CARE HOMES FOR OLDER PEOPLE
Forde Park Residential Home 18 Keyberry Park Newton Abbot Devon TQ12 1BZ Lead Inspector
Mark Sharman Unannounced Inspection 26th May 2006 09:40 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 Residential Home DS0000003702.V289807.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 Residential Home DS0000003702.V289807.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Forde Park Residential Home Address 18 Keyberry Park Newton Abbot Devon TQ12 1BZ 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 352904 01626 356847 The Wilson Crawford Partnership Mrs Barbara Elsie Underhill Care Home 15 Category(ies) of Dementia (15), Old age, not falling within any registration, with number other category (15), Physical disability over 65 of places years of age (15) Forde Park Residential Home DS0000003702.V289807.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: None. Date of last inspection 10/10/05 Brief Description of the Service: Forde Park residential home is a large detached house in a quiet and attractive residential area about a mile from the centre of Newton Abbot. There is a public park nearby. The home cares for up to fifteen people aged 65 or over, who may also have a dementia. There are three ground floor bedrooms, and there are stair lifts on the main staircase. It is necessary to walk up/down a short flight of stairs to reach two of the first floor bedrooms. There are seven single rooms and four double rooms. There is an attractive lounge, separate dining room and a small conservatory. The home is on a level site and has a decked area and a large garden. However there are some steps to the front door (and into the conservatory), making access into the home more difficult for people with reduced mobility. There are ample car parking areas. The organisation which owns this home also operates a home providing nursing care two doors away. Forde Park Residential Home DS0000003702.V289807.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. As part of the inspection process five comment cards were received from residents, four from relatives and one from a community nurse. A completed questionnaire was received from the home’s manager. About seven hours were spent at the home, and a follow-up visit was made later in order to spend time with the manager (the inspection was unannounced). Most of the residents and several of the staff were spoken with, and two relatives were also seen. A sample of care records was inspected. A tour of the home included all of the communal areas and several of the bedrooms. What the service does well: What has improved since the last inspection?
The one requirement (relating to the signing of medication sheets) and recommendation made at the last inspection have been complied with. Further
Forde Park Residential Home DS0000003702.V289807.R01.S.doc Version 5.1 Page 6 improvements have been made to the environment, in particular the refurbishing of the kitchen and the redecoration of several bedrooms. Quite a lot of new bedroom furniture has been bought. 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. Forde Park Residential Home DS0000003702.V289807.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 Residential Home DS0000003702.V289807.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): 3. Standard 6 is inapplicable. Quality in this outcome area is adequate. The needs of new residents are assessed before they are admitted to the home, although the manager is not always involved in this process. EVIDENCE: Three of the residents’ files were inspected and all contained a professional assessment of needs received by the home prior to admission. Two of these were written by local authority care managers, and one by hospital staff when the resident was admitted to the home from hospital. Each file also contained the home manager’s own assessment written shortly after admission to the home. The manager said that whenever practicable she personally visits a prospective new resident to carry out her own assessment. This is important because she knows what level of need her staff can meet and is also aware of the needs of the existing residents. However in the case of a new resident admitted on the day of this inspection she had not had the opportunity to meet him before his admission (although an assessment of needs was received from the hospital
Forde Park Residential Home DS0000003702.V289807.R01.S.doc Version 5.1 Page 9 unit he was discharged from). It is suggested that his admission should have been delayed until she had been able to see him in the hospital unit. Forde Park Residential Home DS0000003702.V289807.R01.S.doc Version 5.1 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, 8, 9 and 10. Quality in this outcome area is good. There were care plans in place for the residents, and their health care needs were being identified and met. There is a satisfactory medication system. EVIDENCE: Three of the residents’ files were examined. They all contained assessments in respect of mobility/manual handling, nutrition, pressure area (skin) and a personal risk assessment. The care plans described the residents’ health, personal and social care needs, and actions to be taken by staff to meet those needs. They had been reviewed regularly and had been signed by the resident in question or a relative (in one case). The staff consulted confirmed that they have ready access to the care plans. All of the residents looked well cared for and well presented, and were neatly and appropriately dressed. The survey forms received showed that residents feel they receive the medical attention they need. There was substantial evidence in the care records of visits by general practitioners and district nurses, and also members of the specialist mental health team in some cases. In fact one resident was visited by a community psychiatric nurse from that team during the inspection. A district nurse (via a comment card) stated that
