Inspection on 14/07/06 for Forest Dene

This inspection was carried out on 14th July 2006.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Forest Dene 48 Hermon Hill Wanstead London E11 2AP Lead Inspector Stanley Phipps Key Unannounced Inspection 12:45 14 July to 28th July 2006 th 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 Dene DS0000067415.V304716.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. Forest Dene DS0000067415.V304716.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Forest Dene Address 48 Hermon Hill Wanstead London E11 2AP 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) 020 8989 2311 020 8530 2822 peter.brooker@sanctuary-housing.co.uk www.sanctuary-care.co.uk Sanctuary Care Ltd Peter Michael Brooker Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Forest Dene DS0000067415.V304716.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 40 elderly people who may have physical or sensory disabilities or mental frailty related to the ageing process but who are not mentally ill within the meaning of the Mental Health Act 1983. To include one named person under 65 years of age Date of last inspection 24/01/06 Brief Description of the Service: Forest Dene is a care home registered to provide personal care for forty elderly people. It was previously owned and managed by Ashley Homes and as of April 2006 has been formally taken over by Sanctuary Care. The transition process to Sanctuary begun in the last quarter of 2005. The home is located on Hermon Hill, Wanstead in the London Borough of Redbridge. It is close to Snaresbrook and Wanstead underground stations and main road routes to Central London and Essex. It is approximately half a mile from Wanstead High Street, which has a selection of amenities including shops, a library, chemist, post office, places of worship, restaurants and public houses. Forest Dene comprises 4 units, set over three floors - a lower ground floor (Ashgrove), ground floor (Beechgrove) and first floor that houses Pinegrove and Highgrove. There is lift access to all floors. There are bedrooms, bathrooms, lavatories and communal lounges on all floors. The main dining room is on the ground floor. None of the bedrooms have en-suite facilities, but all have hand basins. Laundry facilities are sited on the first floor. All rooms are connected to an emergency call system. The facilities also include a hairdressing room with an on-site hairdresser available to service users and a medical room. The home has a domestic sized garden with a paved patio area. The home is staffed on a twenty–four hour basis in providing care and support to elderly service users. Fees are charged at £480.82 and do not include hairdressing priced (variable); newspapers and toiletries (variable prices), private chiropody (£10.00). Forest Dene DS0000067415.V304716.R01.S.doc Version 5.2 Page 5 The home’s statement of purpose is made available to service users on request and a copy is kept in the staff office. Each service user is given a copy of the home’s service user guide, once admitted to the home. Forest Dene DS0000067415.V304716.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and a key inspection of the service for the inspection year 2006/2007. This meant that all key standards were covered as well as any other standard for which a requirement was made at the last inspection. It was carried out over two days beginning on the 14/7/06 at 12.45 p.m. and finished on the 28/7/06. It was the first inspection under the new providers – Sanctuary Care and the visit was timed with this in mind and to look at the progress made since the last inspection. At the time of the inspection plans were in place to refurbish the lower ground floor with a view to providing services to service users with more specialist needs i.e. Dementia Care. Two service users were occupying that area and in line with best practice, appropriate discussions and consultations were due to be held with them over this development. The inspection found that there were key improvements to the service. One of the talking points at the time of the visit was a resident holiday to Butlins planned for September 2006 and there was a buzz of excitement around this. The management and staff felt that the new providers were responsive, particularly in dealing with emergencies in the home. Although there were areas identified for further improvements, it was conclusive that the overall outcomes for service users had improved. As part of the inspection three service users’ files were assessed including that of the most recently admitted service user. They formed part of case tracking. The inspection also entailed interviews with service users, staff, relatives and, where provided, external professionals. Records, policies and procedures and the facilities provided by the home were assessed. There were detailed discussions with the registered manager, deputy manager and two team leaders. A visit to a staff team meeting was also undertaken. A random sample of telephone interviews was also conducted with the relatives of service users. What the service does well: The management and staff continue to demonstrate a commitment to providing good quality care at Forest Dene. This was the feedback from all relatives and service users alike. Service users reported that they feel safe and comfortable in the home as one service user stated ‘ I have been in the home over twenty years and feel very comfortable here’. This feeling of safety and comfort remained a constant theme throughout the inspection. Forest Dene DS0000067415.V304716.R01.S.doc Version 5.2 Page 7 The management and staff demonstrated the ability to provide consistent care and support despite the changes in the organisation and this was service user focussed. There continues to be satisfactory arrangements for meeting the nutritional needs of individuals, although one service user expressed the desire to have fish more frequently. The management and staff also have and maintain positive links with the relatives of service users. All service users are pleased about this. What has improved since the last inspection? What they could do better: Forest Dene DS0000067415.V304716.R01.S.doc