Inspection on 29/10/07 for Forest View

This inspection was carried out on 29th October 2007.

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 View 01/03/07

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Forest View Southway Burgess Hill West Sussex RH15 9SU Lead Inspector Mr D Bannier 29 th Unannounced Inspection October 2007 09:30 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 View DS0000068372.V347614.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 View DS0000068372.V347614.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Forest View Address Southway Burgess Hill West Sussex RH15 9SU 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) 01444 245749 01444 857984 forest.view@shaw.co.uk Shaw Healthcare Ltd Mrs Paula Patricia Devonport Care Home 60 Category(ies) of Dementia - over 65 years of age (60), Old age, registration, with number not falling within any other category (60) of places Forest View DS0000068372.V347614.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. That from time to time the service may admit up to maximum 5 persons from the age of 60 years. 1st March 2007 Date of last inspection Brief Description of the Service: Forest View is a care home which is registered to accommodate up to sixty residents in the category (DE (E) people with dementia over the age of 65 years. Whilst residents are predominantly in this category, it can also accommodate residents in the category (OP) old age not falling within any other category. It provides personal care only. Forest View is a detached property that has been built specifically as a registered care home. The home is divided into six units each of which has its own open plan kitchen, dining room and lounge. Each unit can accommodate up to ten residents. All residents have their own room with en-suite facilities either on the ground or first floor. Both floors are serviced by two passenger lifts. In addition, there is a separate day care unit, which is used by some of the residents for activities. Grounds to the rear and side of the property, which have yet to be landscaped, are secure so that residents can use the area safely. The property is located in a residential area of Burgess Hill, West Sussex. It is near to local shops and a short distance to the town centre. The fee levels range from £420 to £675 per week. Additional charges are made for hairdressing, toiletries, chiropody and newspapers. The registered provider is Shaw Healthcare Ltd, who has appointed Mr Peter Nixey to be the Responsible Individual and to supervise the overall management of the care home. Mrs Paula Devonport is the registered manager, who is responsible for the day to day running of the care home. Forest View DS0000068372.V347614.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection has followed the Inspecting for Better Lives methodology and is called a key inspection as it assesses those standards determined by the Commission as key standards. This inspection will also determine the frequency of inspections hereafter. The registered provider returned an Annual Quality Assessment Form (AQAA) prior to the inspection. Residents who were considered capable of completing it and their relatives were sent surveys by the Commission entitled “Have Your Say.” These are designed to enable residents, relatives and other stakeholders to give their opinions about how the care home is being run. One survey completed by a resident and six surveys completed by relatives were returned to us. The information received from these documents will be referred to in this report. A visit to Forest View was made on Monday 29th October 2007. As this was an unannounced inspection the care home had no notice of this visit. We met and spoke briefly to four residents in order to form an opinion of how it is to live at the care home. We also viewed some of the accommodation and observed care practices. Some records were also examined. The visit lasted approximately seven and a half hours. Mrs Devonport was present and kindly assisted us with our enquiries. What the service does well: The needs of all prospective residents are assessed before the move into this care home. This means the manager can demonstrate they will be able to meet the care needs of residents who have been admitted. The premises is safe and well maintained and is clean and hygienic. This means residents’ accommodation is in good condition and is comfortable. Relatives and friends of residents are made welcome when visiting Forest View. This means residents are encouraged to maintain contact if they wish to do so. Residents are provided with a wholesome and varied diet. This helps to maintain residents’ physical health. Forest View DS0000068372.V347614.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: 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. The summary of this inspection report can be made available in other formats on request. Forest View DS0000068372.V347614.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Forest View DS0000068372.V347614.