Inspection on 07/10/08 for Fore Dore Nursing Home Ltd

This inspection was carried out on 7th October 2008.

CSCI found this care home to be providing an Good service.

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 30/10/07

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 05/12/2008.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Fore Dore Nursing Home Ltd Fore Dore Trebetherick Wadebridge Cornwall PL27 6SB     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Alan Pitts     Date: 0 7 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Fore Dore Nursing Home Ltd Trebetherick Fore Dore Wadebridge Cornwall PL27 6SB 01208863471 01208683963 michaelretter@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Michael John Retter Type of registration: Number of places registered: Fore Dore Nursing Home Ltd care home 32 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 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. Care Homes for Older People Page 4 of 25 Over 65 32 0 Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The key unannounced inspection at Fore Dore took place on the 7th October 2008. The inspector looked at records, toured the building, and spoke to staff and residents. Where possible evidence was cross referenced to other sources (e.g. training records supported by staff comments). Observations of care delivery took place during the course of the inspection. The home is operating at a maximum occupancy of 29 residents as the rooms on the first floor are not used. The number of requirements and recommendations has reduced since the previous inspection. Overall, outcomes for residents are good, though the home is not always Care Homes for Older People Page 6 of 25 best able to demonstrate this as the care records do not reflect the efforts made, particularly in respect of lifestyle. The range of fees at the home is from 308.09 to 600.00 pounds per week. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 25 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who are thinking about a move to Fore Dore are provided with good information to help inform them about their choice of home. Evidence: The registered manager confirmed that copies of the Statement of Purpose and Service User Guide (documents that tell a person about the home) are given to prospective people and residents. This pack also includes the Complaints Procedure. The Statement of Purpose and Service User Guide were last reviewed in July 2007, and the registered manager is aware that they are due for review. The registered manager confirmed that everyone had a contract and this was supported by the care documentation belonging to the most recent admission to the home. Care Homes for Older People Page 10 of 25 Evidence: As part of this inspection we looked at the assessments that were carried out prior to a person moving to Fore Dore. The care documentation of the person most recently admitted to the home showed that a proper pre-admission assessment had take place. The home does not provide intermediate care, though respite care is offered. Care Homes for Older People Page 11 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Many of the people who live at Fore Dore and their relatives feel that they are offered a good standard of care. Each resident has a care plan that has been agreed with them. This is written in plain language, is easy to understand and considers all areas of the individuals life including health, personal and social care needs. The care plan also includes a risk assessment. Improvement is needed to ensure that care needs identified in assessments are evident in the plan of care. The home ensures that each residents plan is reviewed regularly and involves the resident and where agreed their family. The aims and objectives of the home reinforce the importance of treating residents with respect and dignity. Evidence: Comments received from the people who live at Fore Dore were very positive. Comments included ...the staff are lovely, and nothing is too much trouble. Surveys sent to relatives indicated that that people are happy with the service provided and peoples health care needs are well met. Care Homes for Older People Page 12 of 25 Evidence: The care documentation for each residents was seen to include: admission details; property details; care needs assessment; social history; and risk-assessments (including capacity). Three care plans were inspected, two of which showed evidence of resident/family involvement in the development and review of the care. One was a recent admission and had yet to be reviewed. The care plans are generally well written and informative, but care must be taken to ensure that they include all pertinent issues. Two were discussed with the registered manager and it was found that there were more care needs than were evident on the plans of care for the individuals. Daily entries made by staff evidence the general health care given. Supporting documentation showed that clients have access to relevant professional health care agencies as needed. All the people that live at Fore Dore are registered with a GP from either of two local surgeries. All the residents have access to 6-monthly visists from an optician service. The supplying GP surgeries dispense medications for the people living at Fore Dore. We looked at the records relating to the administration of medicines. These were seen to be in order, with two signatures to indicate the entries had been checked as accurate. Medicines are stored securely. There is a contract in place for the safe disposal of medicines. Clients preferred names are recorded and used. Clients have access to a telephone for private use. Staff were observed to interact with residents in a relaxed, unhurried manner. Care Homes for Older People Page 13 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are aware of the need to plan the routines and activities of the home in a way which meets the choice and wishes of residents. The home has open visiting arrangements and residents know they can entertain their family and friends in their own room. The home has made use of advocates who are prepared to act independently on behalf of residents. The food in the home is of good quality, well presented and meets the dietary needs of residents. The cook is experienced, consults with residents and tries to meet the preferences and suggested dishes when preparing the menu. Evidence: The homes daily entries do not demonstrate the lifestyle of the residents, entries being predominantly health care focused and, with the occasional exception, tend to be bland statements such as fine this morning. There is an activity plan displayed near the entrance to the home that shows four activities for the month of October (excercise class, hairdresser, bingo, and a trip out). The registered manager is aware that more needs to be done in this respect. When asked about the lifestyle of residents one comment received was [the staff should] spend more time talking and listening to residents rather than sitting them in front of the TV in the lounge for long periods.... Care Homes for Older People Page 14 of 25 Evidence: This practice was not observed at the time of the inspection. The comment was discussed with the registered manager. When asked if they felt that they had enough to do to occupy themeselves, two residents said yes. The visitors book and comments from residents confirm that contact with loved ones and friends is encouraged. The benefits of the daily entries providing a pen portrait of residents life styles (including times of waking and retiring) was discussed with the registered manager, who said that there was a suitably qualified staff member already working at Fore Dore and he planned