Inspection on 21/04/08 for Foresters

This inspection was carried out on 21st April 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Foresters 06/09/06

Foresters 15/02/06

Foresters 01/09/05

Foresters 10/03/05

Foresters 16/12/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOME ADULTS 18-65 Foresters 18-20 Alexandra Road Weymouth Dorset DT4 7QQ Lead Inspector John Hurley Unannounced Inspection 21st April 2008 10:00 Foresters DS0000020466.V362445.R01.S.doc Version 5.2 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 Foresters DS0000020466.V362445.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 Adults 18-65. 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. Foresters DS0000020466.V362445.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Foresters Address 18-20 Alexandra Road Weymouth Dorset DT4 7QQ 01305 777189 01202 777189 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) Dorset Residential Homes Ms Sara Ann Harpley Care Home 15 Category(ies) of Learning disability (15) registration, with number of places Foresters DS0000020466.V362445.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Four named service users (as known to CSCI) in the category of LD(E) may be accommodated to receive nursing and personal care. 6th September 2006 Date of last inspection Brief Description of the Service: Foresters is a care home registered with the Commission for Social Care Inspection to provide personal care, nursing care and accommodation to 15 learning disabled adults who may also have emotional and behavioural needs. The home is operated by Dorset Residential Homes, a registered charitable trust that operates a number of care homes in Dorset. Foresters is located in a residential area of Weymouth within walking distance of the town centre. The property is made up of 2 large semi-detached Victorian houses that have been altered internally to form one house. The home provides 15 places for service users. The home is staffed by a team of registered learning disability nurses and care staff who provide 24-hour care and support. Foresters DS0000020466.V362445.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is two stars. This means that the people who use this service experience good quality outcomes. The inspector carried out this unannounced inspection over two visits lasting 6 hours in total. They viewed all areas of the home and observed the residents who were at home at the time. The inspector spoke with three care staff on duty and the manager. The inspector did not have an opportunity to meet with any relatives at the time. The inspector spoke with those residents who could express a view as well as taking into consideration the responses in questionnaires that were sent out at the time of the inspection. People important to the residents were asked to comment on the service by way of questionnaires. Where possible the comments received have been included in this report. A number of records were examined including a sample of the residents care plans, health and safety records, the corporate vulnerable adults policy, staff rota’s and recent employment records. Current fees are £987.00 per week but may vary according to the individual’s support needs. What the service does well: The service continues to offer a homely environment for the individuals who are resident. The staff are knowledgeable with regards to the their needs and aspirations and meet these in a empathetic manner. Staff communicate well with the residents having built up a developed knowledge of how each individual can interact with them. The staff treat people with respect and dignity. Each person is treated as an individual and risks are taken to ensure that people can lead a normal life as possible. The staff work well with other agencies in achieving stated outcomes for the resident. All involved in the service promote an open and inclusive culture to ensure people have opportunities in achieving their potential albeit staff or residents. The questionnaires that were returned from people important to the individual residents evidence that they are satisfied with the service offered by the home and are fully involved in the service as appropriate. Foresters DS0000020466.V362445.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. Foresters DS0000020466.V362445.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Foresters DS0000020466.V362445.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. As there have been no new admissions since the last inspection this group of standards were inspected on the basis of the corporate admissions documentation, stated practice combined with discussions with the staff and a manager. If these practices are followed it should ensure a good quality outcome for the prospective resident. EVIDENCE: Comprehensive pre-assessment documents evidence a good approach to any new admissions. The manager or designated staff member undertakes an initial consultation with other professionals and considers any previous documented assessments by other care professionals. The documentation evidences that the home’s manager and other staff should visit the prospective resident in their home environment or significant other place such as a day service to build a holistic picture of this individual needs. The documentation also states that wherever possible the individual should also attend the home to meet the other residents. Following on from these visits and discussions with the individual if possible or people important to them a draft plan of care will be drawn up and agreed with Foresters DS0000020466.V362445.R01.S.doc Version 5.2 Page 9 the individual and their advocates. Foresters DS0000020466.V362445.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. More needs to be done to ensure that care plans reflect the care needs of the individual resident to ensure a consistent approach by staff. EVIDENCE: The inspector sampled a number of the residents care plans. It was found that there was little recorded evidence that care plans and associated documentation had been kept up to date. One resident who has mental health needs does not have a care plan that makes any further reference to these needs outside of the initial assessment. One resident whose plan stated that they should be weighed once a week due to their nutritional intake had not been weighed for over 6 months and a resident who had recently had a operation did not have a post operation plan of care and their care plan made no reference to this operation. Foresters DS0000020466.V362445.R01.S.doc Version 5.2 Page 11 The feedback received from people import to the residents commented that “residents are well cared for, staff treat people with kindness and I am always invited to meetings and feel included in the care that is being provided, my son is treated as an individual”. The residents that the inspector spoke with confirmed that their needs are met and that staff “know what I