Inspection on 10/07/06 for Forest Hill House Nursing Home

This inspection was carried out on 10th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Forest Hill House Nursing Home 29/10/07

Forest Hill House Nursing Home 22/11/05

Forest Hill House Nursing Home 21/07/05

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Forest Hill House Nursing Home Rushall Lane Corfe Mullen Wimborne Dorset BH21 3RT Lead Inspector Debra Jones Unannounced Inspection 10th July 2006 9:45 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 Hill House Nursing Home DS0000064305.V304189.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 Hill House Nursing Home DS0000064305.V304189.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Forest Hill House Nursing Home Address Rushall Lane Corfe Mullen Wimborne Dorset BH21 3RT 01202 631741 01202 632742 foresthilloffice@aol.com 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) Royal Bay Care Homes Ltd Miss Julie Louise Wilson Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (36) of places Forest Hill House Nursing Home DS0000064305.V304189.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. One named person (as known to CSCI) over the age of 65 may be accommodated to receive nursing care in the category MD. One named person (as known to CSCI) in the age range 40-64 may be accommodated to receive nursing care. 22nd November 2005 Date of last inspection Brief Description of the Service: Forest Hill House is set in a rural area with spacious wooded grounds and a large gravelled parking area. Forest Hill House is registered as a care home with nursing for people over the age of 65. It offers accommodation on three floors for 36 elderly people with 18 single rooms and 9 double rooms. Many of the rooms have en-suite facilities and there are sufficient communal W.Cs and bathrooms. There is a passenger lift to all three floors and a stair lift to the first floor. There are a variety of aids and adaptations around the building to allow residents to move about more independently. There is a large sitting room, a dining room and a conservatory, which leads out on to a small patio area with a pond and raised flowerbeds. There is a bird table and a variety of outdoor seating arrangements. The current fees for this home range between £575 and £705 per week. Forest Hill House Nursing Home DS0000064305.V304189.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over four and a half hours and was the anticipated key inspection of the year. Requirements and recommendations made at previous inspections were followed up to see if there had been any progress made towards meeting them. Progress had been made. During the inspection a number of records were looked at. The Inspector walked around some of the building and met with residents and staff who all spoke well of the home. The manager was on holiday at the time of the inspection. The person in charge on the day and people working at the home assisted the Inspector in her work. Comments made included:‘Marvellous’ (a resident) ‘A very friendly place’ (another resident) Prior to the inspection the Commission asked the home to send out / make available comment cards to get views of the home. Five comment cards were returned from residents, one from a relative, and 2 from GP surgeries. All were very positive about the care in the home. ‘Relaxed atmosphere’ (a GP) ‘An excellent establishment’ (another GP) What the service does well: Forest Hill House provides a good service for the older people living there in a house decorated and furnished in a homely way. The home has a comfortable and relaxed atmosphere. A good admissions procedure is in place that goes toward ensuring that only people whose needs can be met are offered places at the home. Prospective residents and their representatives have the opportunity to visit the home to see if they like it before they move in. Assessments and excellent care plans are thoroughly completed and regularly updated to make sure that staff know how to care for the residents living at the home. Daily notes provide strong evidence to show the way that care is delivered. Community health professionals support the nursing and care staff in caring for residents. Forest Hill House Nursing Home DS0000064305.V304189.R01.S.doc Version 5.2 Page 6 The home has systems in place for the storage, administration and recording of medicines. Staff were observed during the inspection to be treating residents with courtesy, patience and kindness. Residents confirmed that they feel well treated. There is a good programme of activities on offer at the home. Some activities are structured and well organised, others are 1-1. Residents are able to do as they wish at the home and join in or not with the activities on offer. Visitors are always welcome at the home and residents are encouraged to maintain and develop relationships with people in the home, with their families and friends and the local community. Meals are varied and planned around the likes and dislikes of residents. Meal needs and preferences are always taken into account and mealtime arrangements are flexible enough to accommodate individual preferences. The complaints and adult protection policies and procedures reassure residents that their well-being and comfort are important to the home and that any concerns raised will be properly investigated and resolved. The home is well maintained, comfortable and safe for the residents living there and anyone visiting. The home is kept clean and smells pleasant. Sufficient nursing and care staff are employed to meet the current needs of residents. The home has succeeded in meeting the Department of Health target of 50 of care staff achieving National Vocational Qualifications in care. A range of training is available to staff at the home. Where residents want the home to look after small amounts of money for them a good system is in place to do this. Systems are in place and records kept that demonstrate