was a requirement of the last inspection.Residents` privacy is not ensured while they are in their own bedrooms, as locks are not fitted to the doors. This was a requirement of the last inspection. Staff spoken to during the inspection were concerned that at times when residents` dependency levels are high there is an insufficient number of staff on duty. The registered manager is to review the staffing levels. Records seen for five staff members did not contain two written references and three of those records did not contain confirmation that Criminal Records Bureau checks had been completed prior to the staff member commencing work at the home. This was a requirement of the last inspection. Residents` monies held in the home were kept securely but were not stored individually. This was a requirement of the last inspection.

CARE HOMES FOR OLDER PEOPLE Flowerdown Nursing Home Harestock Road Winchester Hampshire SO22 6NT Lead Inspector Marilyn Lewis Unannounced 11/04/05 09:30 a.m. 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. Flowerdown Nursing Home Version 1.10 Page 3 SERVICE INFORMATION Name of service Flowerdown Nursing Home Address Harestock Road, Winchester, Hamps SO22 6NT 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) 01962 881060 01962 881935 Tamheath Ltd Mrs Susan Parfitt CRH 53 Category(ies) of OP registration, with number of places Flowerdown Nursing Home Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: One service user date of birth 19th November 1939 can be accommodated. Date of last inspection 10/11/04 Brief Description of the Service: Flowerdown Nursing Home provides care and accommodation for fifty-two older person who require nursing care. The home has been extended over the years and accommodation is provided in fifty single rooms and one shared room, situated on two floors of the old house and the new extension. The home has large well-maintained gardens and ample parking space. Flowerdown is owned and operated by Four Seasons Health Care, a large independent care provider in the UK. The home is situated in a semi rural area on the outskirts of Winchester, Hampshire. Flowerdown Nursing Home Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 6 hours on the 11th April 2005. The inspector toured the home and spoke with six of the forty- three residents, two visitors, a chiropodist, and six members of staff. Records were inspected for staff and residents. What the service does well: What has improved since the last inspection? What they could do better: Written contracts for residents admitted to the home are still not available. This was a requirement of the last inspection. Flowerdown Nursing Home Version 1.10 Page 6 Residents’ privacy is not ensured while they are in their own bedrooms, as locks are not fitted to the doors. This was a requirement of the last inspection. Staff spoken to during the inspection were concerned that at times when residents’ dependency levels are high there is an insufficient number of staff on duty. The registered manager is to review the staffing levels. Records seen for five staff members did not contain two written references and three of those records did not contain confirmation that Criminal Records Bureau checks had been completed prior to the staff member commencing work at the home. This was a requirement of the last inspection. Residents’ monies held in the home were kept securely but were not stored individually. This was a requirement of the last inspection. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Flowerdown Nursing Home Version 1.10 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 Flowerdown Nursing Home Version 1.10 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) 1, 2, and 3 All prospective residents are fully assessed before coming into the home, however contracts are not available to ensure that the terms and conditions for living at the home are clearly known on admission. EVIDENCE: The home has a clear statement of purpose that provides the information required to enable prospective residents to make a choice about where they wish to live. The document states that residents are asked to sign a contract on admission, however contracts are not available and have not been so for some time as this issue is an outstanding requirement of the last inspection. Every prospective resident has a full needs assessment completed by a senior member of the nursing staff before being admitted to the home. The assessment covers all aspects of care needs and forms the basis for the care plans. Flowerdown Nursing Home Version 1.10 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, 9 and 10 Procedures are followed to ensure that the health care needs of residents are identified and met. However the residents right to privacy is at risk due to the lack of locks on bedroom doors. EVIDENCE: Individual care plans were seen for five residents. The plans were up to date and included assessments for the risk of falls, pressure areas and mobility. Comments made by GPs on visits and in telephone calls were recorded. The plans had been signed by the residents or their relatives and consent forms were also signed for the use of bedrails where required. Some GPs visit the home