like and how I want things done”. In one case a staff member was unclear as to how to work with one resident who has behaviour that challenges. The lack of up to date information on the care plans and associated documentation means that staff may not be providing care in a consistent manner, in the case of the person with mental health needs (mentioned earlier) they may not know that the individual has additional needs. Furthermore the impact of outdated information can effect the staffs ability to monitor any changes in the residents well being. This in turn undermines their ability to make informed decisions and give an accurate evidenced based account of the resident well being and progress Overall it would appear that the problem with the resident’s documentation relates to poor recording of care plans rather than poor care practice itself. The inspector spoke with the registered manger regarding this point who informed them that a new approach to care planning and documentation is being introduced and so all plans will be brought up to the required standard soon. The inspector observed residents making choices such as if to go out and attend outside activities, what to wear and what to eat. Comments from visiting professionals stated that choices are only limited by the individual’s abilities relatives also supported these comments. The risk assessments relating to daily living were reasonably comprehensive with only a small minority being out of date. The homes management were able to demonstrate that they have been able to develop complex programmes of care that easily demonstrates risks being taken to ensure that individuals are allowed to maximise independence where possible. Foresters DS0000020466.V362445.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12.13.15,16,17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The residents have good opportunities to be part of the community and attend meaningful activities as appropriate. EVIDENCE: The inspector sampled the records of the home and observed the interactions between the staff and residents as they went about their individual routines. A sample of the records observed demonstrated that the residents engage in a variety of age appropriate leisure activities with their peer groups. These included swimming, shopping as well as day services. The feedback from relatives showed satisfaction with the services on offer and confirmed that they are consulted as appropriate. All of the questionnaires returned commented that the home has a friendly relaxed atmosphere where visitors are made welcome. Foresters DS0000020466.V362445.R01.S.doc Version 5.2 Page 13 The home has a number of different areas where residents can relax in the company of others or on their own. There is a small multi sensory type room.. During the inspection staff were observed to encourage residents to assist in some aspects of the homes running and were positively encouraged into the kitchen area to help where appropriate. All of the interactions that were observed were both respectful and attentive. As discussed earlier the residents care plans need to evidence all of the choices and social interactions that the residents engage in. The routines of the day are structured to enable as much participation as possible. The residents appear to participate well within these structured routines. The staff group adopt a person centred approach that ensures a good balance of flexibility is always used to ensure people have the space and time to complete their chosen tasks. The inspector observed that there were enough food stocks of both fresh and other foods to provide the basis for a nutritious meal. Staff informed the inspector that they were aware of the individuals likes and dislikes and provided that the choices made by the individual ensured a degree of a balanced diet their wishes would be met. Residents routinely accompany staff to the shops to get the groceries. Meal times have a degree of flexibility but Monday to Friday routines assist the residents and staff to ensure that people get to their chosen activities or other associated tasks on time. The residents informed the inspector that the food is good and they can choose what they want to eat. Foresters DS0000020466.V362445.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Whilst it is clear that resident’s health needs are met it would be helpful if the actions taken relating to this area of care are robustly documented. There are appropriate policies and procedures in place regarding the management of medication. EVIDENCE: The service users and people import to them have commented that they consider the support offered by the staff with regards to their emotional needs to be good. The interactions between the service users and staff were also observed as professional and appropriate. Whilst feed back from visiting doctors and health care workers confirmed that residents needs are being met, as mentioned earlier this is not fully evidenced in the care plans and associated documentation. Foresters DS0000020466.V362445.R01.S.doc Version 5.2 Page 15 At present residents are not able to retain or administer their own medication. The residents consent for the home to take responsibility for their medication is well documented. The reasons for this are documented in the individuals file. The home’s procedures for the management and administration of medication were examined at this inspection. Medicines were stored appropriately. The home has a detailed medication policy file, which includes controlled drugs and homely remedy guidance. Foresters DS0000020466.V362445.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home takes reasonable steps to ensure the safety of the residents through its complaints and vulnerable adults policies. EVIDENCE: Some residents, due to the nature of their disabilities, communicate via means other than speech. Due to this reason it was not possible for the inspector to communicate effectively with these residents. However, the residents who could express an opinion were very clear on who to go to if they were unhappy wit the service on offer. The responses received in the form of questionnaires supported these views. There have been no complaints received by the home or the regulator since the last inspection. The home has appropriate policies relating to complaints and the protection of vulnerable adults. Foresters DS0000020466.V362445.