CARE HOMES FOR OLDER PEOPLE
Forest Hill House Nursing Home Rushall Lane Corfe Mullen Wimborne Dorset BH21 3RT Lead Inspector
Debra Jones Unannounced 21 July 2005 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 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 D55 S64305 Forest Hill Nursing Home V240628 210705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Forest Hill House Nursing Home Address Rushall Lane Corfe Mullen Wimborne Dorset BH21 3RT 01243 267755 Telephone number Fax number Email 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 Limited Miss Julie Louise Wilson CRH N - Care Home With Nursing 36 Category(ies) of OP Old age (36) registration, with number of places Forest Hill House Nursing Home D55 S64305 Forest Hill Nursing Home V240628 210705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. One named person (as known to CSCI) over the age of 65 who has mental health needs, may be accommodated to receive care. Date of last inspection 28th February 2005 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.C’s 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. Forest Hill House Nursing Home D55 S64305 Forest Hill Nursing Home V240628 210705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over 4 hours and was one of the two anticipated inspections of the year. The 1 recommendation made at the last inspection was followed up to see if it had been addressed. The Inspector looked around some of the building and a number of records were inspected. The manager – Julie Wilson and Tony Wilson – a representative from Royal Bay Care Homes Limited were spoken to. The inspector met some residents during the course of the inspection. At the time of the visit 31 people were living at the home. What the service does well:
Forest Hill House provides a service for the older people living there in a house decorated and furnished in a homely way and has a comfortable relaxed atmosphere. The home is well organised and the care and contentment of residents is at the heart of the way the home is run. Service users spoken to expressed satisfaction with the home, facilities and their rooms. A good admissions procedure is in place that ensures 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. Residents are well cared for when dying by well-trained and compassionate staff, supported by community health professionals. 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.
Forest Hill House Nursing Home D55 S64305 Forest Hill Nursing Home V240628 210705 Stage 4.doc Version 1.40 Page 6 Residents are able to exercise their civic rights and can continue to be supported by people of their choice outside the home should they so wish. 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 and well-trained nursing and care staff are employed to meet the current needs of residents. Systems are in place and records kept that demonstrate the homes commitment to keeping residents safe. What has improved since the last inspection? What they could do better:
After someone from the home has carried out a pre admission assessment the home needs to confirm in writing that the home is able to meet the potential residents’ needs to give them the necessary reassurance that the home is right for them. It would be good if the minimum and maximum temperatures of the fridge used to store medication were checked and recorded on a daily basis. The few identified gaps in staff records such as Protection of Vulnerable Adult and Criminal Records Bureau checks have to be addressed. These things are important as they help ensure that the right people look after residents. All night staff must be fire trained 3 monthly to remind them of what they should do to protect residents in the event of a fire. It is important that there is a record that all staff taking part sign to show that this has happened. This all goes towards confirming that residents would be as safe as they could be should a fire break out at the home. It would be good if the data product sheets e.g. for the cleaning materials in use at the home, were kept near to where the materials are stored so the appropriate staff could access them easily if they needed to. Forest Hill House Nursing Home D55 S64305 Forest Hill Nursing Home V240628 210705 Stage 4.doc Version 1.40 Page 7 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 D55 S64305 Forest Hill Nursing Home V240628 210705 Stage 4.doc Version 1.40 Page 8 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 Standards Statutory Requirements Identified During the Inspection Forest Hill House Nursing Home D55 S64305 Forest Hill Nursing Home V240628 210705 Stage 4.doc Version 1.40 Page 9 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 standard(s) 3, 4 and 5. 6 is not applicable to this home. 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, the home does not currently assure all prospective residents in writing that their needs can be met. EVIDENCE: Two 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. Prospective residents are given the opportunity to visit the home, as are their representatives. Whilst the home clearly gathers all the information they need to decide if they can provide care for a prospective resident, and offers the place by phone following the completion of the assessment process, this assessed ability to care is not confirmed to the prospective resident in writing.