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care needs of all prospective residents have been assessed before moving into this care home. Intermediate care is not provided. EVIDENCE: The names of five residents, who had been admitted on a permanent basis, were identified for case tracking purposes. Residents and relatives confirmed in surveys that they had received enough information about the care home to help them make decisions. However, one relative commented, “I need to ask sometimes about my relative’s care.” Forest View DS0000068372.V347614.R01.S.doc Version 5.2 Page 9 Records seen showed that residents’ care needs were assessed before admission. This includes an assessment of each resident’s activities of daily living such as communication, behaviour problems, continence, pain management, oral hygiene, foot care, personal hygiene, sleep, nutrition and mobility. Information gathered from the assessment process has been transferred into care plans. This means that staff have up to date information about each resident and the action required of them to meet residents’ needs. Where appropriate the manager has also obtained a copy of the assessment made by the funding authority. Information supplied by the registered provider confirmed that, “All our staff are involved in planning care for residents…” It was confirmed the care home does not provide intermediate care. Forest View DS0000068372.V347614.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The resident’s health, personal and social care needs are set out in individual care plans. They do not include sufficient information about the action staff should take to ensure they have been met. Residents’ health care needs have been met. Residents are not always protected by the home’s policies and procedures for dealing with medicines. Residents feel they are treated with respect and their right to privacy is upheld. EVIDENCE: Forest View DS0000068372.V347614.R01.S.doc Version 5.2 Page 11 Care plans have been drawn up from the information gathered when residents’ needs were assessed. They have also been reviewed regularly to ensure the information they contain is up to date. However, it was not always clear what action staff should be taking to ensure residents’ needs are met. Following discussion, the manager agreed to review care plans to ensure they include clear instructions to all staff. This will ensure residents’ care is provided in a consistent and continuous manner. The care planning system includes risk assessments for manual handling, personal care and nutrition. It also records visits to each resident by doctors and other health care professionals together with any treatment prescribed. Surveys returned by the resident and relatives confirmed that they feel the care home meets the needs of residents. One relative commented that the care home, “…provides a safe and secure environment.” A second relative commented, “I often need to ask to get things done.” Surveys also confirmed that the care home provides the care to their relative that they expect or agreed. One relative commented, “Very helpful and friendly staff. They show a very friendly caring nature.” Another relative commented, “Seems to depend on staffing levels and individual support workers. Continuity lacking – i.e. communication on shift change over.” A third relative commented, “My relative has quite a few falls and can’t reach their bell. It is sometimes quite a long time before someone hears them call out for help.” Information supplied by the registered provider confirmed that, “ We have a weekly G.P surgery to monitor residents’ health care needs. We maintain a good working relationship with district nurses, social workers and other professional agencies. We make sure all residents are well cared for ensuring all residents bathed or showered when they prefer and that all their personal needs are met.” During the last inspection there was evidence that confirmed, “Records were poorly kept and showed that whilst medication had been given it had not always been recorded as such. In one instance, morning medication was given at lunchtime as the person had been asleep, but this was signed as being given in the morning.” During this inspection appropriate systems were seen to be in place for the recording, storing, handling, administration and disposal of medication. Medication record sheets were seen. A picture of each resident is attached to their own medication record. Only senior staff who have received appropriate training administer all medication. Records of staff signatures and initials are kept. However, it was concerning to note that there were still significant gaps in the medication records, where they have not been completed over several days. This means there is no evidence to confirm that all medication has been administered to residents in accordance with the instructions of the prescribing Forest View DS0000068372.V347614.R01.S.doc Version 5.2 Page 12 doctor. The manager said that she has been monitoring medication records regularly and has raised this with staff in staff meetings. In addition, we also discovered that whilst records showed that the district nurse has administered medication given by injection, senior staff have also continued to complete medication records. The manager was asked if she had instructed her staff to do this. She said she had not, but was unable to provide an explanation for this practice. This means that it is not clear if the district nurse or the staff of this care home is administering this medication. There also appeared to be some confusion with regard to the storage of some medication administered in the form of a cream. The manufacturer’s directions state that the cream should be refrigerated. However, the manager confirmed that it is usual practice for the cream to be kept in the resident’s own room at room temperature. Again, the manager was unable to give an explanation for this practice. In conclusion, whilst appropriate systems are place for the administration of medication, it is of concern to note that current practices do not ensure residents are safe. From direct observations staff ensure residents’ privacy and dignity is maintained when providing personal care. Staff ensure residents are in their own room, or in a bathroom or toilet before providing such personal care. They also ensure doors to bedrooms, bathrooms and toilets are closed before assisting residents with undressing. Newly appointed staff are provided with induction training. This covers the principles of good care practices including maintaining residents’ privacy and dignity. Forest View DS0000068372.V347614.