Version 5.2 Page 8 Service users would benefit from having updated information about Forest Dene, particularly in relation to the changes made by the new organisation. Other beneficiaries include prospective service users and relatives. There needs to be closer monitoring of medication, once they are dispensed, even where the service user may have some level of independence. Some aspects of the environment needed attending to and this relates to equipment in the kitchen and an item of hardware for the laundry room. The latter is to prevent the door handle from causing further damage to the wall that it opens onto. A more suitable bath is required on Highgrove as the current facility is inappropriate for meeting the needs of service users. The acquisition of staff recruitment records needed improving to ensure that it complies with legislation. Staff could also be given more support through the formal mechanisms such as regular supervision and annual appraisals. 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 Dene DS0000067415.V304716.R01.S.doc Version 5.2 Page 9 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 Dene DS0000067415.V304716.R01.S.doc Version 5.2 Page 10 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): 1,3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. A detailed assessment of service users’ needs is carried out prior to their admission in determining whether they could be met by the home. Service users and their relatives also have information about the services provided by Forest Dene. However, this information would be more effective to service users if is kept updated. The home does not provide intermediate care. EVIDENCE: An updated statement of purpose and service user guide is normally available to service users and their relatives. The information contained in these documents enables individuals to determine the services and facilities offered by the home. At the time of the visit this document was reportedly reviewed by Sanctuary, but had not been completed. It is important that the updated document is made available to service users – current and prospective, and relatives. It enables one to make an informed choice about the home. As part of the admissions process service users’ needs are assessed prior to being admitted to the home and this is usually carried out by staff that are trained to so do. A summary of the care management assessment is also Forest Dene DS0000067415.V304716.R01.S.doc Version 5.2 Page 11 obtained and this helps to determine whether the individual’s needs could be met by the home. The assessments are also useful in identifying the external support and facilities that are to be provided outside the home. Service users have some assurance that their needs would be met, whilst living at Forest Dene. During the course of the inspection the file of most recently admitted service user was assessed and evidence of detailed assessments were in place. Management and staff were therefore able not only identify the various needs of the individual, but they also detailed a plan of action for how they were met. There was evidence that the staff carry out a monthly assessment of service user dependency levels and this helps to monitor any change in their needs. This is positive. Forest Dene DS0000067415.V304716.R01.S.doc Version 5.2 Page 12 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): (7,8,9,10) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users generally benefit from having a service user plan detailing their needs and this includes their personal, social and health care needs. Service users are supported to maintain a healthy lifestyle and this includes support with medication, although there is room for improvement in this area. All service users spoken to were pleased with the level of privacy and respect they receive at Forest Dene. EVIDENCE: Three service users plans were examined and they included those of the most recent service users, as well as service users who were part of case tracking. There is a good system of service user planning in the home, in that they generally detailed the health, personal and social care needs of service users. Where possible service users and their relatives are involved and they were reviewed at regular periods. It was noted at the inspection that a number of them were up for review and arrangements were in place to have them done. It is important to note that significant changes are recorded and acted upon so as not to compromise the quality of care given to service users. Team leaders have the responsibility for reviewing and updating the service user plans and the deputy manager monitors this process. Forest Dene DS0000067415.V304716.R01.S.doc Version 5.2 Page 13 There was good evidence to confirm that the health of service users was adequately provided for. Service users were registered with a range of different GPs and were in receipt of dental, optical, and chiropody services. Where required the services of the district nurse and continence advisor were also accessed. In one of the cases tracked, a service user had stopped walking and a referral for physiotherapy was made via the GP. The service user had the benefit of a new zimmer frame and the staffing support to enable her to regain her independence in relation to her mobility. Other service users were observed with conditions such as diabetes and hypertension and adequate arrangements through diet, education, medication and liaison with the GPs ensured that individual needs were met. There was positive feedback from relatives regarding their satisfaction with the home’s management of service users health. An integral part of promoting health care involved the use of various types of medication, in which staff were very involved. All staff handling medication received appropriate training to enable them to so do. At the time of the visit none of the service users were independently handling their medication. Medication practices in the home continued to be generally of a high standard. Monthly audits are still carried out by the pharmacist with recommendations made to improve practice. Staff are paying more attention to the recommendations made and this