Inspection on 06/12/07 for Ford Place Nursing Home

This inspection was carried out on 6th December 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

Ford Place Nursing Home 11/09/08

Ford Place Nursing Home 29/09/06

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 23/11/2008.

CARE HOMES FOR OLDER PEOPLE Ford Place Nursing Home Ford Street Thetford Norfolk IP24 2EP Lead Inspector Joanne Pawson Unannounced Inspection 6th December 2007 09:45 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 Ford Place Nursing Home DS0000067712.V356282.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. Ford Place Nursing Home DS0000067712.V356282.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ford Place Nursing Home Address Ford Street Thetford Norfolk IP24 2EP 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) 01842 755002 01842 750964 www.barchester.com/oulton Barchester Healthcare Homes Limited Mrs Denise Hubbard Care Home 49 Category(ies) of Old age, not falling within any other category registration, with number (49), Physical disability (49) of places Ford Place Nursing Home DS0000067712.V356282.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29th September 2006 Brief Description of the Service: Ford Place is a 49 bedded nursing home caring for older people. The home, originally a family mansion, was refurbished in 1997 and an extension was added in 1999 with a further extension in 2005 It is situated in the market town of Thetford and is a short walk from shops and other local amenities. The gardens are a positive feature of this home, with landscaped views over the lawns and river, (which runs along the rear boundary of the property). There is a car park at the front of the home with easy access from the road. The older part of the building is on two floors and is accessed by a small shaft lift. The home was purchased in 2004 by Barchester Healthcare Ltd. Ford Place Nursing Home DS0000067712.V356282.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. We (the commission) carried out an inspection of Ford Place Nursing Home using the Commission for Social Care Inspection’s methodology. This report makes judgements about the service based on the evidence we have gathered. The deputy manager was working in the home on the day of the inspection and assisted us with finding documents and files. A number of records were seen, together with staff personnel files and files of people living in the home. We spoke to some of the residents, their visitors and with staff members. Surveys were also sent to residents, their relatives and care staff. Seventeen surveys were returned from the residents, ten from their relatives but only four were returned from the staff. There comments will be included in this report. What the service does well: What has improved since the last inspection? Another twelve beds have been replaced to give the bedrooms a more homely appearance. There is a conservatory, which over looks the well-maintained gardens and river. Ford Place Nursing Home DS0000067712.V356282.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. Ford Place Nursing Home DS0000067712.V356282.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 Ford Place Nursing Home DS0000067712.V356282.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 and 6 Quality in this outcome area is good. Ford Place will not take a person into the home unless they have had a full assessment and their needs can be met. This judgement has been made using available evidence including a visit to this service. Ford Place Nursing Home DS0000067712.V356282.R01.S.doc Version 5.2 Page 9 EVIDENCE: The Home has a thorough assessment process that assists with the task of ensuring the Home can meet the needs of potential residents. The format was seen at a previous inspection. Due to the complex needs of many of the residents this format is completed in detail. The Home has a few beds that are used for intermediate care with the team of staff at Ford Place working closely with the community team to promote independence and aim to improve the health of the individuals and get them back home. The beds are in constant use by the local authorities and the Home works proactively to get the residents as well as possible. Specialist advice is sought and equipment is provided for specific needs. Ford Place Nursing Home DS0000067712.V356282.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is poor. Care plans do not give the staff all the information they need to meet the residents’ needs. This judgement has been made using available evidence including a visit to this service. Ford Place Nursing Home DS0000067712.V356282.R01.S.doc Version 5.2 Page 11 EVIDENCE: Three care plans were inspected. One care plan for personal care was written in a positive manner and included details about what the service users could do for themselves. However the resident had a waterlow score of 22, which the care plan states places them at high risk of pressure sores. In the tissue viability part of the care plan there were records that stated on the 27th October that there were two broken areas of skin on the residents coccyx area and a dressing had been applied and should be changed every 3 to 5 days unless otherwise indicated. There was no other record about the pressure area until the 11th November, which stated ‘sacral area superficially broken’. Then again there was a gap in the records until the 21st of November when it stated area worsened pressure ulcer grade 2/3. The wound chart also stated complete at each dressing change however it had only been completed on the 21st November. The turning chart for the resident showed long gaps of up to seven hours when the resident was not assisted to turn over to relieve the pressure. We asked a member of staff if staff always recorded when the resident was assisted to turn and she confirmed they did and that if the resident refused to be returned they also record the refusal. A letter from the dietician was found in a plastic wallet which stated