Inspection on 08/10/05 for Forest Court Nursing Home

This inspection was carried out on 8th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Forest Court Nursing Home 05/05/10

Forest Court Nursing Home 23/02/09

Forest Court Nursing Home 01/02/07

Forest Court Nursing Home 23/03/06

Forest Court Nursing Home 23/03/05

Forest Court Nursing Home 12/10/04

Forest Court Nursing Home 16/01/04

Similar services:

Fairfields Country Rest Home

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Fairfax House

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

CARE HOMES FOR OLDER PEOPLE Forest Court Nursing Home Bradley Court Road Mitcheldean Glos GL17 0DR Lead Inspector Mrs Janice Patrick Unannounced Inspection 8th October 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 Forest Court Nursing Home DS0000016438.V254778.R01.S.doc Version 5.0 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. Forest Court Nursing Home DS0000016438.V254778.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Forest Court Nursing Home Address Bradley Court Road Mitcheldean Glos GL17 0DR 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) 01989 750775 01989 750348 BUPA Care Homes Ltd Mr Christopher James Rowlands Care Home 49 Category(ies) of Dementia (49) registration, with number of places Forest Court Nursing Home DS0000016438.V254778.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th May 2003 Brief Description of the Service: This Care Home is part of BUPA Care Homes Ltd and specialises in the care of those suffering from dementia. It is located on the outskirts of Mitchledean in the Forest Of Dean. The Home commands panoramic views from an elevated position and has its own gardens, one of which is enclosed to ensure resident safety. The Home provides well maintained accommodation, which comprises of single bedrooms, spacious communal rooms and ample communal bathing facilities. Staff are committed and trained well to provide the specialised care required. Some adaptations have been made in the Home to make life easier for those that also have a physical dependency. Forest Court Nursing Home DS0000016438.V254778.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out by one inspector between the hours of 10:00am and 1:45pm. The Registered Manager was not present but the Deputy Manager was supernumerary to the staff team on duty and was helpful throughout the process. Care documentation including a selection of staff recruitment files were inspected. Other records pertaining to the medication system, staff supervision and health and safety were seen. During a tour of the building residents were spoken with as was appropriate at the time and one relative. Five members of staff were also spoken with. The environment looked clean and felt relaxed. The Home was generally warm and light. What the service does well: What has improved since the last inspection? What they could do better: Keep staff training files and recruitment files up to date and organised. Provide basic mandatory training for staff within the first 6 weeks of employment, i.e. within their induction period. Forest Court Nursing Home DS0000016438.V254778.R01.S.doc Version 5.0 Page 6 The Registered Manager must ensure he is updated in all mandatory training. 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. Forest Court Nursing Home DS0000016438.V254778.R01.S.doc Version 5.0 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 Forest Court Nursing Home DS0000016438.V254778.R01.S.doc Version 5.0 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): N/A None of the above standards were inspected during this inspection. EVIDENCE: N/A Forest Court Nursing Home DS0000016438.V254778.R01.S.doc Version 5.0 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): 7, 8 & 9 Care plans are well written and give care staff clear direction in how the residents’ care needs are to be met. The residents’ health needs are also met with evidence of a good multidisciplinary approach. The system for medication is organised, ensuring that the process of administration is safe and that it meets the residents’ needs. Records reflect the Homes philosophy of limited use of drugs in dementia. EVIDENCE: There have been no changes to the care planning system since the last inspection. Each resident is reviewed and reassessed by a ‘named nurse’ and records showed that this is carried out on a monthly basis or as changes in care dictate. One resident’s care notes were read in detail. All care plans were appropriate and updated. A recent change in the resident’s capability was recorded and the care plan adjusted. At times this resident can be aggressive and records showed that all incidents are comprehensively recorded. There have been 3 visits so far in 2005 from the Community Psychiatric Nurse, providing specialist monitoring of this resident’s health needs and offering Forest Court Nursing Home DS0000016438.V254778.R01.S.doc Version 5.0 Page 10 guidance to staff where needed. Records show regular input from the Psychogeriatrician and GP and show that the staff are in contact with the resident’s Next of Kin. The medication system was inspected. All documentation was comprehensively completed. During this inspection the Deputy Manager spoke with the Home’s supplying pharmacist to clarify arrangements for removal of surplus medication to ensure the appropriate requirements were being met. BUPA are in the process of organising correct procedures throughout their Homes. The records of one resident showed continual review of their medication and demonstrated that very small amounts are only used when all other intervention fails. Forest Court Nursing Home DS0000016438.V254778.R01.S.doc Version 5.0 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, 13, 14 & 15 The Homes positive approach to residents being able to make choices and carrying out their personal preferences is reflected in the behaviour of both resident and staff. EVIDENCE: The Inspector observed staff actively encouraging residents to make choices or carry out their preferences. How this was done varied depending on the individual resident’s capability. One resident often chooses to have days in bed and will not