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are provided with activities that satisfy their recreational interests and needs. Residents maintain contact with family and friends as they wish. Residents are helped to exercise choice and control over their lives. Residents receive a wholesome appealing balanced diet. EVIDENCE: During the previous inspection there was evidence that, Residents do not always find the lifestyle they experience at the home matches their expectations. … there is no programme of planned activity available at the home and therefore opportunities to pursue leisure interests are very limited. Forest View DS0000068372.V347614.R01.S.doc Version 5.2 Page 14 Since this inspection, an activity coordinator has been recruited. The activity coordinator has spent time considering the needs of residents, and their hobbies and interests identified in initial assessments. A weekly activity programme has also been drawn up. Activities include art and craft, relaxation sessions, reminiscence, quizzes, singalong sessions, ball games, skittles and film sessions. One survey returned by a relative confirmed that the provision of activities for residents is something this care home does well. The relative commented, “Great activities for “users”, e.g. daily and special events. I saw a recent concert one afternoon which was greatly appreciated by everyone.” However, a second relative commented, “More stimulation is desirable in activities.” Information supplied by the registered provider confirmed that, “Our residents have a varied entertainments and activity programme. Weather permitting, staff take the more able residents to the pub for a drink, or to the shops to purchase personal items or sweets.” There was no opportunity to speak to relatives during this visit. However, the visitors’ book provided evidence of frequent visits by friends and relatives of residents to this care home. Surveys completed by relatives confirmed they are able to visit the care home when they wish. One relative commented, “My relative can no longer write or telephone – but I visit often.” A second relative commented, “…I visit twice weekly. The staff are very welcoming to visitors at all times…” Information supplied by the registered provider confirmed that, “We organise parties and get together with relatives and friends.” Where possible residents are encouraged to make choices and decisions about their lives. Staff on duty were seen to ask residents what they wanted. They ensure residents choose what they wish to wear, what they want to eat for lunch and what they wish to do during the day. All staff have undergone a structured induction programme to ensure they know what is expected of them. This covers the principles of good care including respecting residents’ individuality and their right to make choices. Information supplied by the registered provider. “Residents are able to wander around the care home with freedom of movement; they can sit where they like and with whom they like.” Breakfast is served on each of the units from small kitchens provided for this purpose. The main meal of the day consisted of sausages, potato and vegetables. There was also an alternative meal of cold meats with salad. Specialist diets such as diabetic, gluten free and vegetarian are also provided for. Meals are taken from the main kitchen to each unit in heated trolleys to ensure hot food can be served. The meal is served by care staff working on the unit. One survey completed by a resident confirmed they usually like the meals provided. When asked to identify what the care home does well in a the survey one relative commented, “The food, as my relative would agree!” Information supplied by the registered provider confirmed that, “There is choice of meals and (residents have) freedom to sit at whatever table they choose.” Forest View DS0000068372.V347614.R01.S.doc Version 5.2 Page 15 Forest View DS0000068372.V347614.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The registered provider has taken appropriate steps to ensure any complaints made by residents, their relatives or friends will be listened to, taken seriously and acted upon. The registered provider has taken appropriate steps to ensure residents are protected from abuse or neglect. EVIDENCE: There is a written complaints procedure, which is available near the main entrance of the care home. It includes details of the person to whom the complaint should be made and indicates the timescales by which the complainant will receive a response. Surveys returned by residents and their relatives confirmed they knew who they should speak to if they wished to complain about the care and services provided. One relative commented, “Issues are usually resolved by speaking to/corresponding with the manager of the home.” It was also confirmed that the care home has responded appropriately when concerns have been raised about the care provided. One relative commented, “The manager is always prompt over any concerns.” Forest View DS0000068372.V347614.R01.S.doc Version 5.2 Page 17 The manager has maintained a record of