regularly and others on request. A dentist and an optician visit and the community physiotherapist will come to see residents when referred through the GP. Advice has been sought from the dietician with regard to a resident who requires peg feeding and for residents requiring a diet to help with weight loss. A chiropodist visiting at the time of the inspection commented on the helpfulness of staff, saying that ‘they were always willing to help’ and that she Flowerdown Nursing Home Version 1.10 Page 10 knew any instructions she gave for treatment such as dressings would be followed through as communication was very good. The procedures staff followed for the handling of medicines were very good. Medication records seen were up to date and medication was stored properly. Since the last inspection a thermometer had been purchased for the fridge used for storing some medicines and the temperature was being monitored and recorded. Residents are able to see GPs and health professionals in their own rooms. However the bedroom doors do not have locks fitted to ensure privacy when required. This is an outstanding requirement of the last inspection. Flowerdown Nursing Home Version 1.10 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, and 15 Residents are provided with the opportunity to join in a variety of activities and are able to enjoy well-presented meals. EVIDENCE: Although the home does not employ an activities co-ordinator, a programme of activities is organised by staff members. Activities include quizzes, film nights, coffee mornings and the registered manager said that a Body Shop party was being held shortly. Members of a local church visit the home regularly to organise and help with activities such as board games and they also hold a communion service at the home once a month for those who wish to attend. Two visitors spoken to were able to visit at any time and that staff made them feel welcome. Visits can take place in the lounges, gardens or in the privacy of the residents’ room. On the day of the inspection a carer was preparing the meals, as the cook was not in work due to sickness. The carer had received training in food hygiene and had assisted in the kitchen on other occasions. The inspector had the opportunity to talk to residents at lunch and comments received were ‘I enjoy the food and I’m never hungry’, ‘the food is good’ and ‘I always enjoy the food’. The meals for the day consisted of bacon and egg, cereals, toast, fruit juice and grapefruit for breakfast and faggots, broccoli, cauliflower and Flowerdown Nursing Home Version 1.10 Page 12 potatoes or chicken salad, followed by sponge and custard for lunch. A hot supper or sandwiches followed by apricots and cream were on the menu for supper. Fruit juice and tea/coffee were served throughout the day. Flowerdown Nursing Home Version 1.10 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 standard(s) 16 and 17 Residents at the home feel confident their complaints will be taken seriously. EVIDENCE: The homes’ complaints procedures are clear and records are kept of all complaints received. In the last year four complaints have been recorded, three of which were not substantiated and one is not yet resolved. Three residents spoken to were aware of how to make a complaint and said they felt the complaint would b taken seriously. The registered manager reported that all the residents were on the electoral roll and would be able to vote in the forthcoming elections. Many would use the postal voting system or if support is available, would be able to go to the polling station. Information on advocacy services was able if required. Flowerdown Nursing Home Version 1.10 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 standard(s) 19, 20, 21, 23, 24 and 26 Recent refurbishment of some rooms has helped to make the home a safe and homely environment for those living there and the recruitment of staff for domestic duties has improved the cleanliness of the home. EVIDENCE: Since the last inspection refurbishment work has started in some of the rooms in the older section of the home where paintwork was in need of attention and light switches required renewing. As rooms become vacant further refurbishment will take place, however there are no timescales for completion of the work. Water damage on a stairway noted on a previous visit had been repaired. Two large lounges are provided, one on each floor of the home. A dining room is situated next to the lounge on the ground floor. These communal rooms looked comfortable and homely. Flowerdown Nursing Home Version 1.10 Page 15 The home has four assisted baths and two showers. All of the bedrooms have access to en-suite toilet facilities, although some of the en-suite toilet facilities are shared between two rooms. The doors to these shared facilities are fitted with locks to ensure privacy for residents. Since the last inspection the sluice room on the ground floor requiring attention, has been retiled and new flooring has been fitted. Two passenger lifts, grab rails and ramps allow residents access to all areas of the home and hoists are available to assist residents with poor mobility. Residents’ bedrooms looked clean and homely with many personal items