CARE HOMES FOR OLDER PEOPLE
Forde Park Nursing Home 6-7 Forde Park Newton Abbot Devon TQ12 1DE Lead Inspector
Andrea Peryer Unannounced Inspection 15th December 2005 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 Forde Park Nursing Home DS0000028670.V275493.R01.S.doc Version 5.1 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. Forde Park Nursing Home DS0000028670.V275493.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Forde Park Nursing Home Address 6-7 Forde Park Newton Abbot Devon TQ12 1DE 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) 01626 354037 01626 356847 Mr Paul Wood Crawford Brenda Lowe Care Home 47 Category(ies) of Dementia (3), Dementia - over 65 years of age registration, with number (3), Mental disorder, excluding learning of places disability or dementia (3), Old age, not falling within any other category (3), Physical disability (47), Physical disability over 65 years of age (47), Terminally ill (47) Forde Park Nursing Home DS0000028670.V275493.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Nursing includes young adults and older persons Date of last inspection 20th April 2005 Brief Description of the Service: Forde Park is a refurbished Victorian home situated in a pleasant open setting overlooking the park. The railway station is approximately a five-minute walk from the home, local buses pass close by, and shops, post office and churches are within easy reach. The home provides nursing care on long or shorterterm basis. The staff team consists of RGN’s, trained nursing auxiliaries (Health Care Assistants) and nursing auxiliaries (Care Assistants) in training. The home is accredited to train adaptation nurses from other countries to achieve Nurses & Midwifery Council registration. The nursing team are supported by housekeeping, catering, maintenance and office staff. Forde Park Nursing Home DS0000028670.V275493.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection was carried out over a morning in discussion with the deputy manager, qualified and unqualified staff, residents and an administrator. The inspector toured the home and the inspector had an opportunity to see most of the residents in private in their own rooms or in the homes lounge areas. The inspection centred on the care of four individuals, on the home medication administration systems and on the homes environment. This is the second inspection of the home within the financial year (April 2005 to April 2006) and this report should be read with the announced inspection report as the two reports combined give an overall picture of the home and how they have met standards. What the service does well: What has improved since the last inspection? What they could do better:
A period of high levels of long term sickness in the home has resulted in care staff carrying out domestic and care tasks and as the care of residents has been a priority, areas of the home were not as clean or as well- maintained as they had been at the previous inspection. In particular need of attention where the shower rooms, which are in need of cleaning, repair and redecoration. Bathrooms were also being used as storage areas increasing the risk of cross infection and potential for accidents to happen. The cleanliness and repair of resident’s rooms could be improved with carpeting needing
Forde Park Nursing Home DS0000028670.V275493.R01.S.doc Version 5.1 Page 6 cleaning and curtains being securely fitted. This will also reduce the risk of accidents and improve the environment for residents. The home is in contact with the Commission in how to move forward in these areas. In the past this has not been an issue for this home and this is currently being seen as an unfortunate set of events, which have resulted in a drop in the normal standard for the home. The home has a process of recruitment and selection that normally includes details of all checks and any staff who have not yet had all checks received into the home are counted as additional to the normal staff on duty and are supervised. In the future the home will ensure that the Commission is aware of the staff whom work in the home while awaiting any checks, in line with guidance from the Criminal Records Organisation. The homes recruitment systems need to be more consistently completed such as ensuring application forms are fully completed, interview notes are fully completed and references and police checks are completed before the member of staff starts work at the home. Shortly after the inspection the homes representative produced evidence that CRB checks for staff had been completed. Continued vigilance in this area will safeguard residents from potential staff who may not be suitable to work with vulnerable adults. 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. Forde Park Nursing Home DS0000028670.V275493.R01.S.doc Version 5.1 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 Forde Park Nursing Home DS0000028670.V275493.R01.S.doc Version 5.1 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): Not inspected on this occasion: The home does not provide intermediate care. EVIDENCE: Forde Park Nursing Home DS0000028670.V275493.R01.S.doc Version 5.1 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 the following standard(s): 8,9 Resident’s health care needs are fully met and residents are protected by the homes policies and procedures for dealing with medicines. EVIDENCE: Residents spoken to consistently said that the staff did their best to meet all of their needs, including health needs. Members of staff spoken too described residents complex health needs including dealing with often challenging behaviours such as dealing with aggressive or very physically frail residents. Members of staff spoken to were clearly aware of resident’s complex needs and knew how to meet those needs. The deputy manager who was in charge on the morning of the inspection described residents care and praised members of staff for continuing to provide a good standard of care to residents despite a shortfall in domestic staff due to long term sickness. This shortfall in domestic staff has meant staff providing care and completing some domestic duties, which in the longer term, will impact on the care of the residents. The deputy manager confirmed that action was being taken to support care staff and that the manager and proprietor were in the process of dealing with this. The home operates a monitored dosage system of medication which is blister packed into individual sealed packs for safety and ease of administration. The