Forest Hill House Nursing Home D55 S64305 Forest Hill Nursing Home V240628 210705 Stage 4.doc Version 1.40 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8 and 11. 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. EVIDENCE: Care plans seen were of a very high standard. 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 being reviewed monthly. Care plans echoed the ethos of the home to provide total care to the person and treat them with respect and dignity. One plan noted how the resident liked to be involved in the choosing of her clothes, how her hair is styled and of how she likes ‘ to be made to feel like a lady’. Daily notes support and evidence the delivery of care to residents and were also of a high standard. These notes were comprehensive and gave a good picture of the daily lives of residents, the care that is delivered to them by staff in the home and by visiting community health professionals. The Inspector
Forest Hill House Nursing Home D55 S64305 Forest Hill Nursing Home V240628 210705 Stage 4.doc Version 1.40 Page 11 was particularly impressed with the way the daily notes linked to the care plan making 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. The Inspector discussed with Ms Wilson the potential expansion of their hospital admission documentation to include body charts / detailed records about the condition of residents when leaving the home and going to hospital. Although the standard about medication was not fully assessed on this occasion the recommendation made at the last inspection was discussed. The home had been asked to record the temperature of the fridge where medication is stored on a daily basis. The home is still trying to get hold of a thermometer that shows the maximum and minimum temperature and although the home is recording the actual temperature of the fridge this is not happening daily. The Inspector looked at the care notes of a resident who had recently died at the home. These demonstrated how the staff at the home had worked with the GP to care for the resident in her last days. They showed the changing care needs of the resident and the way the home responded to these changing needs e.g. in respect of diet, personal care, nursing needs and medication. Notes were comprehensive yet sensitively written. The home was in close touch with the relatives of the resident and supported them through the funeral arrangements. Forest Hill House Nursing Home D55 S64305 Forest Hill Nursing Home V240628 210705 Stage 4.doc Version 1.40 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: None of these standards were inspected on this occasion. Forest Hill House Nursing Home D55 S64305 Forest Hill Nursing Home V240628 210705 Stage 4.doc Version 1.40 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 17 and 18 A system is in place to deal with any complaints that might be made by residents. The legal rights of residents are protected and they are encouraged to participate in the civic process. 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. No complaints have been received by the home since the last inspection or by the Commission. Residents are supported by their families, solicitors and friends in managing their affairs and protecting their rights. At the last general election one resident exercised their right to vote and did so by post. The home has an adult protection policy and there is ongoing staff training in this subject at the home. Forest Hill House Nursing Home D55 S64305 Forest Hill Nursing Home V240628 210705 Stage 4.doc Version 1.40 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,22,23,24,25 and 26. 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. Residents will benefit from the regular documented review of individual ‘emergency / alarm’ needs to minimise any of risk they might be exposed to when out of the sight of staff. EVIDENCE: The home is well decorated throughout. The lounge, dining area and conservatory are comfortably furnished. The home is set in attractive grounds and views from windows are very pleasant.
Forest Hill House Nursing Home D55 S64305 Forest Hill Nursing Home V240628 210705 Stage 4.doc Version 1.40 Page 15 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 the home 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. Suitable laundry equipment is in place at the home. The home was clean and there were no unpleasant odours. All rooms seen by the Inspector had emergency alarm call points. Not all had the cords attached that would make these alarms more accessible to residents in an emergency situation. This was discussed with Mr Wilson along with the alternative systems the home has in place for keeping a close check on residents. The reasons for not providing the emergency call bell cords and the risks associated with providing or not providing them was not documented or reviewed in assessments or care plans. Forest Hill House Nursing Home D55 S64305 Forest Hill Nursing Home V240628 210705 Stage 4.doc Version 1.40 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30 Sufficient, well-trained nursing and care staff are employed and deployed to ensure that the care needs of residents can be met. Robust recruitment procedures are in place to protect residents from the risk of unsuitable staff working at the home although not all staff have got their full Criminal Record Bureau certificates back yet or had POVA 1st checks. 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 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. Evidence of what was actually worked was seen. The manager talked confidently about the recruitment procedures at the home and was knowledgeable about the recent changes that have come with the introduction of the Protection of Vulnerable Adults list. Well-ordered files are kept that demonstrate the recruitment process in action. A few gaps were found in the documentation that must be obtained for staff employed at the home. Where CRB disclosures have not been returned POVA 1st checks must be applied for and proof of the outcome of the check kept. Where these are not yet returned staff are well supervised. The home employs some workers from abroad. It was clear from the files that the home gathers the right sort of information about people’s rights to work in
