Inspection on 30/10/07 for Fore Dore Nursing Home Ltd

This inspection was carried out on 30th October 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Fore Dore Nursing Home Ltd 07/10/08

Fore Dore Nursing Home Ltd 26/06/07

Fore Dore Nursing Home Ltd 09/01/07

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Fore Dore Nursing Home Ltd Fore Dore Trebetherick Wadebridge Cornwall PL27 6SB Lead Inspector Alan Pitts Unannounced Inspection 30th October 2007 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 Fore Dore Nursing Home Ltd DS0000066667.V349859.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. Fore Dore Nursing Home Ltd DS0000066667.V349859.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fore Dore Nursing Home Ltd Address Fore Dore Trebetherick Wadebridge Cornwall PL27 6SB 01208 863471 01208 683963 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) Fore Dore Nursing Home Ltd Michael John Retter Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (32) of places Fore Dore Nursing Home Ltd DS0000066667.V349859.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th June 2007 Brief Description of the Service: Fore Dore is a detached property situated within a rural village location, surrounded by countryside. The nearest main town is Wadebridge. Fore Dore provides accommodation and nursing care for up to 32 people in need of care due to old age, physical disability or terminal illness. The accommodation is on two floors, with the upper floor being accessed by a stair lift/narrow stairs. The upper floor accommodation is for more able, non-nursing residents. Fore Dore has several long corridors and wings, which give the feel of separate units. Most areas of the home are accessible by sloping corridors to facilitate differing levels of the floor. Service users have a choice of 4 sitting rooms and a dining area as communal space. There is an outdoor seating area to the front of the property. There is also a car park at the front of the home. A trained nurse is on duty over the 24-hour period. There is a registered provider in post. The range of fees charged was not ascertained at this inspection in the absence of the registered provider and registered manager. Fore Dore Nursing Home Ltd DS0000066667.V349859.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The key unannounced inspection at Fore Dore took place over approximately 5 hours with two inspectors. The inspectors looked at records, toured the building, and spoke to staff and residents. Where possible evidence was crossreferenced to other sources (e.g. training records supported by staff comments). Observations of care delivery took place during the course of the inspection. The number of requirements and recommendations has reduced since the previous inspection in June 2007. Overall, outcomes for residents are good, though the home is not always best able to demonstrate this as the care records do not reflect the efforts made. The range of fees at the home per week is from £300.58 to £580. What the service does well: What has improved since the last inspection? A new complaints procedure has been introduced. A new adult protection procedure has been introduced. A National Training Organisation compliant induction programme is in place. Fore Dore Nursing Home Ltd DS0000066667.V349859.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. Fore Dore Nursing Home Ltd DS0000066667.V349859.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 Fore Dore Nursing Home Ltd DS0000066667.V349859.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, 6 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home ensures that the care needs of prospective residents are assessed prior to admission. The home does not provide intermediate care. EVIDENCE: Care needs are assessed prior to admission to ensure that the home can meet the care needs of prospective residents. The registered manager showed a good understanding of the residents’ care needs and the capabilities of the home and the staff, and was planning to go out to do a pre-admission assessment on the day of the inspection. The registered manager was seen to liaise with other health care professionals in order to ascertain the relevant information. The home does not provide intermediate care. Fore Dore Nursing Home Ltd DS0000066667.V349859.R01.S.doc Version 5.2 Page 9 Fore Dore Nursing Home Ltd DS0000066667.V349859.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, 10 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The resident’s health, personal and social care needs are being met as evidenced by direct observation, and discussion with the staff and residents. The resident and staff interactions were noted to be very positive. EVIDENCE: Care plans remain poor, being uninformative and incomplete. They do not direct care effectively. Four samples were inspected, one was completely inadequate, one was a significant improvement on the others, but all showed inconsistent review and none involved the resident in this process. Of the residents spoken with one was aware of care planning, but all confirmed that they had not been involved in care plan reviews. The registered manager is in the process of introducing a new format for records, which it is hoped will encourage better recording. The good outcomes for residents, as evidenced by their comments, is undone by the staffs’ continued failure to support their work with sufficiently informative records. Residents were complimentary of the staff Fore Dore Nursing Home Ltd DS0000066667.V349859.R01.S.doc Version 5.2 Page 11 and their kindness and courtesy, confirming that they felt their needs were met. Comments from residents and staff do show that care needs are mostly being met (the deficit being in the area of social/recreational interaction), and the residents have ready access to other health care professionals as needed. All the residents are registered with a general practitioner. The residents receive annual health checks. Chiropody and dental services are available in the home as required. Dietary information is included in care planning and daily records include the intake of meals and drinks. Medications were not inspected at this time as the systems were found to be satisfactory at the previous inspection. Residents were complimentary of the staff and their kindness and courtesy, confirming that they felt they were respected and their right to privacy upheld. Fore Dore Nursing Home Ltd DS0000066667.V349859.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is an activity plan, but this is not reflected in the care notes. The home welcomes all family and friend visitors to Fore Dore and encourages them to stay in touch with their relative. A wholesome, appealing diet is provided. EVIDENCE: There is an activity plan for each month. The care plans purport to include social/recreational preferences, but in fact say little about the individual resident. The daily records provide too little evidence of how these needs are being met, and whether the planned activities are actually happening. There is no doubt in the inspectors’ mind that there is an intent to provide social/recreational care, the comments of the residents reflect this. A more coordinated approach is needed. There have been no changes to visiting arrangements since the previous inspection, the home operating a ‘open-door’ policy. Residents have personal possessions with them, as seen and also evidenced by the property records kept on admission to the home. Appropriate information is provided via the home’s Statement of Purpose and Service User Guide, which are also on Fore Dore Nursing Home Ltd DS0000066667.V349859.R01.S.doc Version 5.2 Page 13 display in the entrance. The residents are able to handle their own financial affairs as long as they are able, and where necessary relevant and accurate records are kept. Residents are asked daily for their choice of meal that day. There are two hot main lunch choices and up to four choices available at tea. A record of the choices made and food provided is kept. Specific diets can be catered for. The menu is planned a week in advance allowing the cook to use a fresh ingredients as possible. The cook has achieved the intermediate food hygiene certificate. The dining area was set nicely with the lunchtime menu displayed. Home made food and baking is provided, and local produce is used wherever possible. Fore Dore Nursing Home Ltd DS0000066667.V349859.