displayed. A resident remarked on her pleasure at being able to bring her own bedroom furniture into the home with her. Flowerdown Nursing Home Version 1.10 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 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 and 29 Staff were concerned that staffing levels were not high enough when residents care needs were very high and the recruitment procedures were not robust enough to ensure that residents were safe. EVIDENCE: At the time of the inspection the staff team on duty were, the registered manager, the deputy manager, two trained nurses, five carers, a student nurse, an administrator, two domestics and a laundry assistant. The registered manager agreed to review the staffing levels with regard to the dependency level of residents and not the number of residents, as three staff members voiced concerns that it was difficult to provide the care required at times when dependency needs were high. Records seen for five staff members indicated that recruitment procedures were not robust and were putting residents at risk. At the last inspection records seen did not contain the two required written references and it was the same on this occasion. Three of the staff members had been allowed to start work at the home before Criminal Record Bureau checks had been completed. The registered manager stated that some of the information required had not been forwarded from the organisations’ head office as some staff were recruited through a recruitment agency by the organisations’ Human Resources department. The registered manager was advised that the information was required to be kept at the home. Staff records seen at the last inspection were also incomplete. This was a requirement of the last inspection. Flowerdown Nursing Home Version 1.10 Page 17 Flowerdown Nursing Home Version 1.10 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 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) 31, 35 and 38 The registered manager has the qualifications and experience necessary to manage the home and staff training in fire safety safeguards the residents, however the practice of keeping all the residents’ monies in one container does not safeguard their financial welfare. EVIDENCE: The registered manager is a trained nurse who holds the Registered Managers Award and has many years experience in providing nursing care in care homes. Mrs Parfitt has been the registered manager of Flowerdown since 1998 and prior to that was the manager of another care home. Two residents keep control of their own money, while other residents have their relatives invoiced for items such as hairdressing, chiropody and newspapers. The home keeps some monies for residents and records and Flowerdown Nursing Home Version 1.10 Page 19 receipts are kept for all transactions. The money is stored securely in the safe, however it is not stored individually as required. This was a requirement of the last inspection. During the tour of the home it was noted that the kitchen looked clean and in good order with food stored appropriately. Cleaning materials were stored securely. Records seen indicated that all staff received fire safety training and fire drill practise and procedures were in place for staff to secure the building at night. Flowerdown Nursing Home Version 1.10 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. Where there is no score against a standard it has not been looked at during this inspection. 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 3 1 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 3 3 3 3 3 2 x x STAFFING Standard No Score 27 3 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 x 3 x x x 2 x x 3 Flowerdown Nursing Home Version 1.10 Page 21 yes 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 OP2 Regulation 5(1)( c ) Requirement The registered person must provide each resident with a written contract of terms and conditions for residency at the home. This is an outstanding requirement of the inspection dated 10/11/04 Suitable locks must be fitted to all residents bedroom doors to ensure the residents right to privacy is upheld. This is an outstanding requirement of the inspection dated 10/11/04 Staff records must contain all the information required in Schedule 2 of the Care Homes Regulations including two written references and CRB checks. This is an outstanding requirement of the inspection dated 10/11/04 The registered person must review the staffing levels with regard to the level of dependency needs of the residents. The registered person must ensure that monies held for residents is stored individually. This is an outstanding reuirement of the inspection dated 10/11/04. Version 1.10 Timescale for action 31/05/05 2. OP10 12(4)(a) 31/05/05 3. OP29 19(1) 31/05/05 4. OP27.1 18(1)(a) 31/05/05 5. OP35.3 16(2)(l) 31/05/05 Flowerdown Nursing Home 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 Good Practice Recommendations Flowerdown Nursing Home Version 1.10 Page 23 Commission for Social Care Inspection 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Flowerdown Nursing Home Version 1.10 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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