be dissuaded from this. Regular checks were made on this resident and her meal delivered to her. Another resident who suffers from great anxiety has been provided with a keypad for her own bedroom. Arrangements are in place to ensure this person can make choices safely. Several residents were seen to be walking up and down the corridors, free to visit areas as they chose, with staff regularly interacting with them even if the resident did not respond in return. One resident walked into the Manager’s office in a disorientated state. The Deputy Manager quietly explained to her that it was a dead end and allowed her to wander freely until she changed direction under her own volition. One visitor comes to the Home each day and helps her husband with his lunch. She explained that he is no longer able to feed himself and she feels this is something that she can still do for him. She confirmed that she has never Forest Court Nursing Home DS0000016438.V254778.R01.S.doc Version 5.0 Page 12 witnessed anyone being forced to do anything they do not want to do. She was also delighted to have been invited to have Christmas Lunch with her husband and is looking forward to this. Another visitor has a similar routine and confirmed that he is still always made welcome by the staff. Both confirmed that they are able to talk with staff freely as and when needed. Another resident was sitting in the upstairs hallway at lunchtime; the Inspector was concerned that she had been forgotten. The Deputy Manager explained that staff knew the resident’s routine well and they would come and find her. This they did and the resident chose to have lunch with another resident in their bedroom, which is something they both like to do fairly often. A choice of food is offered, sometimes by needing to physically put the two choices in front of the resident, as witnessed in one case. Where the resident is unable to express their preference, as seen in another situation, the staff member was aware of the resident’s preference. Since the last inspection one of the numerous communal rooms has been converted into a designated activities room. The activities co-ordinator was not in the Home during this visit, but it has been recognised as a very positive move by other staff. It now allows small groups or individual residents to partake in an activity without distraction. The Deputy Manager also explained that lunches have been served in this room, where the aim has been to make the meal time a social gathering for a small group. Committed staff members and their families gave their time and painted a huge mural on one of the walls in this room. Records are kept of the residents’ activities and each session is designed to meet the individuals’ needs and capabilities. The Home does not have links with the local community. Staff feel this is due to the type of client group the Home cares for. The vicar from the local town however, is always willing to attend and another resident who is catholic, enjoys a weekly visit from a Priest. Many residents enjoy singing hymns and partaking in musical and movement sessions, but these times are purposely kept informal and allow for those who may lose concentration and wander. Forest Court Nursing Home DS0000016438.V254778.R01.S.doc Version 5.0 Page 13 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, 17 & 18 Staff are committed to ensuring that the residents rights are upheld and that they are protected from any wrongdoing or abuse. The Home has robust complaints procedures, which allows for complaints to be fully investigated. EVIDENCE: The Deputy Manager discussed two different situations with the Inspector that demonstrated that the residents, who are often unable to speak for themselves, are sheltered from those who do not understand their illness or from those who are not acting in their best interest. All staff receive Adult Protection training and there are internal arrangements for staff to be able to report any situation that they feel unhappy about, however small. Staff were observed to be treating residents in an appropriate and kind manner and this behaviour was confirmed as being the ‘norm’ by two visitors who know the Home well. The Complaints Procedure is within literature that is in a prominent position in the reception area. Small concerns and worries are often discussed before they have a chance to become a complaint. One recent internal situation was fully investigated by the company to ensure all staff had behaved appropriately. The outcome was deemed as being satisfactory. Forest Court Nursing Home DS0000016438.V254778.R01.S.doc Version 5.0 Page 14 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, 24 & 26 The Home offers an environment that is well maintained and comfortable, and which is clean and safe. EVIDENCE: The Inspector toured the building and a selection of bedrooms were viewed. Some are more personalised than others, but the company furnishes them all to meet the National Minimum Standards. One bedroom smelt strongly of urine, despite the carpet having just been replaced. The Deputy Manager was unaware that the odour had returned. She has subsequently confirmed that this room now has non-slip washable flooring. Memory boxes with Perspex fronts have been provided outside each bedroom. The idea being, that a visual prompt is placed inside. This would be something that hopefully the resident would relate to and an opportunity gained to talk about a period of time the resident remembers well. It may help the person locate their individual bedroom. One has been filled with small items that the resident used in his working life as an engineer. Forest Court Nursing Home DS0000016438.V254778.R01.S.doc Version 5.0 Page 15 The Deputy Manager felt these were initially a good idea, but was not totally convinced of their value. She did say that they seem to have been placed at a height that several residents do not see and consequently they knock against them. The general environment is well maintained and one bedroom, seen in the last inspection to be halfway through being decorated, now looks warm and inviting. The laundry was inspected, this was clean and organised and has all the appropriate