is positive and is an improvement from the last inspection. Medication storage and disposal was satisfactory, however there was room for improvement in administration. An observation made during the inspection involved a service user’s medication being left with her on the table as she was finishing her meal. There was a staff presence, but they were engaged with other service users and the service user proceeded to take her medication, when one of the tablets fell to the floor. She then became quite anxious, as she could not locate it. A staff member was summoned and the situation was satisfactorily rectified. However, service users need closer monitoring to ensure that the medication prescribed for them is taken safely taken by the individual/s concerned. It was noted that the service user had some degree of independence, but even so, closer monitoring was required to minimise risks. An assessment of the medication policy indicated that reference was made to the trained nurses in relation to administering medication. This reference should be removed, as Forest Dene does not provide nursing care. On the day of the visit staffing engagement with service users indicated that service users were respected and their privacy upheld. This was evident even when service users were out enjoying the weather in a social setting. Interviews held with service users and their relatives confirmed this. The staff demonstrated a caring attitude and worked in line with the General Social Care Council’s Code of Conduct. Staffing interventions were person centred and all feedback received from relatives strongly supported this. One service user wrote ‘ all staff without exception are most kind and patient – even when they Forest Dene DS0000067415.V304716.R01.S.doc Version 5.2 Page 14 appear busy’. This atmosphere is positive and credit must be given to the management and staff for maintaining this. Forest Dene DS0000067415.V304716.R01.S.doc Version 5.2 Page 15 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) Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to the service. Service users now enjoy increased levels of activity at Forest Dene that is in line with their social, recreational and religious interests. They also enjoy maintaining strong links with family, friends and the local community. Their lifestyle is enhanced by the provision of meals that are suited to their needs. EVIDENCE: Service users are given opportunities to engage in activities that suit their lifestyle and expectations. This follows on from an individual assessment for each service user. Internally activities included: sing-a-long, reminiscence bingo, craft, chair based exercises, karaoke sessions and church services. Outside entertainers visit once per month and service users choose the activity they prefer. An activity person has been brought in and has been on two occasions previously to do light exercises in movement with service users. The plan is to have this monthly. All service users spoke to were pleased with the internal activities in the home. It was also clear that the management and staff adopted a flexible approach to activities e.g. during the hot weather a large number of service users preferred to sit out with sun shades and skin protection enjoying cool drinks and various types of fresh fruit to maintain hydration, as opposed to having an indoor activity. Religious observance is promoted and currently is arranged for Roman Forest Dene DS0000067415.V304716.R01.S.doc Version 5.2 Page 16 Catholics on a weekly basis and for Church of England followers – monthly. There are plans to have the latter reverted to two–weekly. Communion is held on Sundays and is well attended. One other faith has been identified in the home and the service user has been given the opportunity to pursue this, but chose not at the moment and this is respected. There has been a significant improvement in the level of external activities in the home. For the first time plans were in place for service users to have a holiday in Butlins between the 8/9and 11/9/06. Up to ten service users planned up to go and from speaking with a couple they were looking forward to this. There was a buzz of excitement around the holiday and this was positive. Plans were in place to have short breaks every three months giving all service users a chance to go. One service user commented ‘I could not last on a long holiday, but would on a short break’. It was reported that relatives were involved and quite eager to support plans for short break holidays. At the time of writing this report feedback from one relative stated ‘it was a lovely occasion-one that brought tears of joy to the eyes of many, service users and relatives’. She also stated that the management and staff were ‘excellent’ throughout the process. Prior to this, six service users went out to a tea dance in Hackney and ten service users were down to attend an evening of classical music in South Woodford. This is a great outcome for the service users living at Forest Dene. The management and staff continued to demonstrate a commitment to involving friends and relatives in line with service users’ wishes. A good example of this could be drawn from the fact that a service user’s niece was located in France by going through old notes held by the home. This resulted in connections being established and contact was actually made on the first day of the inspection to the delight of the individuals concerned. More importantly plans were in place for the relatives to visit in the near future. Other examples included plans for a service user to see her sister in Saffron Walden and this was in process, while another individual wanted to reconcile with a friend in Devon and this was also in process. One service user has a friend that is a minister and they meet up in the home. The friends and relatives meetings are still held and convened during the planning of the short break recently. This is a strong area of the homes operations. There was evidence that service users were given support to exercise choice and control in their lives. From an interview held with one service user, he spoke about his experiences in the home in a positive manner. He