complaints she has received. This includes the details of the complaint and action taken to resolve any shortfalls identified. Following discussion, it was recommended that details of any investigations that have taken place should also be recorded. Two complaints have been recorded since the last inspection. One complaint is currently being investigated in line with Safeguarding Adults procedures. Information supplied by the registered provider confirmed that, “We give a complaints procedure to all residents/relatives and explain how the process works with contact details of external managers if they are not satisfied. Information on how to make a complaint is also contained in the Statement of Purpose which in the main entrance…” During the previous inspection there was evidence to confirm that, Residents are potentially at risk of harm… in that, …staffing levels do not provide for supervision of residents at all times. In response to a requirement being made the registered provider confirmed that, Staffing levels have been increased by 119 hours per week, this will be monitored and reviewed monthly. At this inspection the manager provided further evidence to confirm she had recently received authorisation from the registered provider to recruit staff to increase still further staffing levels in each unit. The registered provider has drawn up a staff development and training programme. This also includes induction training for newly appointed staff. This indicated that all staff have been provided with appropriate training in identifying all forms of abuse and reporting any allegations made. It was also noted that the registered provider has a copy of the Adult Protection procedures published by West Sussex Local Authority. Information supplied by the registered provider confirmed that, “All staff are trained in Adult Protection and POVA (Protection of Vulnerable Adults) procedures during induction training with an ongoing statutory training programme which refreshes and updates previous learning.” Forest View DS0000068372.V347614.R01.S.doc Version 5.2 Page 18 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. 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. Residents live in a safe, well-maintained environment. The home is exceptionally clean and hygienic. EVIDENCE: The private accommodation of several residents was viewed along with the communal areas, including dining rooms and the lounges located in several units. These areas were decorated and furnished in a homely and comfortable manner meeting the needs of the residents accommodated. Bedrooms have also been appropriately decorated. Residents have been encouraged to bring personal effects and small items of furniture in order to make bedrooms as individual as possible. Forest View DS0000068372.V347614.R01.S.doc Version 5.2 Page 19 Individual aides and adaptations have also been provided as required. Bathrooms and toilets have also been fitted with appropriate equipment such as raised seats, grab rails and specialist bathing aids. Each unit had been named after a flower such as Snowdrop, Buttercup or Bluebell. Signs with pictures had been fitted to the main door of each unit to help residents identify where they live. Signs had also been attached to doors of bedrooms and included the name of the resident who lived there. Doors to toilets, bathrooms, communal areas had been fitted with signs which identified where these facilities could be found. Surveys completed by relatives asked them what they felt the care home does well. One relative commented, “They provide superb facilities. This will be improved when the garden project has been completed.” Information supplied by the registered provider confirmed, “We have provided a home where our residents can feel it belongs to them. We have provided large, open spaces for residents to be able to wander freely around without feeling closed in.” All areas of the premises have been maintained to a good state of cleanliness. This included the laundry and sluice areas. Policies and procedures are in place for control of infection. The home has a contract with a waste disposal company for the collection and disposal of clinical waste. Information supplied by the registered provider prior to the visit indicated that the premises has been visited by the Fire Officer and Environmental Health officer to ensure it is safe and meets requirements in terms of fire safety and health and safety regulations. The registered provider has also confirmed that any shortfalls identified have been rectified. Procedures are in place to ensure equipment such as gas installations, electrical wiring and equipment is regularly checked and maintained to ensure they are safe to use. It was also confirmed that, “Health and safety is maintained throughout the home to ensure residents, staff and visitors are not put at risk.” Forest View DS0000068372.V347614.R01.S.doc Version 5.2 Page 20 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. 