CARE HOMES FOR OLDER PEOPLE
Fontenay Nursing Home 39 Watts Avenue Rochester Kent ME1 1RX Lead Inspector
Lucy Ansell Announced Inspection 1st November 2005 09:30 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 Fontenay Nursing Home DS0000026167.V254758.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 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. Fontenay Nursing Home DS0000026167.V254758.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Fontenay Nursing Home Address 39 Watts Avenue Rochester Kent ME1 1RX 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) 01634 843753 01634 830173 Mr Thomas Michael Kelly Mrs Florence Mary Hussin Care Home 28 Category(ies) of Dementia (1), Old age, not falling within any registration, with number other category (27) of places Fontenay Nursing Home DS0000026167.V254758.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. To accommodate one person with dementia whose date of birth is 19.09.1919. 20th April 2005 Date of last inspection Brief Description of the Service: Fontenay Nursing Home is a detached Victorian home providing accommodation on two floors, and a further third floor with the communal areas. There is a passenger lift to all floors. Fontenay is a 28-bedded unit providing nursing care to older people. The home is situated in a residential area less than a mile from Rochester town centre. The home is located on a main bus route and within walking distance of shops and a Post Office. The home has attractive front and side gardens with seating. The Kelly Family has owned the home for over thirty years, the registered manager has also been in post for many years and the home has an experienced staff team. Fontenay Nursing Home DS0000026167.V254758.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This Announced Inspection took place on the 1st November 2005 by one inspector Lucy Ansell. The Inspector agreed and explained the inspection process with the Registered Owner and the manager. Documentation and records were read, including care plans. Time was spent reviewing a sample of written policies and procedures, looking at care plans and records kept within the home. A tour of premises was undertaken. The focus of the inspection was to assess the Home in accordance to the National Minimum Standards for older persons and to seek resident’s and representatives views of the home. In some instances the judgement of compliance was based solely on verbal responses given by those spoken with. Some Standards were not inspected in full and the last report should be read in conjunction to obtain a full picture. What the service does well:
The plans of care indicated in detail the care required to meet the individual needs of the residents. The care plans seen were of a high quality and exceeded the required standard. It was noted that staff regularly review all aspects of the care plan recording outcomes and making changes, as required, daily logs were informative and comprehensive. On inspecting the home it was apparent that staff maintain a high level of cleanliness and a high level of decorative order was maintained throughout the home. The home have shown a high commitment to giving the staff sufficient skills and knowledge to ensure the service users are well cared for. The home has achieved 95 of their staff having gained the NVQ level 2 in care or above. The home provides a comprehensive induction package for all new staff. The home has a comprehensive and robust policy and procedure on recruitment that they follow meticulously. The information retained by the home on staff files is kept well maintained. There was good feedback from the service users and relatives and the home was recognised as being on the whole able to provide an excellent service. The manager and her staff are approachable and the home well managed. Service users were complimentary about the staff and about the way in which their service was provided. The food was also praised as “excellent and very tasty”. Fontenay Nursing Home DS0000026167.V254758.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? 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. Fontenay Nursing Home DS0000026167.V254758.R01.S.doc Version 5.0 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 Fontenay Nursing Home DS0000026167.V254758.R01.S.doc Version 5.0 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): 1,2,5 Prospective service users and their relatives have access to the information they require to make an informed choice about the home. Service users benefit from a comprehensive assessment of their needs prior to moving into the home that ensures their assessed needs can be met. EVIDENCE: The home’s statement of purpose and service users guide is two separate formats. They were clear and concise with all relevant information included. They are used for their correct purpose of informing residents prior to choosing a home and as a source of reference after moving into the home. These are reviewed annually and updated as required. Residents are provided with a statement of terms and conditions when moving into the home. Evidence was seen of the homes contracts, which were very detailed and signed by the resident or their representative. The Local Authority contracts with the home were also seen, these all appeared to cover overall care provided and fees payable.