was very independent and involved in sports and felt he did not want to carry on with life, but for the staff who support him well. He was able to go the bank with his friend on the day of the visit and when he complained that his medication was making him dizzy, staff supported him to have a review. His quality of life has Forest Dene DS0000067415.V304716.R01.S.doc Version 5.2 Page 17 improved as a result and he is given the space to enjoy his classical music, enjoy periods on his own and reminisce about the successes in his life. Another example included, arrangements that were made to have an occupational therapist assessment with a view to acquire an aid (pole) to maintain an individual’s independence. One service user likes plants and he is encouraged to assist with bedding plants. The hairdresser now visits twice weekly to give the service users more choice and one service user still attends a day centre. Another has stopped due to personal issues and this is respected and staff are working through these issues with her. Service users are therefore well supported to maintain control in their lives. Meals provided at the home continue to be of a very high standard. The atmosphere is relaxed as service users enjoy meals to light background music. Support with meals was provided in a sensitive manner and meals presented on the day were attractive, varied and nutritious in content. The caterers were familiar with the specific needs of service users and this was duly recorded. Service users are offered a choice of meals from menu options and the cultural wishes of service users were taken into account. One service user of Asian origin reported that she was happy with the food provided by the home. Written and verbal feedback received from relatives and service users significantly indicated that meals in the home are of a high standard and that they are happy with them. One comment noted from an individual, indicated that she would like more fish and this needs to be considered by the management of the home. Food storage and handling was satisfactory and snacks along with hot and cold beverages were widely available to service users. Staff demonstrated a sound awareness with regard to ensuring the hydration and comfort of service users during the warm weather. Forest Dene DS0000067415.V304716.R01.S.doc Version 5.2 Page 18 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): (16,18) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Adequate protocols and procedures are place for safeguarding service users from abuse. This is complimented by the management’s handling of complaints, as and when they arise. EVIDENCE: A satisfactory complaints procedure is in place and available to service users and their relatives. Staff interviewed demonstrated an understanding of their role in enabling and supporting service users to complain. Service user and relatives’ feedback indicated that they were aware of how to complain. The complaints record was assessed and was generally satisfactory, although one of the most recent complaints by a neighbour required a bit more evidence of a final outcome. This was discussed with the deputy and she informed that the neighbour refuses to put anything in writing. Various options were discussed to deal with ensuring that a final position on the matter had been achieved. Some thirty-five complaints were handled over the last year with over ninety-seven per cent with clear outcomes. There was an improvement in the standard on protecting service users from abuse, as most of the staff team including bank staff were up to date with their adult protection training. There were no adult protection issues in the home since the last inspection and staff interviewed were clear about their role in protecting vulnerable adults. This included their awareness of whistle blowing. The management and staff were able to demonstrate development and learning from previous involvement in adult protection issues in the home. This is positive as an outcome for service users. Forest Dene DS0000067415.V304716.R01.S.doc Version 5.2 Page 19 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): (19,21,24,26) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users continue to live in an environment that is designed to meet their needs, safe and well maintained. Some improvements are required to ensure that the overall standard of the home is enhanced. EVIDENCE: Service users and their relatives were pleased about the standard of the accommodation with respect to both the private and communal spaces in the home. Importance is placed on ensuring that service users retain their independence and do so in a safe manner. A handyman walks around the home weekly and deals with smaller items of maintenance that is recorded in the maintenance record, which is monitored by the manager and his deputy. Larger jobs are referred to the Sanctuary helpdesk where contractors are contacted and this arrangement seems to be operating smoothly. There were however some areas that required attention and they included a the recently serviced ventilation system in the kitchen that was reportedly noisy and ineffective, causing some discomfort to the catering staff and a Forest Dene DS0000067415.V304716.R01.S.doc Version 5.2 Page 20 broken dishwasher. The latter of the two has been broken for over two months and this meant that staff had to wash up by hand. This is a challenge particularly when the main meals are served and action for the repairs should have been completed. What was disconcerting for the staff was they were unclear as to when this machine would be repaired. A doorstopper was also required in the laundry room to prevent the door handle from damaging the wall. The toilets and bathrooms were adequate and accessible in number and service users were observed at various times during the day–safely accessing them, independently and with the support of staff. They were in a generally good condition with facilities and aids that were suited to the needs of the service user group. However, it was noted that a bath on Highgrove was very rarely used. This bath is very low and it was no surprise that service users were not using this. A more