the homes commitment to keeping residents safe. What has improved since the last inspection? The home keeps some medication in a fridge and they are now checking and recording on a daily basis the minimum and maximum temperatures of this fridge. A set of data product sheets e.g. for the cleaning materials in use at the home is now kept near to where the materials are stored so the appropriate staff can access them easily if they need to. Forest Hill House Nursing Home DS0000064305.V304189.R01.S.doc Version 5.2 Page 7 What they could do better: Once the home have carried out their pre admission assessment for prospective residents it would be reassuring if all those assessed were given a written outcome of that assessment. In this way they would know for sure if the home is or is not able to meet their health and welfare needs. Where equipment, such as bed rails, is in use that physically restrains residents the home must carry out assessments outlining why the equipment has to be used, how it is to be used and written permissions for its use have to be given. Assessments must be regularly reviewed to make sure that the use of such equipment remains the best option to maintain the safety of the residents. When the Commission pharmacist visited the home in June 2006 her assessment was that the standard of recording needed some improvement to ensure that residents are getting the medicines they should as they should. To assist matters the GP should be asked to include full directions on all prescribed medicines. The Pharmacist also thought it would be good if the medicines policy were updated with her recommended additions. In addition, to bring medication into the care planning system a section on medication should be included in care plans. Care plans could also do with expansion in the area of diabetes to ensure that all aspects of care to do with this condition are covered. At the inspection visit some records could not be found, including the complaint records. These should always be available for inspection so it important that whoever is in charge at the home knows where to find things. Before allowing a new member of staff to work at the home certain pre employment checks have to be carried out and information and documents obtained to protect residents from potentially unsuitable people working at the home. At this inspection there were shortfalls in the records seen of new members of staff. Once employed certain other information listed in the law must be kept. This also was not readily available for the same members of staff. To ensure that residents are in safe hands and staff know what the home expects from them all need to have up to date basic training and when new staff start at the home they must undergo a structured induction training. In order for the home to know what the people they care for and other interested parties think about how they are running the home the home has to carry out an annual quality assurance audit. The report of that annual audit should be available along with any actions that the home has taken in response to the audit. Forest Hill House Nursing Home DS0000064305.V304189.R01.S.doc Version 5.2 Page 8 Certain policies should be updated with information about the Protection of Vulnerable Adults list. All policies should be regularly reviewed and where any are updated or amended these should be dated as to when the changes took place. Who undertook the review or made the changes should also be noted. 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 Hill House Nursing Home DS0000064305.V304189.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 Hill House Nursing Home DS0000064305.V304189.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): 3 and 4. Standard 6 does not apply. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A good admissions procedure enables prospective residents to make informed decisions about admission to the home and ensures that only service users whose needs can be met by the home are offered places there. However not all prospective residents are assured in writing whether the home can meet their needs or not. EVIDENCE: Three files of recently admitted residents showed that prior to them moving to the home their needs were fully assessed by a senior member of staff from the home. All three had resulted in successful placements with residents moving into the home within a couple of days of their assessment. These pre admission assessments were thought to have been carried out by telephone and it was not clear from the paperwork how far the people themselves had been involved with the assessment. It is suggested that serious thought be Forest Hill House Nursing Home DS0000064305.V304189.R01.S.doc Version 5.2 Page 11 given to assessments taking place face to face for the benefit of both the prospective resident and the home. Prospective residents are given the opportunity to visit the home, as are their representatives. This option was taken up in at least two of the three cases looked at. The home only currently confirms in writing the outcome of the assessment and if they will be able to meet the needs of the residents or not to privately funded residents. Of the five residents who returned comment cards all said that they had enough information before they moved in to the home so they could decide if it was the right place for them. Two said that they had received a contract and the other 3 said that they were not sure, or did not know if they had. Forest Hill House Nursing Home DS0000064305.V304189.