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents were confident that they would be listened to, and a complaints policy is in place. Residents are protected by an adult protection policy and procedure. EVIDENCE: There is a new complaints policy, which provides residents and their representatives with the necessary information and contact details. This has been sent to all the existing residents and is included in the home’s Statement of Purpose and Service User Guide for prospective residents. Residents were confident in the staff and the registered manager and said that they would feel able to express any concerns. The home has a clear adult protection procedure, and staff were familiar with the action to take in the event of an allegation of abuse. Fore Dore Nursing Home Ltd DS0000066667.V349859.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Fore Dore is suitable for its stated purpose. The property is generally well maintained and provides a safe, clean environment for residents. EVIDENCE: The home has had, and continues to be in the process of ongoing maintenance, upgrading, and redecoration since it’s purchase by the current owner. Access around the ground floor is generally level with ramped access where needed. The staircase is protected by a keypad system. There is sufficient, pleasantly decorated and comfortable communal space. There is generous car parking available. There are seating areas outside for residents, and one of two ponds has been filled in with the intention of providing another level seating area. Fore Dore Nursing Home Ltd DS0000066667.V349859.R01.S.doc Version 5.2 Page 16 Resident’s rooms were seen to be clean and tidy, and personalised to varying degrees. No odours or evident hazards were noticed in the home. There is documentary evidence of regular and frequent maintenance of the premises and the equipment in use. Fore Dore Nursing Home Ltd DS0000066667.V349859.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 30 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The numbers and skill mix of the staff meet the needs of the current residents. The welfare of residents is safeguarded. There is an evident commitment to ongoing training. EVIDENCE: On the day of the inspection the registered manager was on duty with 27 residents living at the home. The care staff was provided as follows: • 1 Nurses • 4 care staff (normally 5, but one called in sick) The staffing compliment at other times is normally: • pm; 1 nurse 4 carers • night; 1 nurse 2 carers The shift patterns in use are: • 7am – 2pm • 2pm – 9pm • 9pm – 7am • The shifts include a 15 minute handover period at the end of the shift. Fore Dore Nursing Home Ltd DS0000066667.V349859.R01.S.doc Version 5.2 Page 18 There is sufficient staff to meet the needs of the residents, and comments about the care from the residents was very positive. Occupancy at the home is steadily increasing. The home is operating at a maximum occupancy of 29 as the three rooms upstairs are not in use. Comments from staff support the registered providers’ and registered managers’ commitment to providing ongoing staff training. The staff comments also showed a good team spirit in place, and staff said they enjoyed working at Fore Dore. There is an induction programme in place for new staff, which is based on the National Training Organisation units, though the home is not using recognised formats for recording the training and the registered manager undertook to ensure that the resultant qualification would be transferable and valid outside of Fore Dore. Fore Dore Nursing Home Ltd DS0000066667.V349859.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The registered manager is experienced and able to meet the home’s stated purpose, aims and objectives. The home could do more to ensure that the interests of the residents are best served. Residents financial interests are safeguarded. Residents are kept safe. EVIDENCE: The registered provider is continuing to improve the fabric of the building and gardens. The registered manager is experienced, and comments from the staff were positive in respect of his leadership and approachability. Residents also said that they would feel able to approach either the staff or the registered manager. Fore Dore Nursing Home Ltd DS0000066667.V349859.R01.S.doc Version 5.2 Page 20 The registered manager did send out some quality assurance questionnaires earlier this year, and has taken action as a result of some of the feedback (specifically identified staff training has been provided), and will be publishing a summary of the findings and any action taken as a result of the responses. Small amounts of residents’ money are held securely at the home, and are supported by accurate records and receipts. The registered manager is intending to change to a retrospective invoice system, where any costs are funded from the homes’ petty cash negating the need to store any residents’ money. Although there are annual appraisals there is no formal, regular staff supervision taking place. A sample of records relating to the safety of the residents, staff, and building were inspected and seen to be in order. Fore Dore Nursing Home Ltd DS0000066667.V349859.R01.S.doc Version 5.2 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 X 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 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 3 Fore Dore Nursing Home Ltd DS0000066667.V349859.R01.S.doc Version 5.2 Page 22 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. Standard OP7 Regulation 15 Requirement The registered manager must ensure that there is an effective care plan in place for each resident that clearly states the care need and the manner in which the need is to be addressed. Where possible, the resident or their representative should be included in this process. The registered manager must ensure that staff understand the importance of evidencing their work with entries in the care notes. 2. OP36 18 The registered manager must ensure that regular and frequent staff supervision takes place and is recorded. 01/02/08 Timescale for action 01/12/07 Fore Dore Nursing Home Ltd DS0000066667.V349859.R01.S.doc Version 5.2 Page 23 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 OP12 Good Practice Recommendations The registered manager should do more to ensure that staff understand the importance of the residents’ life at the home and record a picture of the residents’ day in the care notes. Fore Dore Nursing Home Ltd DS0000066667.V349859.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Devon Area Unit D1 Linhay Business Park Ashburton TQ13 7UP 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. Extracts may not be used or reproduced without the express permission of CSCI Fore Dore Nursing Home Ltd DS0000066667.V349859.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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