Forest Hill House Nursing Home D55 S64305 Forest Hill Nursing Home V240628 210705 Stage 4.doc Version 1.40 Page 17 the country and any restrictions on that work. Records are kept of training that staff undertake. These records showed that staff have access to a good range of basic training and receive their regular mandatory updates e.g. manual handling and CPR. Training needs are discussed at supervision sessions. The qualified staff decide what training they need/ are interested in doing and are supported in this by the home. Recent training subjects for all staff have included abuse, palliative care, hypnotherapy and food hygiene. Health care staff have expressed an interest in training in wound care, which is both pertinent and relevant to their work given the nature of the needs of residents at the home and this training will take place in the coming months. The way that staff were conducting themselves in the home and working with the residents on the day of inspection demonstrated that the training that they had had, had been understood and was being applied in practice. Forest Hill House Nursing Home D55 S64305 Forest Hill Nursing Home V240628 210705 Stage 4.doc Version 1.40 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32, 37 and 38 The home is well organised and the care and contentment of residents is at the heart of the daily management and running of the home. Staff fire training records do not demonstrate that residents would be as safe as they could be in the event of a fire breaking out. 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. 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.
Forest Hill House Nursing Home D55 S64305 Forest Hill Nursing Home V240628 210705 Stage 4.doc Version 1.40 Page 19 All records were made available as requested during the inspection and are appropriately stored. An up to date insurance certificate was on display along with Forest Hill House’s registration certificate. Fire records were in place and internal checks are being carried out. An external company carries out quarterly checks of the fire equipment. Fire training records for staff did not show that all staff – particularly night staff, had had fire training at the required intervals. (For night staff this is every 3 months). Accident records and accident analyses were looked at. Most accident records were excellently completed in that they were clear about how staff came across accidents or if they had witnessed them. Analysis of such records provides the home with important information as to the effectiveness of the emergency systems in operation and of any further measures that could be put in place to minimise risks to residents. Records are kept of the servicing of equipment and facilities. The Dorset Fire and Rescue Service will be carrying out a routine visit in October 2005. Data product sheets are also kept, although these were not with the cleaning equipment or readily accessible to the staff using the products. Forest Hill House Nursing Home D55 S64305 Forest Hill Nursing Home V240628 210705 Stage 4.doc Version 1.40 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 2 10 x 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x
COMPLAINTS AND PROTECTION 3 3 3 2 3 3 3 3 STAFFING Standard No Score 27 3 28 x 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 3 x x x x 3 2 Forest Hill House Nursing Home D55 S64305 Forest Hill Nursing Home V240628 210705 Stage 4.doc Version 1.40 Page 21 NO Are there any outstanding requirements from the last inspection? 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 4 Regulation 14 Requirement The registered peson must confirm in writing to the resident that havng regard to the assessment the care home is suitable for the purpose of meeting their needs in respect of health and welfare. Where there are no emergency cords attached to the emergency call bell system in residents rooms the reason for this must be recorded, appropriate assessments be undertaken, kept under review, and where necessary other systems be put in place to ensure that staff can be alerted to emergency situations. A full CRB or POVA first check must be obtained before anyone can start working at the home. All night staff are to have fire training every 3 months and sign to say that they have attended this. Timescale for action 1 11 05 2. 22 13 1 9 05 3. 4. 27 38 19 23 1 9 05 1 9 05 Forest Hill House Nursing Home D55 S64305 Forest Hill Nursing Home V240628 210705 Stage 4.doc Version 1.40 Page 22 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 9 Good Practice Recommendations The registered person should obtain a thermometer that records the maximum and minimum temperature of the fridge used to store medication and the temperatures should be recorded daily. The registered person should ensure that the data product sheets e.g. for cleaning products, be kept near to where the products are in use / stored. 2. 38 Forest Hill House Nursing Home D55 S64305 Forest Hill Nursing Home V240628 210705 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection Unit 4 New Fields Business Park Stinsford Road Poole Dorset 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 D55 S64305 Forest Hill Nursing Home V240628 210705 Stage 4.doc Version 1.40 Page 24 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