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 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is an excellent care planning system in place to make sure that staff have the information they need to meet the needs of the residents. The health needs of the residents are also well met with evidence of good support from community health professionals. The home has systems in place for the storage, administration and recording of medicines. The standard of recording needs improving to protect residents and the home is working to address this. Residents confirmed that they were treated well. EVIDENCE: Care plans seen continue to be of the high standard noted at previous inspections. They flowed from the assessments made by the home, were easy to read, to the point and informative about the needs of the resident and how the home was to meet their needs. All information contained in the care plans was relevant and up to date with plans and assessments being regularly Forest Hill House Nursing Home DS0000064305.V304189.R01.S.doc Version 5.2 Page 13 reviewed. Care plans echoed the ethos of the home to provide total care to the person and treat them with respect and dignity. Two of the three plans reviewed had been devised soon after the resident moved into the home. Daily notes support and evidence the delivery of care to residents and were also of a high standard and made it easy to see that the care plan was being adhered to and for the reviewer of the plan to know when changes needed to be made. A number of residents have bed rails to protect them from falling out of bed at night. The use of these is not covered by assessments and is therefore not reviewed. Permissions for their use is not noted. Care plans do not contain a section on medicines and where residents are diabetic the care needed to respond to this condition was not fully described in the plan. Residents spoken to at the visit were very pleased with the level of care they received at the home. They described staff as friendly and caring. When asked ‘do you get the care and support you need?’ Four of the five residents who returned comment cards prior to the visit replied ‘always’ and the other one ‘usually’. The relative who responded by comment card said that they were informed of important matters in respect of their relatives and consulted about their care. Most residents at this home are registered with a surgery whose GPs make fortnightly visits to the home. This makes GPs very accessible to residents and enables a prompt response to any concerns raised by them or the staff in respect of their health. It is documented when people need to seek medical advice and why, along with the outcome of the consultation. Residents also have access to the range of community services e.g. chiropodists, dentists and opticians. Some come to the home, others have to be accessed in the community. Where this is the case residents get the support of the home in accessing and going to appointments. Four residents who returned comment cards said that they ‘always’ received the medical support they needed and one said they ‘usually’ did. One resident commented that they ‘would like a bit more physio to get me more mobile.’ The two GP surgeries that returned comment cards to the Commission said that the home communicated clearly, worked in partnership with them and that staff demonstrated a clear understanding of the care needs of residents. They also said that the home took appropriate decisions when they could no longer manage the care needs of residents. The Commission Pharmacist visited the home on 14 June 2006. Forest Hill House Nursing Home DS0000064305.V304189.R01.S.doc Version 5.2 Page 14 She found that whilst the home had a medicines policy it did not include risk assessment and monitoring of self- medication. It also lacked detail on how staff were to handle medication errors and of the need to inform CSCI of such errors along with residents and their relatives and of reviewing to prevent a recurrence. There was no mention of monitoring medicine refrigerator temperatures and the action to take if it was out of range or of what happened to the ‘cin bin’ for waste medicines. There was no documentation to confirm that the home has a contract with a waste disposal company for the disposal of medicines as described by the nurse in charge. At the time of the Pharmacists visit waste medicines were not being stored appropriately. This has been addressed and they are now locked away. Medicines in use are stored securely as were controlled drugs. There is a separate medicines refrigerator. At the Pharmacist’s visit the actual rather than the maximum and minimum temperature was recorded. This has now also been addressed and the home has obtained an appropriate thermometer, this is in use and records are now being kept. Oxygen is stored in a stand and there was a warning sign on the door. Most medicines are supplied in monitored dosage system (MDS) blister packs. The receipt and disposal of medicines is recorded. There were some gaps in the records of medicines that the Pharmacist checked. She noted that medication records and audit trails are monitored at the end of each 28 day cycle and the outcome reported to staff. It was suggested that some monitoring be done in the middle of the cycle to improve the standard of recording. The pharmacist checked MDS blister packs and the number of tablets remaining agreed with the records indicating that they were given as prescribed. For medicine not in the blister packs she noted that there was a system for recording the date when a new pack was started but this was not consistently followed so it was not possible to confirm whether some medicines checked were given as prescribed and recorded. A medicine had been handwritten on one of the MAR charts and it had been countersigned to show that a second nurse had checked that the details were correct. Changes to medication were clearly recorded on the communication sheet. The labelling of one resident’s eye drops did not include which eye(s) they should be applied to and the doctor should be asked to include full directions on the next prescription. One resident administers his own eye drops but there was no risk assessment or records of when he was given a new supply. The resident told the pharmacist that he was given a new bottle every four weeks. Forest Hill House Nursing Home DS0000064305.V304189.R01.S.doc Version 5.2 Page 15 The two GP surgeries that returned comment cards to the Commission prior to the inspection said that in their opinions the residents’ medication was appropriately managed in the home. Staff were seen to be treating residents in a respectful and dignified way during the course of the inspection. Residents spoken to said that they felt well cared for and were treated well. When asked if there was anything the home could do better for them residents were unable to make any suggestions. The two GPs who returned comment cards to the Commission confirmed that they were able to see their patients in private. The relative who returned a comment card also said that they were able to visit their relative / friend in private. Forest Hill House Nursing Home DS0000064305.V304189.