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. There has not always been sufficient staff on duty to meet the needs of residents accommodated. This also means that residents have not been in safe hands at all times. Residents are supported and protected by the home’s recruitment policy and practices. The registered provider has ensured staff are trained and competent to do their jobs. EVIDENCE: A selection of staff rotas was examined. The working day is divided into four shifts. They are the morning shift which is from 8am to 2pm; the afternoon shift which is from 2pm to 5pm; the evening shift from 5pm to 10pm and the night shift from 10 to 8am. Of the 6 six units, the two units accommodating the most frail and dependent residents are covered by two staff, whilst the Forest View DS0000068372.V347614.R01.S.doc Version 5.2 Page 21 remainder are covered by 1.5 staff. One member of staff is expected to work between two units. During the night this is reduced to six staff, one of whom is agency staff or permanent staff working overtime. We have been notified of several incidents that indicate staffing levels have been insufficient. Residents’ care needs have not been met and residents have not been appropriately supervised to ensure they are safe. The registered manager was able to confirm she had been given permission to increase staffing levels. This will mean two staff will be made available throughout the day on five units where residents with dementia are accommodated. The sixth unit, where residents who are elderly and frail live, will continue with 1.5 staff during the day. There has been a high turnover of staff since Forest View has opened. This has meant that the care home has used a high number of agency staff to cover shifts. There was evidence to demonstrate that, where possible, the care home uses the same agency staff to ensure continuity of care provided. Surveys returned by relatives expressed some concerns about how this has had a poor effect on the provision of care. One relative commented, “Excellent staff – although I believe they are short staffed and agency are not as reliable.” A second relative commented, “Care plans are perhaps not always read by all staff, especially agency staff. ” information supplied by the registered provider identified how improvements have been made in the last 12 months as “ We have recruited more effectively which reduces the use of agency staff.” Relatives expressed some concerns in returned surveys when asked if the care home gives the care expected to their relative. One relative commented, It seems to depend on the staffing levels and individual support workers. Continuity is lacking – i.e. communication on shift changeovers” A second relative commented, “I have found that my relative is not always wearing her glasses and today they could not be found at the home.” Information supplied by the registered provider confirmed they have “Made every effort to retain staff by making sure they feel part of the team and not ignored or left to get on with it.” The records of three staff recruited since the last inspection, were examined. Records seen were well maintained and were up to date. The information seen included references, criminal records checks and evidence which confirmed the identity of the member of staff. The inspector concluded that the manner in which staff are recruited ensures appropriate checks are carried out to confirm the applicant is appropriate to work with vulnerable residents. Information supplied by the registered provider confirmed that, “We ensure all documentation is in place before staff are offered a position.” Mrs Devonport confirmed that all staff have undergone a structured induction programme. Training records were examined, including induction training. The programme currently used follows the basic principles of good quality of care Forest View DS0000068372.V347614.R01.S.doc Version 5.2 Page 22 including understanding how to provide care in a manner that respects residents’ rights of choice, privacy, dignity, independence and being treated as an individual. However, there was no evidence that induction training included a basic understanding on the needs of a resident who has dementia even though the majority of residents accommodated at Forest View have this condition. When asked to comment on what could be improved one relative stated, “By making sure new carers know the capabilities of each resident, so that appropriate care is given.” Following discussion, the registered manager agreed to discuss this with her line manager to see if this could be included. There is also a training programme for all staff. The programme includes mandatory training such as fire safety, moving and handling and food hygiene. Surveys returned by relatives confirmed staff usually have the right skills and experience to look after people properly. One relative commented, “Younger staff perhaps need more training and support.” Another relative said, Many staff are or seem to be very experienced. Staff shortages and reliance on agency staff does mean that staff are not always aware of each user’s requirements.” Other comments included, “The staffing problems (unable to fill vacancies) put added pressure on existing staff and agency staff do not know the residents to any great level. It would be good for staff on units to be as consistent as possible as the poor residents are confused enough already!! Staff building relationships with residents would lead to greater knowledge of residents.” Information supplied by the registered provider confirmed what they do well as, “We give as much support as possible to all new and existing staff. We also offer training and development.” The registered provider also confirmed that, currently. 17 of permanent care staff employed have an NVQ (National Vocational Qualification) in care at Level 2 or above. Seven staff are working towards the same qualification. Forest View DS0000068372.V347614.