Forde Park Residential Home DS0000003702.V289807.R01.S.doc Version 5.1 Page 11 “the staff are very competent and the care given to service users is to a very high standard”. The home has a secure metal drugs trolley. A sample of the medication administration recording sheets was inspected. Several of the staff confirmed that they have received professional medication training in the last few months. Forde Park Residential Home DS0000003702.V289807.R01.S.doc Version 5.1 Page 12 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, 13, 14 and 15. Quality in this outcome area is generally good. Residents are free to pursue their own interests and routines as far as they are able, and contact with relatives and friends is encouraged. The catering arrangements are satisfactory. Further thought needs to be given to providing more activities for residents with dementia. EVIDENCE: The more able residents tend to pursue their own interests and are not inclined to participate in group activities. For example one said that he prefers to keep his own company in his own room, where he will also take his meals. Another likewise said she prefers to keep to herself, and will go out frequently in fine weather. She still keeps a vehicle at the home in which she is taken out by a friend. Another regularly attends a local community centre each week. Sometimes a few residents are able to join an activity being run by the nearby associated nursing home, and for example on the day before this inspection four of them went on a minibus trip with residents from that home. Other recent activities at the nursing home attended by some residents have included a fashion show and a musical afternoon. An activities record which is kept showed some evidence of the activities offered within the home, such as games, puzzles and reminiscence sessions. However the survey forms received from residents and comments from two
Forde Park Residential Home DS0000003702.V289807.R01.S.doc Version 5.1 Page 13 relatives suggest that more stimulation is needed, especially for less able residents who are unable to go out. Several of the residents said they have regular visitors, which was confirmed by the many entries in the visitors book. Indeed some visitors were seen during the inspection and three residents were taken out by their relatives. All of the residents consulted about the standard of the meals were satisfied or very satisfied. The lunch on the day of the inspection looked appetising and substantial, and the menus showed that there is also always a hot dish at tea time. Some of the residents prefer to have meals in their own rooms, which was the case during this inspection. Forde Park Residential Home DS0000003702.V289807.R01.S.doc Version 5.1 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): 16 and 18. Quality in this outcome area is good. The home has a satisfactory complaints procedure, with evidence that service users feel that their views are listened to and taken seriously. There are arrangements in place to ensure that they are protected from abuse. EVIDENCE: The home has an appropriate complaints procedure which was displayed in the hall, and the residents’ survey forms received showed that they know how to make a complaint. No complaint has been received by the Commission for Social Care Inspection since the last inspection. The home has an abuse policy, including a whistleblowing policy, and also policies/procedures on physical restraint and dealing with physical aggression. The staff said they were aware of these policies, and the senior carer in charge said that they have had professional training on the issues of abuse. Some of the certificates relating to this training were seen in a sample of staff files which was examined. Forde Park Residential Home DS0000003702.V289807.R01.S.doc Version 5.1 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 and 26. Quality in this outcome area is adequate. Although substantial improvements have been made recently to the environment, access into the building is still difficult for residents with reduced mobility. The home was very clean and smelt fresh. EVIDENCE: The home had a warm, welcoming atmosphere and the communal rooms looked attractive. The kitchen has been substantially refurbished and new equipment has now been installed. One bedroom was being redecorated on the day of this inspection and several others have been done recently, and a substantial amount of new bedroom furniture has been bought. However there are steps at the home’s front door, which is the only public