Forde Park Nursing Home DS0000028670.V275493.R01.S.doc Version 5.1 Page 10 home has two medication storage areas spread over two floors of the home, making it easier for staff to distribute medication safely to residents. These areas were clean and tidy with medicines clearly labelled, in date and stored securely indicating that the home monitor and review their systems of medication. The home has also purchased two trolley’s which were securely fastened when not in use to help staff move around the home safely administrating medication that could not be placed in blister packs to be administered. The home has two areas that the staff can not reach with the trolleys and the deputy manager confirmed that in these areas staff administrating medicines took blister packs into the resident and that medications were not prepared and placed on trays in advance (As to do so would be poor practice, increasing the risk of medication being administered incorrectly.) The recording of medication administered to residents was on the whole well completed, clearly dated and consistently signed for. There were a number of entries in handwriting that had not been signed or dated and the deputy manager said that these were entries made on instruction from the GP or when a new resident came into the home over a weekend so that printed sheets were not always available. As much as possible handwritten notes should be avoided and when notes are made they must be dated and signed by the person writing the note. This will ensure that any questions about that medication can be addressed to the person identified as writing the entry on the sheets and reduce risks of errors. The home has detailed policies and procedures on medication, which were kept in a central area for all staff to see and the deputy manager confirmed that all staff saw these documents as part of their induction in the home. The deputy manager confirmed that no residents are currently looking after their own medication. Forde Park Nursing Home DS0000028670.V275493.R01.S.doc Version 5.1 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 the following standard(s): 12 Residents find the lifestyle experienced in the home matches their preferences and satisfies their recreational interests and needs. EVIDENCE: The home as up until recently employed an Occupational Therapist to act as an “activities organiser” working with individual residents and in small groups to provide a range of activities in the home. This means that residents are offered the opportunity to remain mentally and physically stimulated and maintains links with the local community. The deputy manager confirmed that the manager and proprietor were in the process of advertising and recruiting a replacement person to fulfil this role. The residents were receiving visitors on the day of the inspection and that evening staff were coming into the home, some in their free time to put Christmas decorations up around the home. This was to ensure that residents was continued to be supported in participating in festivities over the Christmas period and until a news “activities organiser” could be employed. Residents said that the homes staff continued to help them socialise if they wish too and that visitors were always welcome in the home. Forde Park Nursing Home DS0000028670.V275493.R01.S.doc Version 5.1 Page 12 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): Not inspected on this occasion EVIDENCE: Forde Park Nursing Home DS0000028670.V275493.R01.S.doc Version 5.1 Page 13 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): 19,26 Residents do not live in a safe, well- maintained home, with access to safe and comfortable indoor facilities. Resident’s rooms are comfortable and personalised however they were not clean and hygienic. EVIDENCE: The inspector toured the premises and despite several improvements since the last inspection the overall impression in the home is that homes day -to -day maintenance and cleanliness has deteriorated since the last inspection. The home has benefited from new flooring in the dining area and two of the homes bathrooms being repaired and redecorated, however two shower rooms are dark, uninviting and on the day of the inspection one shower room had faeces on the floor and one had a hole in the ceiling. In Resident’s rooms basic repairs to curtains had not been completed and carpeting was in need of cleaning. Bathrooms were being used as storage areas including storage of chemicals which were accessible to residents and specialist equipment such as pro pad