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Forest View has not always been well managed. It has not always been run in the best interests of residents. Staff have been appropriately supervised. The health, safety and welfare of residents and staff are not always promoted and protected. EVIDENCE: Forest View DS0000068372.V347614.R01.S.doc Version 5.2 Page 24 Mrs Paula Devonport is the registered manager. She was appointed prior to Forest View being opened and has been responsible for setting up the care home. Surveys returned by relatives where mixed when commenting on the management of Forest View. One relative commented, “I think Forest View is a very well managed home with a dedicated team. Another relative commented, “At the moment the care seems to depend on who is on duty. It’s hit and miss – sometimes my relative is dry and clean and their room is tidy- sometimes none of these things are done. These are the days I dread visiting as once again I have to ask for something to be done.” The manager confirmed she arranges staff meetings and supervision sessions with individual staff. This is to ensure there are opportunities for the manager to communicate with all staff about the day to day running of the care home, training needs of staff, and the care needs of residents. One such meeting took place in October 2007. Issues raised and discussed included recent complaints received about the standard of care provided, staffing levels, training issues, and general issues related to the day running of the care home. The manager has also met with relatives of residents in September 2007 with the intention of arranging a formal meeting with them every 3 months. Again, this provides an opportunity for the manager to communicate with relatives and deal with any issues raised. Issues raised included staffing levels and staff recruitment, the provision of day care and activities, plans to celebrate Christmas and the first anniversary of the homes’ opening. Information supplied by the registered provider confirmed that, “The manager commits herself to everyone in the home, including relatives and visitors and is always available to offer support and advice whenever needed… The manager holds regular staff meetings so that any issues can be raised and addressed.” Mrs Devonport provided evidence to confirm that Shaw Healthcare, the registered provider, has set up a quality assurance system whereby the running of the care home is regularly reviewed and, where necessary, improvements are made. The manager is expected to conduct an internal review every three months. Records seen confirmed the last internal review took place in September 2007. Shaw Healthcare conducts annual audits on each of its care homes. It is expected that this will take place for the first time at Forest View in November 2007. Practices employed for the administration of medication at this care home are of concern. It was first raised during an inspection, which took place in March 2007. The manager has demonstrated that staff responsible for administering medication have received appropriate training. The manager has confirmed she has been closely monitoring practices and, where necessary spoken to staff individually and in meetings about any shortcomings. Internal reviews of the running of the care home have confirmed this. However, they have also Forest View DS0000068372.V347614.R01.S.doc Version 5.2 Page 25 identified concerns about medication. Yet, at this inspection there remain shortcomings with regard to administration, recording and storage. Since this care home has been registered, we have been informed of a large number of incidents and events affecting the wellbeing of residents. These include accidents and falls where residents have required hospital treatment and events which have affected the well being of residents. When asked about this the manager was unable to confirm she has been monitoring and assessing such incidents to determine if action can be taken to reduce any risks to residents which such an assessment has highlighted. Following discussion, the manager was advised that, as she has a responsibility for ensuring the health and safety of residents, she set up such a system to help her identify risks to residents and to staff. The registered provider has supplied information that indicates equipment such as boilers, other gas installations and electrical equipment will be regularly serviced and maintained when required. According to training records staff have been provided training in such subjects as fire safety training, moving and handling, food hygiene and health and safety. Forest View DS0000068372.V347614.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 X X 3 X 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X 3 X 2 Forest View DS0000068372.V347614.R01.S.doc Version 5.2 Page 27 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 OP9 Regulation 13.2 Requirement When medication is administered to people who use the service it must be clearly recorded to ensure that people receive correct levels of medication. The previous timescale of 09/03/07 was not met. When medication administered to people using the service is stored it must be done so in accordance with manufacturers instructions to ensure it is safe and effective for use. Accidents and incidents affecting residents’ wellbeing must be assessed to identify any risks presented to people that use this service. Action must be taken to minimise any identified risks Timescale for action 02/12/07 2 OP9 13.2 02/12/07 3 OP38 13.4 02/12/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Forest View DS0000068372.V347614.R01.S.doc Version 5.2 Page 28 No. Refer to Standard Good Practice Recommendations Forest View DS0000068372.V347614.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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