to allocate some specific hours to this person for social/recreational activities. Rooms are personalised with plenty of evidence of personal possessions being brought in. The home maintains a personal property record to reflect this. The days menu is displayed on the wall of the dining room, and shows that a choice is available. There is a record of food provided kept. The daily entries show if a resident has eaten well that day. Soft diets are available, and care is taken to ensure that such meals are presented in a manner that is attractive. The chef has achieved the Level 3 Supervising Food Safety Certificate, and the home is following the Safer Food Better Business programme. The people who live at Fore Dore said the food is lovely, and the chef was observed going round asking people for their meal choices. Care Homes for Older People Page 15 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people at Fore Dore are confident that their concerns will be listened to and acted upon. The people that live at Fore Dore are protected from abuse by appropriate procedures and ongoing staff training. Evidence: There is a complaints procedure displayed in the entrance to the home. A copy of the complaints procedure is available in the service user guide. Neither the Commission nor the home have received any complaints since the last inspection. One of the responsibilities a care home has is to protect people from abuse, and the Commission expect homes to be proactive in this matter. There is a sfaeguarding procedure and ongoing safeguarding training taking place, which the registered manager said would continue until all staff had received this training. Currently 18 out of 27 staff have received safeguarding training provided by the local authority. The home adheres to a robust employement procedure, including Criminal records Bureau checks to safeguard residents. Care Homes for Older People Page 16 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live at Fore Dore benefit from accommodation that for the most part has been designed to meet their needs. Three rooms on the first floor are not in use, and the home is operating at a maximum occupancy of 29. The shared areas provide a choice of communal space with opportunities to meet relatives and friends in privacy or in their own rooms. The accommodation is clean and odour free. Evidence: We looked around the home with the Manager, as part of this inspection. The rooms seen were all clean and in good order, there were no unpleasant odours. Some of the people had brought items of their own in to decorate their rooms. All of the rooms are of sufficient size. The shared areas provide a choice of communal space with opportunities to meet relatives and friends in privacy or in their own rooms. There is a choice of bathing facilities, both assisted and unassisted, showers and baths and there are a number of toilets strategically placed around the home. The management has a good infection control policy, with gloves, aprons and alcohol solution available thoughout the home. The kitchen and laundry areas are well equipped and were seen to be clean and organised. A water cooler has been provided near the entrance to the home so that people can help themeselves to a drink. The sluice room adjacent to the fire panel was seen to be cluttered with equipment on the floor. Care Homes for Older People Page 17 of 25 Evidence: Whilst generally acceptable the home does show signs of wear and tear internally and externally (e.g. damaged walls, window frames need attention). The home does not employ a maintenance person. Care Homes for Older People Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The numbers of staff on duty are sufficient to meet the health care needs of the residents. Residents have confidence in the staff that care for them. Rotas show well thought out and creative ways of making sure that the home is staffed efficiently. The recruitment procedures are robust to safeguard residents. Training is encouraged and facilitated. Evidence: At the time of the inspection there were 27 people living at Fore Dore, with the registered manager, one nurse, and five care staff on duty. Five staff are undertaking the National Training Organisation induction to care. Information provided by the Home shows that in excess of 50 of care staff have a National Vocational Qualification Level II or above. The registered manager was able to produce a print out of training under a variety of subjects, such as manual handling, which easily identifies where further training is needed. The registered manager was aware of the need to continue with staff training opportunities in areas relevant to the jobs they do (such as dementia care). Examination of personnel files showed that the home is adhering to a robust employment procedure, including Criminal records Bureau checks, the taking up of relevant references, and a record of interview. Care Homes for Older People Page 19 of 25 Evidence: When we looked around the house people were up, dressed and there was no evidence of a lack of care. Care Homes for Older People Page 20 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager has the required qualifications and experience and is competent to run the home. Efficient systems are in place to monitor staff adherence to policies and procedures during their practice. The home has access to professional business and financial advice and has all the necessary insurance cover in place to enable it to fulfil any loss or legal liabilities. Residents are provided with facilities to keep their valuables and money safe. Evidence: The registered manager is a nurse and has also achieved the Registered Managers Award. Mr Retter has worked at Fore Dore for a number of years. The registered Provider is in regular and frequent contact with Mr retter. Quality Assurance forms have been sent out to find out about peoples views about the service, and also to stakeholders, such as doctors. A small number have been returned, and the registered manager said that the feedback would be analysed and a Care Homes for Older People Page 21 of 25 Evidence: summary of the findings published (possibly in the Service Users Guide). 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. Staff files supported the registered managers statement that staff supervision had commenced since the last inspection and would continue to be provided to all staff. Records relating to the safety of the residents, staff, and building were inspected and seen to be in order (e.g. electrical testing, fire system maintenance). Care Homes for Older People Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action 1 7 15 The registered manager 01/12/2007 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 36 18 The registered manager 01/02/2008 must ensure that regular and frequent staff supervision takes place and is recorded. Care Homes for Older People Page 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 The registered manager should arrange for the regular monitoring of care plans to ensure they have all the information pertinent to the care interventions needed. The registered manager should do more to ensure that there are regular and frequent activities available to all residents, and that the lifestyle of the residents is reflected in the care records. The registered provider should consider the benefits of a regular maintenance person in order to maintain and improve the environment. The registered manager should provide more storage racking in the sluice to avoid the need for equipment to be on the floor. 2 12 3 19 4 26 Care Homes for Older People Page 24 of 25 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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