appropriate bathing facility needs to be made available for service users. This could be installed in consultation with service users and specific to their needs. The ground floor bath was in need of a tile edging for safety purposes. A number of service user bedrooms were looked at and in the main they remained individualised and specific to the service user needs. Service users are given a choice in room colours and décor when works are required and all individuals spoken to were happy with their individual spaces. At the time of the visit plans were in place to install another pole in a service user bedroom for the promotion of her independence. It was clear that the management and staff were prepared to ensure that service users’ independence and safety remained a priority. One service user with a similar facility in the past had moved on and the aid was duly removed. This is a strong area of the homes operations. The home was clean and hygienic on the day of the visit and feedback received from relatives strongly supported this. Evidence was available to demonstrate that during the recent emergency with the mains waste to the front of the building, that the management and staff maintained a safe environment. This included the use of air odour eliminators to maintain a pleasant smell in the home. One relative stated ‘you could really tell once inside the home, that there was a sewer problem outside’. Infection control measures were in place and this included staffing awareness and good practice, as well as having adequate facilities in place to maintain a high standard of hygiene at Forest Dene. Forest Dene DS0000067415.V304716.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): (27,28, 29,30) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Generally service users receive a good standard of care from a team that is motivated, skilled and in adequate numbers. Service users would be safer once the registered persons maintain their recruitment records held on staff in accordance with the Care Homes Regulations 2001. EVIDENCE: At the time of the visit there were twenty-eight service users and from examining the staffing rotas there was evidence that the numbers on shift were capable of meeting the needs of the service user group. From the written and verbal feedback received service users commented either that staff were always or usually available. Interviews held with relatives also indicated a similar outcome. The numbers and mix on duty is matched on the dependency levels of service users and this is reviewed on a monthly basis. There was an improvement in the quality of recording in relation to critical incidents as this has been addressed with the staff team. Further monitoring of service user plans is planned to ensure that the quality of staff input is reflected in these documents. This is positive. The training records were assessed and indicated that seventy-five per cent of the staff had achieved at least an NVQ level two in Care. All staff receive a thorough induction training which ensures that staff have a sound understanding of the requirements of the service users and expectations of the organisation. Service users benefit from this in that the staffing interventions are based on knowledge of the individual/s, their needs and how to safely care Forest Dene DS0000067415.V304716.R01.S.doc Version 5.2 Page 22 for them. There was evidence that up to six staff held a current first aid certificate, which again is useful in terms of their ability to manage emergencies that may occur in the home. The registered manager started a record on night duty in which staff evidence their findings, having walked through the various floors. This is good practice in maintaining safety in the home. The recruitment records were examined found to be generally in line with regulatory requirements. There was the odd occasion where a photograph was not on file and this needed to be corrected. The registered manager was also going through all the staff records particularly the longer serving staff to ensure that the records held on them were in line with regulation. Some staff have been there for a long time and have experienced several changes in employers while working at the home and there are cases where recruitment information held on them did not satisfy the standard required. This piece of work needs to be completed. A training and development schedule was in place for all staff and there was evidence that staff were in receipt of training. Some of the key training provided included: first aid, vulnerable adults, fire, care planning and person centred care. Most of the staff were in receipt of at least three days paid training per year and this was in line with the minimum standard. It was noted that the night staff were somewhat behind in care planning and person centred care – training and this is identified for improvement. One of the staff interviewed demonstrated a sound understanding of the needs of the service users she had responsibility for and was observed carrying out her duties with confidence. All service users spoken to were extremely satisfied with the way in which staff discharged their duties. Forest Dene DS0000067415.V304716.R01.S.doc Version 5.2 Page 23 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): (31,33,35,36,38) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users benefit from a home that has sound management practices, which positively impacts on the quality care they receive. Their health and safety, financial and best interests are also well provided for. This could be enhanced further, by providing more regular supervision for staff working with service users. EVIDENCE: The registered manager is committed to providing and improving the quality of care at Forest Dene. He has achieved his registration with the Commission and is in the process of doing his NVQ level 4 in Management and Care. From discussions held with him, he plans to complete this by December 2006. He has also attended refresher training in fire, first aid and adult protection over the last year. During the course of the inspection he was observed leading from the front, by directly engaging with service users and