Forde Park Nursing Home DS0000028670.V275493.R01.S.doc Version 5.1 Page 14 cushions were being also being stored in these areas. This increases the risk of spreading infection and makes bathroom areas unpleasant areas to bath in and less hygienic, with chemicals available to residents a potential health risk to residents. The homes deputy manager and the homes representative said that there were plans in place to continue to refurbish and repair areas of the home including the bathrooms which had been delayed due to the Christmas period. The home have been going through a difficult period with four domestic staff off on long term sick which has meant staff sharing care and cleaning tasks and the manager had contacted the Commission to discuss the shortfall in staff so that the Commission was aware of the homes difficulties. However the home must demonstrate improvement in this area and how these areas are to be addressed. The manager shortly after the inspection contacted the Commission to discuss positive ways forward. The lounges and dining areas were clean and tidy and these areas and residents rooms had been personalised to be warm and welcoming. A range of specialist equipment continued to be in evidence in the home, including hoists and special mattresses, reducing the risk of poor manual handling and residents developing sores. Forde Park Nursing Home DS0000028670.V275493.R01.S.doc Version 5.1 Page 15 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): 27,28,29,30 Residents have their needs met and are protected by trained and competent staff, with sufficient numbers of staff whom had been subject to the homes recruitment practices and policies. EVIDENCE: Staff rosters were inspected and show a registered nurse working on each floor of the home, for each shift, supported by senior members of staff and care assistants. The home also has the support of a administrator/accounts assistant and a administrator who deals with recruitment and selection of staff. The proprietor and his son also work along side administration and care staff in developing the homes systems, monitoring budgets and planning for the future. As previously stated there has been significant shortfalls in domestic staff due to long term illness and the home are in discussion with the Commission on how this is being resolved. The home has a number of nurses and care assistants who have been recruited from abroad all the staff spoken to said that this had been a real benefit to the home. The home has detailed recruitment policies and procedures, including guidance on recruiting from abroad. Three staff folders containing staff recruitment details were examined and these show that the home has a detailed application process which is monitored by a designated member of staff who is part of the administration team. The administration staff was not on duty as
Forde Park Nursing Home DS0000028670.V275493.R01.S.doc Version 5.1 Page 16 they were on holiday or sickness leave and the person who deals with recruitment was not on duty at the time of the inspection. The home has a process of recruitment and selection that normally includes details of all checks and any staff who have not yet had all checks received into the home are counted as additional to the normal staff on duty and are supervised. In the future the home will ensure that the Commission is aware of the staff whom work in the home while awaiting any checks in line with guidance from the Criminal Records Organisation. A small number of the files examined were inconsistently completed with some application forms well completed while other had gaps in that there was no written record of the home exploring. References and police checks were available for most applicants however one applicant who has started work at the home did not have references, police or Protection of Vulnerable Adult checks in place. The homes representative indicated that this information might be stored somewhere not immediately available to them and the representative contacted the Commission shortly after the inspection to confirm that the police check for this person was available. Interview records were also inconsistently completed with some interview notes being well completed while others where not on file. Nurses recruited from abroad are also required to have work permit and proof of identity documents, which the home also had in place. Forde Park Nursing Home DS0000028670.V275493.R01.S.doc Version 5.1 Page 17 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): Not fully inspected on this occasion EVIDENCE: An area of development for the home, which has not been inspected on this occasion but has been carried over as the time scale is not yet reached, is ensuring that all residents have an individual bank, building or post office account, rather than the current system of one account for all residents. This will give residents more choice in this area. Forde Park Nursing Home DS0000028670.V275493.R01.S.doc Version 5.1 Page 18 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 x x x x HEALTH AND PERSONAL CARE Standard No Score 7 x 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 x 2 x x x x x x 1 STAFFING Standard No Score 27 3 28 3 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x x x x x x x Forde Park Nursing Home DS0000028670.V275493.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? yes 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 2 3 Standard OP26 OP19 OP26 Regulation 23 23 23 Requirement Ensure that bathrooms are clean and free from items of furnishings. Ensure the downstairs shower room roof is made safe and repaired Ensure shower rooms are pleasant areas in which to bathe and ensure these areas are clean. Ensure that all chemicals are stored in locked facilities, so that residents do not have unsupervised access to them Ensure that all staff have completed thorough recruitment checks before starting work at the home including references, completed application forms and police and protection of vulnerable adults checks Ensure that residents have individualised bank, building or post office accounts. (This has been carried over from the last inspection as the timescale has not yet expired) Timescale for action 15/01/06 15/01/06 15/01/06 4 OP26 12,13 15/01/06 5 OP29 18,19 15/01/06 6 OP3535 20 30/08/06 Forde Park Nursing Home DS0000028670.V275493.R01.S.doc Version 5.1 Page 20 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 OP9 OP12 OP29 Good Practice Recommendations Sign and date any handwritten notes on medication administration records. Proceed as planned to reappoint an “activities organiser”. Consistently complete recruitment records for all staff including interview records. Forde Park Nursing Home DS0000028670.V275493.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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