to offer Maxijul. This information was not included in the residents eating and drinking care plan. There was a short-term care plan for eating and drinking but it did not have a date on it so it was not possible to know if it was current. The care plan stated weigh monthly but as there was no date it was not possible to know if this had been followed through, as there was only one record of the resident being weighed. There were several different care plans for one person for different areas of assessed needs such as personal care, communication and eating and drinking but the long-term objective was the same on all the care plans. Care plans should be personalised to meet the assessed needs of each resident. The daily notes for the same resident showed that her sacrum was actually noted as being sore from the 15th October. The daily notes for the same resident on the 23rd October stated ‘please encourage upright position in bed/recliner for meals and assist with meals rather than leave to feed herself, this information was not updated on to the care plan so could easily have been missed by staff. The daily notes showed that there had been an error in the amount of one medication the resident had been receiving. On the 26th November the daily notes state ‘ due to do sacrum but fast asleep, leave it and handover for the night staff to do’. However there was no record of the night staff applying cream or changing the dressing. There was no record on the 27th November about the sacrum area but on the 28th November the record stated’ sacral dressing came off’. Ford Place Nursing Home DS0000067712.V356282.R01.S.doc Version 5.2 Page 12 For the second care plan looked at there was minimal information about the residents needs. The resident had recently moved into the home although there was no pre admission information in the care plan folder. A risk assessment for the third resident which was completed in September stated review at least monthly. There was no evidence that the risk assessment had been reviewed since September. None of the residents or their relatives that were spoken to said that they were aware of their care plan or had ever been asked if they would like to read it. Two residents said that they were not aware they had a key worker or named nurse or what their role is. One relative spoken to stated that staff were ‘pretty good most of the time’ however when staff had assisted her mother with a bed bath the day before the inspection they had not taken her socks off to wash her feet and that she had needed this to be done. The medication administration sheets were inspected and found to be satisfactory. Ford Place Nursing Home DS0000067712.V356282.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. The meals are served in pleasant surroundings and are wholesome and well balanced. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The lunchtime was observed. One resident complained that there was too much food on her plate so it was replaced with a new plate with smaller portions on it. The residents received the support they needed to eat. The dining area is nicely decorated and the tables had cloth tablecloths and napkins and flowers. Food looked appetising and the residents seemed to enjoy it. One resident stated that there is only one main course but that if you don’t like it you can ask for something else. A relative of a resident stated that he thought cheap ingredients was used for some of the meals and the quality could be improved by using better quality ingredients such as better cuts of meat. The manager has informed us that Ford Place Nursing Home DS0000067712.V356282.R01.S.doc Version 5.2 Page 14 they use a local butcher who has a reputation for supplying quality meat and no one else has ever reported this to be an issue. One resident told us that she had moved into the home for intermediate care and had chosen to stay in the home. She stated that staff are very helpful and most of them knock on her bedroom door before entering. She also stated that the activity person brought her books in that she knows she would be interested in. Religious services are organised in the home for those residents that want to take part. The results form the residents surveys showed that four residents thought there were always activities they could take part in, four thought there were usually activities they could take part in, five residents stated there were sometimes activities and two thought there were never activities arranged by the home that they could take part in. The pre inspection information completed by the manager stated that there are regular music sessions with pianist, interdenominational church service and entertainment. Ford Place Nursing Home DS0000067712.V356282.R01.S.doc Version 5.2 Page 15 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 and 18 Quality in this outcome area is poor. Although procedures are in place not al of the residents are aware of the procedure to follow if they wish to make a complaint. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A relative of a resident stated that she had complained to the manager about standards of care but did not always feel that her concerns were dealt with. The results of the residents’ surveys showed that nine of the service users knew how to make a complaint but seven residents stated they didn’t know how to make a complaint. Of the 13 training files looked at only one person had received training in the protection of vulnerable adults. This lack of knowledge could place the residents’ at risk. Ford Place Nursing Home DS0000067712.V356282.R01.S.doc Version 5.2 Page 16 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): 19,23,26 Quality in this outcome area is excellent. Residents live in a safe, well maintained home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All areas are clean and tidy. A new conservatory has been completed with plenty of room to enjoy the view of the garden and the corridor housing the nursing station is enclosed to allow