Fontenay Nursing Home DS0000026167.V254758.R01.S.doc Version 5.0 Page 9 The pre-assessment paperwork seen was very detailed and had been updated to include the date, signature, care manager details and the place where the interview was conducted. A good practice recommendation was made to quantify mini mental test scores. The home does not offer intermediate care. Fontenay Nursing Home DS0000026167.V254758.R01.S.doc Version 5.0 Page 10 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): 7-10 Residents benefit from a high standard of care planning and are treated with respect and dignity. All residents benefit from being consulted, regarding their wishes concerning terminal care and arrangements after death. Residents can be confident that the home’s policies and procedures on medication safeguard and protect them. EVIDENCE: Residents care plans were looked at; these were detailed records that contained good personal and health care recording. The health needs of residents are well met with evidence of good multi-disciplinary working taking place on a regular basis. The risk assessments were clear and concise and evidence was seen they are reviewed regularly. The home has asked all residents sharing a room whether they are happy with this agreement and this is now recorded on their care plan. Fontenay Nursing Home DS0000026167.V254758.R01.S.doc Version 5.0 Page 11 Evidence was seen that reviews of the care plans are taking place regularly. The manager has in place a system to monitor all care plans after the staff have completed their reviews. The home operates a key worker system where residents have an identified staff member. The staff are now recording enough detail in the daily report, it was also noted that when events and care delivery occurs throughout the day a detailed and comprehensive record is kept with good use of times. The home promotes and maintains residents health through supporting and facilitating medical appointments as required. The home is well able to manage residents with pressure areas with treatment and has a tissue viability link nurse. The home has good links with other professionals and the home can offer a choice of G.Ps from the many surgeries situated locally. The staffs on duty were observed indirectly throughout the inspection, they were seen to interact in a positive and respectful manner with residents. Residents gave positive feedback during the inspection about the approach of the staff team, comments included “nothing is too much trouble for the girls” and “they show great care and kindness”. In the residents shared rooms it was noted that privacy curtains were in place that ensured privacy and dignity for the occupier. Residents are consulted regarding their wishes concerning terminal care and arrangements after death and this is recorded on their care plans. The home has received several letters from relatives following the death of their loved one thanking them, and allowing them a dignified and compassionate end to their life. The homes medication cupboard and policies and procedures were scrutinised and were found to be well maintained with clean and tidy drugs trolley and cupboards. The policies were individual for any clients needing PRN medication and universal for all other policies and contained the required information. All medication when checked had dates when they had been opened, and all medication tallied in the controlled drug book and no gaps were seen on the administration sheets. A recommendation was made to ensure that they have a contract with a waste disposal company for the removal of all waste medication. Fontenay Nursing Home DS0000026167.V254758.R01.S.doc Version 5.0 Page 12 Fontenay Nursing Home DS0000026167.V254758.R01.S.doc Version 5.0 Page 13 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): Not Inspected. EVIDENCE: Standards 12 and 13 were exceeded on the last inspection and this still appears to be the case. No change to chefs only that the winter menu is now in place, but all residents complimented the food. Fontenay Nursing Home DS0000026167.V254758.R01.S.doc Version 5.0 Page 14 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): 17 and 18 The residents can be confident that all staff know how to report appropriately any possible abuse, and what immediate action to be taken to protect them. Residents can be confident that the home protects their legal rights. EVIDENCE: The residents at the home were all able if they wished to participate in the last elections. Many residents used postal votes and family took residents up to the polling station, which is very close by. The home has access to an available advocacy service if no family or care manager is available to fulfil this role. The home ensures the residents are safeguarded from any abuse, neglect or harm by robust policies for the home. The homes nominated Adult abuse trainer gives training for all staff at induction, the staff then attend courses in the Local Authorities protocols on Adult Protection, as well as having a copy of the updated policy on file. Staffs when questioned were able to give comprehensive replies to what they would do in case of suspected harm to a resident. The home has a whistle blowing policy. Fontenay Nursing Home DS0000026167.V254758.R01.S.doc Version 5.0 Page 15 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): 19,20,24,25,26 Residents benefit from living in a safe, well maintained, clean and homely environment in which there are high standards of décor, furnishings and fittings. EVIDENCE: The home location and layout is suitable for its stated purpose; it has been visited recently by the fire officer and environmental health and had met all their requirements. The home has one communal lounges spread across the top floor of the building, split into three sections one of which is a quiet room, another for viewing the television and a arts and craft area. The home has a small dining area, also at the top of the home but most residents eat in their rooms. On the day of the inspection five residents had chosen to eat up there after they had finished their activities. Several residents spoken to commented “On the welcoming feeling of the home”. The residents have a choice on whether they would like their bedroom doors open and all residents decide this and although it adds to the noise and hustle and bustle, all residents when questioned enjoyed feeling part of a busy home.