access into the home. Thus the problem remains of access for people with reduced mobility, which must be resolved so that all residents may more easily go outside (or be taken) if they wish. At the same time access into the conservatory should also be improved. Forde Park Residential Home DS0000003702.V289807.R01.S.doc Version 5.1 Page 16 A domestic assistant was cleaning the building, and all of the parts seen were very clean and there was no unpleasant odour. All of the residents surveyed said the home is always clean and fresh. Forde Park Residential Home DS0000003702.V289807.R01.S.doc Version 5.1 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): 27, 28, 29 and 30. Quality in this outcome area is good. Staffing levels are generally sufficient and there is a stable staff group. Staff receive regular training and the home’s recruitment practice is satisfactory. EVIDENCE: The residents surveyed felt that there are always enough staff available for their needs. The staff spoken with also felt that this is generally the case, although it was noted that sometimes there are only two staff on duty at teatime. It is recommended that there should always be three on duty at this time. All of the staff (except for the kitchen assistant) have worked at the home for several years, which contributes to continuity of care for the residents. The staff were cheerful and said they work well together. The manager and all of the other staff consulted said that the organisation has a good training programme, which is run by a training co-ordinator at head office. Examples of recent training include manual handling, medication management, first aid, dementia care and fire training. A sample of training certificates was seen in the three staff files inspected. There is an NVQ training programme and 50 of the care staff have achieved level 2 (or 3). The new kitchen assistant said he had received induction training, and the manager had worked two nights during the week of this inspection in order to induct and supervise a new night carer. With regard to recruitment practice three of the staff files were examined, and all contained a Criminal Records Bureau disclosure and two written references.
Forde Park Residential Home DS0000003702.V289807.R01.S.doc Version 5.1 Page 18 Forde Park Residential Home DS0000003702.V289807.R01.S.doc Version 5.1 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, 33, 35 and 38. Quality in this outcome area is good. The manager is appropriately experienced and qualified, and has good administrative support from head office staff. There is a well established quality assurance system in place, and health and safety arrangements are satisfactory. EVIDENCE: The registered manager has managed the home for over eight years. She has recently achieved the registered managers award and NVQ level 4 in care (certificates not yet available), and is an NVQ assessor. She continues to attend appropriate training, and gave some recent examples of this (diet and nutrition, care of the dying). The organisation has a professional quality management system which is subject to external audit. This system includes a requirement for the manager to submit monthly quality audit sheets in respect of care practice to head
Forde Park Residential Home DS0000003702.V289807.R01.S.doc Version 5.1 Page 20 office, and the home’s care planning system was reviewed recently. The manager said that she administers the personal money for three residents. The records were examined, including receipts for expenditure made, and were found to be satisfactory. With regard to health and safety the manager is aware of the health and safety issues which might affect the residents. The fire log was examined and was satisfactory, and staff attended professional fire training a few weeks ago. They said that four of them are about to attend first aid training. The radiators accessible to residents are guarded, and the manager said that first floor windows are restricted (a few were checked). Forde Park Residential Home DS0000003702.V289807.R01.S.doc Version 5.1 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 x x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Forde Park Residential Home DS0000003702.V289807.R01.S.doc Version 5.1 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 OP19 Regulation 23 Requirement Access into the home must be improved to enable residents with reduced mobility to enter and leave the building. The wall behind the washbasin in bedroom 1 must be redecorated. Timescale for action 31/08/06 2. OP19 23 31/08/06 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. 4. Refer to Standard OP3 OP12 OP19 OP27 Good Practice Recommendations The registered manager should always be personally involved in the assessment of any prospective new resident unless this is impracticable. A review should be undertaken of activities available, especially for those residents with dementia. The decking at the rear of the building should be treated to make it less slippery when wet. There should always be three staff on duty at tea-time. Forde Park Residential Home DS0000003702.V289807.R01.S.doc Version 5.1 Page 23 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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