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents’ lives are enriched by the social opportunities afforded by their visitors and the stimulating social activities available in the home. Visitors are made welcome at the home and can come whenever it suits the residents. Residents are helped and encouraged to exercise choice in their daily lives at the home. The meals in this home are very good offering both choice and variety and are served in a pleasant environment. EVIDENCE: Forest Hill House has a dedicated activities organiser demonstrating the home’s commitment to providing a stimulating environment for residents. Emphasis is placed on providing activities linked to the world outside the home e.g. seasons, the queen’s birthday, sporting events, fundraising activities for worthy local causes. A recent barbeque proved popular with residents and it is hoped the weather will improve so that they can have another. Activities are arranged for groups and are also 1-1. Forest Hill House Nursing Home DS0000064305.V304189.R01.S.doc Version 5.2 Page 17 Adverts were up in the main hall for the summer fete. Families and friends are invited too. Photos of the recent Easter bonnet event were also on display. Hobbies and interests are explored with residents when they first move to the home, along with finding out about people’s happy memories and achievements. This information then feeds into the programme that the activities organiser develops. The activities organiser talked with enthusiasm about her work and the residents clearly benefit from this dedicated role. Of the five residents who returned comment cards 3 said that they it was ‘always’ the case that there are activities arranged by the home that they can take part in; 1 said that this was true ‘usually’, and 1 said ‘sometimes’. One resident who said there were always things to take part in commented ‘but we don’t wish to take part.’ Information is given to residents and their relatives / friends about staying in contact and visiting the home. The visitors’ book confirms the number and range of visitors to the home. The relative who returned a comment card to the Commission said that they felt welcome in the home at any time. People are encouraged to make choices about how they live their lives at the home. Residents are to get up and go to bed when they want, choose to eat what they like and join in with activities as they wish. Choice extends to where people spend their days in the home, where they eat and which bath they prefer. Where people are not able to say what they want the home consults with relatives and seeks background information as well as using their judgement as to what people want based on non verbal communication. Menus are based around the known likes and dislikes of the residents. The home has summer and winter menus on a six week rotation. Residents are offered meal choices on the day and alternatives can be provided. The meal served on the day of inspection was salmon with broccoli, carrots and boiled potatoes. One person chose to have an alternative. Dessert was rhubarb crumble and custard. Residents spoke highly of the food. The mood at the mealtime was very relaxed with staff getting the food from the kitchen to the residents quickly and being on hand for those who needed assistance. Special diets are catered for e.g. diabetic, high protein, low fat. The chef on the day spoke knowledgably about the likes and dislikes of residents and showed an understanding of their nutritional needs. As well as knowing what they like it is also noted how much residents like to served. One resident, who is diabetic likes smaller meals more often and talked to the inspector about how he always had a sandwich later in the evening to steady his blood sugar levels. Forest Hill House Nursing Home DS0000064305.V304189.R01.S.doc Version 5.2 Page 18 Residents can have meals where it suits them. The home has a pleasant dining area that residents can eat in if they wish. Others prefer to have their meals in their rooms. Prior to the inspection five comment cards were received by the Commission from residents. Two of the five said that they ‘always’ liked the meals at the home and the other three said that they liked them ‘usually.’ Forest Hill House Nursing Home DS0000064305.V304189.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A system is in place to deal with any complaints that might be made by residents. The home’s adult protection policy and staff training demonstrates the homes commitment to understanding abuse and of protecting residents. EVIDENCE: The home has a complaints policy / procedure that is included in the information given to residents. The Commission has not had to investigate any complaints since the last inspection. In the last year the home has had three complaints that they have dealt with or are dealing with. On the day of inspection the complaints file could not be found and so it could not be seen if the home had investigated these complaints appropriately and in a timely manner. When this standard was assessed last year it was considered to be met. The comment cards sent to residents asked the question ‘Do you know who to speak to when you are not happy?’ Five residents sent back cards. All five answered ‘always’ to this question. In respect of knowing how to make a complaint all said ‘always’. Forest Hill House Nursing Home DS0000064305.V304189.R01.S.doc Version 5.2 Page 20 The relative who returned a comment card said that they were not aware of the complaints procedure but confirmed that they had never had to make a complaint. The home has an adult protection policy. This policy does not make reference to the Protection of Vulnerable Adults list. The disciplinary procedure also does not make reference to how staff who are sacked for abusive behaviour would be referred to this list. There is ongoing staff training in abuse awareness at the home. Staff themselves, along with their training records, confirmed this. Forest Hill House Nursing Home DS0000064305.V304189.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well–maintained and a comfortable and safe environment is provided for the residents living there and anyone visiting. Bedrooms are decorated, furnished and personalised to suit the residents. Adequate facilities are available to meet the number and needs of the people living there. The home is kept clean and smells pleasant thereby making daily life for all in the home more pleasurable. EVIDENCE: The home is set in attractive grounds and views from windows are very pleasant. The home is well decorated throughout. The lounge and dining area have just been redecorated and new carpet and lino is about to be fitted in this area. Forest Hill House Nursing Home DS0000064305.V304189.R01.S.doc Version 5.2 Page 22 There are a number of communal bathing areas in the home and a number of rooms have en suite facilities. Aids and adaptations are available throughout and some residents with particular needs have their own personal equipment to assist with their independence. Other useful aids and adaptations are around the home for use by all e.g. raised toilet seats. Residents are able to personalise their rooms with general belongings. There is a passenger lift in the home, enabling easy access between floors. A suitable laundry room with appropriate equipment is in place at Forest Hill House. Residents are asked to mark their clothes with their names to ensure that they don’t get confused with other peoples. Staff at the home strive to look after residents’ clothes well and get them back to their owners. One resident said that they were very good with the laundry and when asked if they ever lost anything replied, with good nature, that this only happened when they (the residents) hadn’t labelled things properly. At the time of the visit the home was clean and there were no unpleasant odours. Residents said that they were happy with the cleanliness at the home. Four of the five residents that returned comment cards to the Commission said that the home is ‘always’ fresh and clean. The other said this was the case ‘usually.’ Forest Hill House Nursing Home DS0000064305.V304189.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Sufficient nursing and care staff are employed and deployed to meet the number of residents with their level of need. Recruitment procedures are in place to protect residents from the risk of unsuitable staff working at the home but records did not demonstrate that this procedure was currently operating in practice. The home is meeting the target of having 50 of care staff with National Vocational Qualifications (NVQs) in care and a strong emphasis is placed on ensuring that staff have access to the training they need, however shortfalls in evidencing basic training and induction let the home down. EVIDENCE: Clear staffing rosters are in place that show who is on duty, when and what jobs they do. At least one qualified nurse is on duty at all times, with Ms Wilson (the registered manager) additional to the qualified staff. 6 health care assistants are on duty between 8am and 2pm and 4 between 2pm and 8pm, three care assistants are on duty at night. Residents were asked are the staff available when you need them? Four of the five who responded said ‘usually’. With the comments ‘they say they are sometimes busy with someone but will tell us first.’ ‘if they are dealing with someone else they usually tell us.’ Forest Hill House Nursing Home DS0000064305.V304189.R01.S.doc Version 5.2 Page 24 The other respondent said that staff were ‘sometimes’ available when they needed them. The relative who returned a comment card to the Commission said that in their opinion sufficient numbers of staff are on duty. Health care assistants are encouraged to undertake study for NVQs in care. The Department of Health target is that 50 of care staff in every home should have this qualification. This home reports that they are currently meeting this target. One member of staff talked of the encouragement they had received at Forest Hill House and of how she was going on to do NVQ 3 in care. At the last inspection it was noted that well-ordered files were kept that demonstrate the recruitment process in action. Four files were reviewed at this visit for members of staff who had started working in the home in the last 7 months. No files contained all the pre and post employment information required by law. In addition it was not clear from the information held on file that, in the case of a worker from abroad, they had the right to work in this country or at the home. Records are kept of training that staff undertake. These records show that staff have access to a good range of basic training. Staff on duty talked of how they had recently had training in infection control training, manual handling updates and abuse. For the new staff whose files were reviewed no record of induction could be found. Forest Hill House Nursing Home DS0000064305.V304189.