equipment required by the Home. There are set cleaning schedules within the Home with regular carpet cleaning taking place. There were no offensive odours in the Home except the bedroom previously mentioned. Forest Court Nursing Home DS0000016438.V254778.R01.S.doc Version 5.0 Page 16 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, 29 & 30 Staffing levels and good skill mix allow for residents to be cared for by persons that are knowledgeable and committed to the care of those with dementia. Recruitment processes are generally good and help protect the residents from any form of abuse. EVIDENCE: The Home was fully staffed on the day of this inspection except for the administrator’s position, which is due to long term sickness. Some administrative tasks have been covered by staff in other Homes or by staff helping out within Forest Court. The situation obviously has not been ideal and filing is severely behind schedule. The Home does have some vacancies for which it is actively recruiting. The Registered Manager was not present but has returned to his post at the Home, having completed several months in another role within the company. The Deputy Manager who has competently managed the Home in his absence was on duty. A selection of staff files were seen and five were inspected in detail. These were at varying stages of filing due to the lack of administration support, which the Inspector fully allows for. All records showed evidence of appropriate criteria being met, but the Home must be careful to explore any gaps in a persons employment as seen on their application form. Forest Court Nursing Home DS0000016438.V254778.R01.S.doc Version 5.0 Page 17 The Inspector spoke with one member of staff about her induction training, but was unable to see any record of this, as the member of staff did not have her booklet with her. She had not received mandatory Fire or COSHH training since starting in this post, but explained she had been shown the fire points and told what to do in the event of a fire. She also confirmed that she had received these trainings in her last job, but there was no evidence of this in her file. Some of the individual training records were not up to date although evidence could be seen elsewhere that staff had completed their trainings, such as fire training and moving and handling. The Inspector spoke with the senior carer responsible for moving and handling training in the Home. Records showed all staff to be updated unless there was a good reason for them not to be. The Registered Manager has subsequently forwarded certificates that show he is also fully updated. All updates for this training are due in December 2005. Records show that some staff undertake additional trainings on a regular basis. All staff receive ‘in house’ training in dementia care from the Registered Manager and clearly have enjoyed this. Dementia training is also now available through BUPA and three staff completed a three-day course recently. The Deputy Manager and one Registered Nurse are due to commence a post registration course in dementia care in the New Year. The Home also employs two staff qualified in psychiatric nursing. The Registered Manager has completed extensive post registration study in dementia care. Forest Court Nursing Home DS0000016438.V254778.R01.S.doc Version 5.0 Page 18 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): 36 & 38 Staff supervision arrangements are in place for day staff to ensure they have the skills and understanding to perform their job correctly, this same assurance cannot be afforded to the night staff as supervision for this group is behind. On the whole, arrangements for staff to receive Fire Awareness Training are in place, but not all staff are receiving this early enough in their job to help ensure the safety of the residents. EVIDENCE: Records showing that staff are receiving supervision were seen, although night staff have not received supervision since May 2005. Senior staff are aware of this and plan to recommence regular supervision for these staff. Forest Court Nursing Home DS0000016438.V254778.R01.S.doc Version 5.0 Page 19 Record shows that all night staff had recently received Fire Awareness Training. There was no record to show that the Registered Manager is updated in Fire Awareness. Several extra fire doors have been put in place on the first floor. This has reduced the length of corridor behind a fire resistant door. Building work has also been carried out in the roof space to aid fire containment and the fitting of additional fire detectors has been completed. All external fire doors are alarmed, particularly important as this home specialises in the care of those with dementia. Two members of staff who had commenced work at the home in June 2005 and August 2005 still had not received formal fire training. Although one said she had received this in her last employment there was no record/certificate in her staff file to prove this. Forest Court Nursing Home DS0000016438.V254778.R01.S.doc Version 5.0 Page 20 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 3 8 3 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X 3 X 3 STAFFING Standard No Score 27 3 28 X 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X 2 X 3 Forest Court Nursing Home DS0000016438.V254778.R01.S.doc Version 5.0 Page 21 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 OP29 Regulation 19 Schedule 2 (6) Requirement The Registered Manager must ensure a full employment history, together with a satisfactory written explanation of any gaps in employment. This must be obtained for all new recruits before their employment. The Registered Manager must ensure a record of training is held on all staff and that it is kept updated. Timescale for action 09/01/06 2 OP30 17 (6)(f) 09/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Forest Court Nursing Home DS0000016438.V254778.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: 0845 015 0120 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 Forest Court Nursing Home DS0000016438.V254778.R01.S.doc Version 5.0 Page 23 - 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. 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