privacy and confidentiality to take place. The gardens are kept in good order and are easily accessible to residents. Plans are in place to improve the garden by the conservatory and install areas that are more accessible for wheelchairs. Ford Place Nursing Home DS0000067712.V356282.R01.S.doc Version 5.2 Page 17 The bedrooms are clean, well decorated and noted was how personalised each room was. Many beds have been replaced with nice wooden, homely looking hospital beds. Residents, although quite poorly were looking comfortable and had their personal bits and pieces surrounding them. There was one area in the home that had an unpleasant odour. Ford Place Nursing Home DS0000067712.V356282.R01.S.doc Version 5.2 Page 18 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. Not all the staff have the received that appropriate training to meet the needs of the service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: One resident stated that they staff are always polite but that they are often short staffed and has had to wait up to 20 minutes for assistance. One residents turning chart showed that she had been assisted to turn at 9.15 am the previous day and then not again until 3.15pm. The resident confirmed that she had not been turned in between these times and that this was a regular occurrence. One resident’s relative stated that that the home is sometimes short staffed and when this happens the residents’ don’t always get an afternoon drink. The deputy manager stated that staffing levels were normally 6 carers and two nurses. However the rota showed that on occasions the staffing levels were lower. The rota showed that on Friday 30th November there had only been 2 nurses and three carers and on this day three new residents had moved into the home. Ford Place Nursing Home DS0000067712.V356282.R01.S.doc Version 5.2 Page 19 Staff spoken to stated that due to the nursing needs and high care needs of the residents more staff on shift would ensure that their needs could be met in a timely manner. The residents’ surveys showed that five residents thought there were always enough staff available, eight thought there were usually staff available and three thought that there were only enough staff available sometimes. One staff survey stated that they would like more time to spend with the residents’. The staff numbers were discussed at the previous inspection. The provider must ensure that the staffing levels can meet the complex needs of the residents. Three staff files were inspected. The files contained all of the relevant recruitment documentation apart from the interview notes for one member of staff. The training records are kept on a computer to which we were given access. However for many of the staff members there are no records of mandatory training courses being completed or refreshers being undertaken. An immediate requirement was issued stating that gaps in knowledge must be identified and training courses booked by 1st January 2008 (this does not mean all training has to be completed by this date). One member of staff stated in their survey ‘visitors to ford place say what a lovely atmosphere there is, we all care very much about the quality of life for our elderly residents and our matron is excellent’. Ford Place Nursing Home DS0000067712.V356282.R01.S.doc Version 5.2 Page 20 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): 31,33,35,38 Quality in this outcome area is good. Residents do live in a Home that is run by a person who is fit to be in charge. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Registered Manager has been the Matron of the Home for many years. She is a qualified nurse with a management qualification. One resident stated that no one comes and asks her if she is happy with the service being provided but that she had been given a questionnaire about the home. Ford Place Nursing Home DS0000067712.V356282.R01.S.doc Version 5.2 Page 21 Another resident stated that she had attended the residents meetings and could discuss any concerns. All chemicals were locked away and all COSHH regulations and safety data sheets were held in a file (seen) in the store cupboard for easy access if required by staff members. There were no records available for the testing of the fire alarms before November 2007. The emergency lighting was not tested in March 2007. The pre inspection information completed by the manager stated that the home has regular health and safety meetings and that there are audits by clinical development nurses & clinical governence and quality surveys sent out by company. Ford Place Nursing Home DS0000067712.V356282.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 4 X X X 4 X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Ford Place Nursing Home DS0000067712.V356282.R01.S.doc Version 5.2 Page 23 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 Care plans must detail all the needs of residents and state how staff should meet these needs to ensure there is a consistent approach. There must be a record kept of all pressure sores and their treatment to ensure residents are receiving the appropriate treatment. All staff must receive training in the protection of vulnerable adults to help to protect the service users. There must be at all times sufficient staff on duty to meet the needs of the service users. All staff must attend mandatory training to ensure they have the skills to meet the needs of the service users. Timescale for action 01/03/08 2 OP8 17(1)(a) Schedule 3 (3)(n) 13(6) 01/02/08 3 OP18 01/03/08 4 5 OP27 OP30 18(1)(a) 18(1)(c)(i ) 01/02/08 01/04/08 Ford Place Nursing Home DS0000067712.V356282.R01.S.doc Version 5.2 Page 24 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 OP16 Good Practice Recommendations Service users should be made aware of the complaints procedure. Ford Place Nursing Home DS0000067712.V356282.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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. 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