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well organised and the care, contentment and safety of residents is at the heart of the daily management and running of the home. Whilst there is nothing to demonstrate that the home is not run in the best interests of residents the results of the quality assurance audit were not available to support this view. Residents can have confidence that the home will look after their pocket money properly should they wish for this to happen. EVIDENCE: The home is managed by Julie Wilson, an experienced nurse and manager. In her absence rosters show that it is always clear who is in charge at any time in the home. Forest Hill House Nursing Home DS0000064305.V304189.R01.S.doc Version 5.2 Page 26 The home is part of the Royal Bay Care Homes Ltd group. The Responsible Individual registered with the Commission for this company – Russell Wilson has his office on the premises, so is closely involved in the day to day running of the home. The home has recently achieved the ‘investors in people’ award. An up to date insurance certificate was on display along with Forest Hill House’s registration certificate. The home sent out and made available comment cards for the Commission as requested prior to this inspection. Those that came back were positive about home. It is clear that policies and procedures are amended / updated but it is not clear when this happens or how regularly. The home responds to Commission inspection reports and maintains a high quality service for residents. The results of the homes own quality assurance system could not be located on the day of inspection. The home keeps a little money belonging to residents and a solid system is in place to look after it. Records are kept of balances held. The total cash on the premises on the day of inspection held by staff accorded with records. Fire training records for staff are easy to follow and it could be seen at a glance that staff were up to date with their fire training and when it is next due. Records are kept of the internal checks of the fire fighting equipment and emergency lighting. An external company also carries out regular checks. Recent accident records were looked at. Senior staff are now checking these before they are filed and later analysed. Few accidents have been recorded in recent months. The last analysis was carried out in 2005. Records are kept of the servicing of equipment and facilities. Data product sheets are now being kept near to the cleaning equipment and so are now more readily accessible to the staff using the products. The Dorset Fire and Rescue Service last visited in October 2005 and found the existing fire precautions were being satisfactorily maintained. They will next visit in October 2006. Environmental Health last visited the home in December 2004. Forest Hill House Nursing Home DS0000064305.V304189.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Forest Hill House Nursing Home DS0000064305.V304189.R01.S.doc Version 5.2 Page 28 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 OP4 Regulation 14 Requirement The registered person shall not provide accommodation to a resident at the care home unless they have confirmed in writing to the resident that having regard to the assessment the care home is suitable for the purpose of meeting the residents needs in respect of his health and welfare. • Where any equipment is in use that physically restrains the person this should only be employed when this is the only practicable means of securing the welfare of the person and there are exceptional circumstances. There must be an assessment outlining why the equipment is in use, how it is to be used and written permissions for its use given. The assessment must be regularly reviewed. Where residents are diabetic the care needed to respond to this condition Timescale for action 01/09/06 2. OP7 13 01/09/06 • Forest Hill House Nursing Home DS0000064305.V304189.R01.S.doc Version 5.2 Page 29 must be fully described in the care plan. 3. OP9 13 There must be robust evidence that medicines are given as prescribed or the reason for omission. There must be an assessment of risks for each resident who selfmedicates and records of when medicines are supplied to them. 31/07/06 4. OP16 22 The registered person shall 01/08/06 supply to the Commission a statement containing a summary of the complaints made during the preceding 12 months and the action that was taken in response. Before allowing a new member of staff to work at the home the information and documents listed in regulation 19 and schedule 2 must be obtained. Once employed the information listed in schedule 4 as per regulation 17 must be kept. Such records must be available for inspection at all times. The registered person shall ensure that the persons employed to work at the care home receive training appropriate to the work they are to perform including structured induction training. The registered person shall supply to the Commission a report in respect of any quality review conducted in 2005/6. 01/09/06 5. OP29 19 and 17 6. OP30 18 01/09/06 7. OP33 24 01/08/06 Forest Hill House Nursing Home DS0000064305.V304189.R01.S.doc Version 5.2 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP7 OP9 Good Practice Recommendations Care plans should include a section on medication. The medicines policy should be updated with the recommended additions. The GP should be asked to include full directions on all prescribed medicines. Policies should be updated with information about the Protection of Vulnerable Adults list. All policies should be regularly reviewed and where any are updated or amended these should be dated as to when the changes took place. The person who undertakes the review or makes the changes should be noted. 3. 4. OP18 OP33 Forest Hill House Nursing Home DS0000064305.V304189.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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 Hill House Nursing Home DS0000064305.V304189.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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