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,28,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is clean and hygienic. The plans to improve the home will enhance the environment when they have been completed The registered manager needs to ensure that all infection control policies are robustly applied for the protection of staff and residents. Risk assessments must be in place in order to protect the staff, residents and visitors. EVIDENCE: The home provides spacious accommodation that allows residents to live comfortably as a group but also retain a degree of privacy and quiet if they wish. Foresters DS0000020466.V362445.R01.S.doc Version 5.2 Page 18 The environment offers comfortable and practical accommodation that is mostly well decorated and pleasantly furnished. There is ample space and seating in all the communal areas. The building gets a considerable amount of wear and tear because of the needs of the residents, and it was evident throughout the building that the maintenance is generally good but some repair work takes to long to be addressed for example- a window in a residents bedroom that was boarded up due to a breakage on the first visit was still boarded some weeks later. The work to carry out the planned refit to a number of rooms and create more enquires continues to be delayed with no start date available. As areas of the home required redecorating and in one case, the shower room significant retiling, it would be helpful if a date for work to start was set or the poor areas of the home immediately brought up to the expected standard The inspector was surprised to see that the home was using communal towels for the residents. This practice undermines infection control policies and reinforces an institutional approach (an approach that is not apparent in any other practices or policies noted or observed within the home) When this was pointed out to the management this practice was stopped and reassurances given that all residents would be provided with their own towels. The kitchen was clean and well organised and used by all who wished to assist in this area. It would be helpful if the use of the kitchen area by residents was risk assessed in line with health and safety policies. Foresters DS0000020466.V362445.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff team are well trained and knowledgeable with regards to the resident’s needs and aspirations. EVIDENCE: The home is fully staffed. It was explained to the inspector that all new staff undertake induction and foundation training leading onto NVQ training. Some of the homes management hold NVQ assessor awards. The representations from people important to the people who reside at the home consider that there is a good mix of professionally trained nurse’s complemented by competent and qualified care staff. At the time of the inspection there were sufficient staff on duty to meet the needs of the residents. The rotas showed that these levels are maintained. Foresters DS0000020466.V362445.R01.S.doc Version 5.2 Page 20 The home has regular staff meetings which residents are free to join in if they wish. As the home has a nursing registration those who take managerial responsibility on each shift are qualified nurses. This has lead to meetings of “qualified” staff, care staff meeting, kitchen staff meetings etc as well as whole staff group meetings. As the home is exploring ways of including “non qualified staff” in the day to day running of the home, as it looks to drop the nursing registration, the inspector considers it would also be helpful if it looked at the language that has developed when describing peoples roles and responsibilities at the home. The staff records were examined and in general contained all the required information in relation to recruitment and training. However one staff members file did not contain a reference from a previous employee although others had been taken up. The manager acknowledged this point. Staff training records were seen and provided evidence that all mandatory training is regularly completed. Staff were observed relating to residents in a positive manner and residents and staff appeared comfortable and confident in their relationships. Rotas evidenced that there are sufficient staff on duty to meet residents’ needs, staff and where possible residents confirmed this information. Foresters DS0000020466.V362445.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,42 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 managed and this benefits residents and ensures their needs are well met. The environment is safe. EVIDENCE: The inspector viewed a number of key documents during the inspection ranging from care plans to staffing records. With the exception of some details relating to care planning and assessment all documents were found to be well laid out and in good order. Foresters DS0000020466.V362445.R01.S.doc Version 5.2 Page 22 The staff the inspector spoke with staff that said that the manager was approachable and fair, often working with them and the residents. The feedback received via questionnaires informed the inspector that relationships with other professionals and people important to the residents remain positive and professional. During the sampling of the staffing records the inspector noted that it is planned that staff undergo one to one formal supervision on a regular basis, however this does not always happen. The standard of the health and safety documentation is good. Fire maintenance was up to date and fire drills and training had regularly taken place. Environmental risk assessments are in place. Staff are aware of infection control and have received training in this. Water temperatures were regularly checked. The inspector examined the COSHH information, which was kept in the health and safety file and found it to be comprehensive. Notices and memos were also displayed in the COSHH cupboard. The statutory health and safety poster is displayed in the office. Foresters DS0000020466.V362445.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 x 2 x 3 3 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 3 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 2 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 3 3 x x 3 x Foresters DS0000020466.V362445.R01.S.doc Version 5.2 Page 24 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 YA6 Regulation 15 Requirement The registered manager must ensure that residents’ care plans are reviewed to reflect changing needs and recorded evidence is available to demonstrate how these needs will be met and by whom Timescale for action 12/07/08 2. YA9 13(4) The registered manager must 12/07/08 make ensure all environmental and personal risks are assessed and the identified action to minimize the risk is recorded and acted upon to minimize the risk of harm to people who use the service and staff 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 YA36 Good Practice Recommendations The registered manager must ensure that staff are regularly and formerly supervised as set out in the homes DS0000020466.V362445.R01.S.doc Version 5.2 Page 25 Foresters documentation. 2 YA39 The quality assurance system and consultation needs to be formalised and recorded to demonstrate the work completed. Foresters DS0000020466.V362445.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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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