Fontenay Nursing Home DS0000026167.V254758.R01.S.doc Version 5.0 Page 16 Two of rooms have ensuite toilet facilities and rooms where these are not included a suitable bathroom/toilet is located nearby. The home has sufficient toilet and bathroom facilities for the number of service users. Bedrooms seen had all been personalised by the service users. The rooms were all clean and well decorated. Bedrooms have sufficient space to accommodate the required furniture. The home has very high standards of cleanliness and cleaning staff have rotas of which rooms to deep clean daily and no odours were detected anywhere in the house. The home has a separate laundry room, which met infection control requirements. The kitchen was viewed and this was well maintained. The home has two sluice rooms and a large basement which doubles as a storage space and a staff room. Hand washing facilities are prominently sited and the provision of protective clothing was clearly seen. The home has a 6 monthly contract for servicing for the hoists and parker baths. The maintenance man checks and services all the wheel chairs and recorded evidence is kept of this. Call systems were seen in all the rooms and provided in communal areas. Fontenay Nursing Home DS0000026167.V254758.R01.S.doc Version 5.0 Page 17 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): 28, 29,30 Residents can be confident that they are protected by the home’s robust recruitment policies and procedures. The good quality of care offered to residents is provided by competent staff that receive regular, on-going training. EVIDENCE: A number of staff files were sampled, which included all types of staff, who had been at the home for varying lengths of time. The files seen did contain all the correct information. Evidence was seen of clear colour photos of staff, rather than relying on a blurred copy of the passport photo. The reference request now asks managers to confirm dates that an employee worked for the said firm. Good practice was seen of recording dates when asking for any references or CRBs and then consequently when received. Evidence was seen of interview notes on one of the files for a new member of staff. All staff had enhanced CRB disclosures. A good practice recommendation is made for home to have a front sheet checklist on staff files recording when all paperwork is sent and received instead of writing on file copies. Fontenay Nursing Home DS0000026167.V254758.R01.S.doc Version 5.0 Page 18 The home is to be commended on its active role in securing training, with all staff having completed NVQ’s level 2 and 3, and the newest staff member is also enrolled on the course. The home gives excellent support in all aspects of training. The home has a very robust and inclusive induction programme carried out in-house. A good Practice recommendation is getting all new staff to sign key policies and keeping a copy for them selves. The home will be starting a recruitment drive to cover several staffs maternity leave and replacing a member of staff who has left. Overall a high standard of training with only adult abuse to be completed this year. Fontenay Nursing Home DS0000026167.V254758.R01.S.doc Version 5.0 Page 19 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, 34, 36, 37, The residents benefit from being cared for by a well supported and well led staff team who are appropriately supervised. The residents’ best interests are safeguarded and protected by the home’s policies and procedure as is their health, safety and welfare. EVIDENCE: The manager was seen to communicate a clear sense of leadership and direction to her staff. The process of management appeared to be open and transparent. Staff indicated that they felt part of a good team and this was due to the way the home was managed. The manager is also able to lead by example and many of the good practices seen in the home come from good leadership. The homes record keeping is effective and efficient with reviews of policies and procedures happening yearly, good record keeping for the residents, which
Fontenay Nursing Home DS0000026167.V254758.R01.S.doc Version 5.0 Page 20 safeguard their rights and best interests. Individual records and home records are kept secure up to date, in good order and used in accordance with the Data Protection Act. The manager ensures supervision is carried out at least six times a year and this is split between herself and her deputies to complete this. The manager also carries out unobserved supervision of the staff while they are working and she is very pleased with the high standard of work. The homes record keeping is effective and efficient with reviews of policies and procedures happening yearly, good record keeping for the residents, which safeguard their rights and best interests. Individual records and home records are kept secure up to date, in good order and used in accordance with the Data Protection Act. Fontenay Nursing Home DS0000026167.V254758.R01.S.doc Version 5.0 Page 21 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 3 3 x x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 x 17 3 18 3 3 3 x x x 4 3 3 STAFFING Standard No Score 27 x 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 x x 3 x 3 3 x Fontenay Nursing Home DS0000026167.V254758.R01.S.doc Version 5.0 Page 22 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(2) Requirement The home to ensure that they have a contract with a waste disposal company for the removal of all waste medication. Timescale for action 30/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP3 OP29 OP27 Good Practice Recommendations A Good practice recommendation was made to quantify mini mental test scores used A good practice recommendation is made for all new staff to sign policies seen and understood. A good Practice recommendation is getting all new staff to sign key policies and keeping a copy for them selves. Fontenay Nursing Home DS0000026167.V254758.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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