their relatives. There has been a high level of praise from service users and their relatives with regard to his management of the service. Forest Dene DS0000067415.V304716.R01.S.doc Version 5.2 Page 24 There was evidence of monthly provider visits, which looked at issues in the home with regard the overall quality of care provided at Forest Dene. The views of service users and their relatives are also acquired as part of monitoring the quality of the service. Service user development is determined through their annual reviews. This is positive and should go some way into improving standards in the home. There was also evidence that the registered providers were engaging with service users with regard to the care and support they receive. More importantly, service users and relatives interviewed informed that they had better information with regard to the developments at Forest Dene. Sanctuary was in the process of reviewing the service, having recently acquired it. In this respect an internal audit of the service along with an annual development plan is imminent. The financial and accounting interests of service users were satisfactorily safeguarded and this included arrangements for accurately billing service users. This is now handled directly by Sanctuary Care. An external person monitors the financial operations of the home to ensure that finances are handled in line with policies and procedures. Petty cash and a random sample of service users’ personal finances were assessed and found to be accurate. There is an amenities budget comprising donations from families and monies raised through fundraising activities. This goes towards the benefit of service users in the home and this was also maintained in a satisfactory manner. Feedback from staff indicated that they felt supported by the management of the home and there were clear systems in place to enable this. Forums such as team meetings, handovers, informal discussions and supervision (where this occurred) were crucial to enabling this. Attendance at a team meeting provided evidence that staff views are encouraged, as lively discussions were held about the service users and the service as a whole. This is positive. One item that came up was the nomination of a staff member to represent the staff on the Sanctuary Consultative Forum and this was again seen as positive. However, there were lapses in the formal supervision for staff and this needed to improve to ensure that staff have maximum support to provide a quality service. There was also the need to carry out regular annual appraisals for the staff. This was discussed with the manager for improvement. The health and safety files were assessed and found to be in order. Staff had health and safety training as well as access to health and safety guidance. Health and safety signs were appropriately posted and arrangements for infection control were satisfactory. Risk assessments were also in place for first aid, fire, food hygiene, moving and handling and infection control. Satisfactory arrangements were in place for gas and electrical safety as well as for the lift maintenance and other equipment in the home. Staff have the benefit of a structured induction in line with the Learning Skills Councils guidelines. The home was visited by environmental health on 24/7 and a verbal report indicated that there were no major concerns in the home. The report is still awaited. Forest Dene DS0000067415.V304716.R01.S.doc Version 5.2 Page 25 Systems are in place e.g. weekly water temperature testing to ensure that problems are identified at an early stage for relevant action to be taken. This is good practice. It was reported that a garden maintenance contract is now in place for the external aspects of the home. Refresher training in food hygiene for staff has been identified and dates were awaited from Sanctuary Care. The home had a fire safety inspection in January 2006 and the report was satisfactory. At the time of the visit there were no issues relating to fire safety in the home. This means that service user safety is assured at Forest Dene. Forest Dene DS0000067415.V304716.R01.S.doc Version 5.2 Page 26 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 2 x 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 2 X X 4 X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 3 Forest Dene DS0000067415.V304716.R01.S.doc Version 5.2 Page 27 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 OP1 Regulation 6(a) Requirement The registered persons are required to review and update the statement of purpose for the benefit of service users. The registered manager is required to ensure that staff monitor medication in a manner that ensures service user safety – at all times. (See Standard 9). The registered persons are required to: 1) Carry out and assessment and of the ventilation system in the kitchen and where necessary take steps to ensure its effectiveness 2) make suitable arrangements to have the dishwasher repaired and 3) Fit a door stop behind the laundry door. The registered persons are required to ensure that an appropriate bathing facility–best suited for the needs of service users, is fitted on Highgrove. The registered persons are required to ensure that staffing recruitment records are held in line with Schedule 2 of the Care Homes Regulations 2001. DS0000067415.V304716.R01.S.doc Timescale for action 25/10/06 2 OP9 13 25/10/06 3 OP19 23, 16(2)(g) 31/10/06 4 OP21 23 30/11/06 5 OP29 19 30/11/06 Forest Dene Version 5.2 Page 28 6 OP36 18(2)(a) The registered manager is required to ensure that: 1) staff receive formal supervision at least six times per year and 2) annual appraisals are carried for all staff. 31/12/06 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) Refer to Standard OP9 Good Practice Recommendations The registered persons should remove references made to ‘nurses’ from the home’s medication policy. Forest Dene DS0000067415.V304716.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU 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 Dene DS0000067415.V304716.R01.S.doc Version 5.2 Page 30 - 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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