CARE HOME ADULTS 18-65
Forton House 3 St Johns Road Exmouth Devon EX8 4BY Lead Inspector
Vivien Stephens Announced Inspection 8th February 2006 10:30 Forton House DS0000021938.V277103.R01.S.doc Version 5.1 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 Forton House DS0000021938.V277103.R01.S.doc Version 5.1 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. Forton House DS0000021938.V277103.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Forton House Address 3 St Johns Road Exmouth Devon EX8 4BY 01395 222621 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) Devon Partnership NHS Trust Mr Kevin Shaun Brooks Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Forton House DS0000021938.V277103.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Age range 18 to 40 years Date of last inspection 21st July 2005 Brief Description of the Service: Forton House is registered to provide residential care for up to 3 younger adults who have learning disabilities. The property is a detached family style house situated in a residential suburb of Exmouth. There is ample parking on site, and good-sized gardens. There are 3 bedrooms on the first floor, one of which is used as an office and sleeping-in room. There is also a bathroom and separate toilet. On the ground floor there is a lounge, separate dining room, a bedroom, and a kitchen. Forton House DS0000021938.V277103.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection lasted for approximately three hours. All three service users were at home during the morning, although they all had planned activities outside the home at some time during the day. Two staff were on duty on arrival at the home and the Acting Manager, Hugh Akiba Jones was present for the second half of the inspection. There have been no new admissions in the last year and it is unlikely there will be any changes in the foreseeable future. The service users have limited communication skills. Their families were consulted prior to this inspection and they all gave assurances that they are satisfied with the level of care and facilities provided. What the service does well: What has improved since the last inspection?
The atmosphere within the staff team has improved. Residents now benefit from a stable staff group and the home is generally running smoothly. Forton House DS0000021938.V277103.R01.S.doc Version 5.1 Page 6 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. Forton House DS0000021938.V277103.R01.S.doc Version 5.1 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 Forton House DS0000021938.V277103.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 Information about the home for residents and their relatives/representatives is out of date and therefore unsatisfactory. EVIDENCE: The three residents have lived at Forton House for many years. There have been no new admissions in the last year and it is unlikely there will be any new admissions in the foreseeable future. The statement of purpose has not been reviewed or updated in the last year. This must be carried out to reflect recent changes in the management and staffing of the home. Trust Residential Services have a comprehensive admissions policy and good information is available as and when any new admission might be considered. Forton House DS0000021938.V277103.R01.S.doc Version 5.1 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 Excellent care plans are in place. EVIDENCE: Since the last inspection the care plans have been developed to provide a summary of the daily and weekly care needs. The full care plan documents hold a large amount of information on all aspect of each resident’s health and personal care needs. Through discussion with staff there was evidence that the care staff have a thorough understanding of each resident’s personality, ability, needs and preferences. The care plans demonstrate how the staff respect and promote the rights of each resident. The care plans include risk assessments. Forton House DS0000021938.V277103.R01.S.doc Version 5.1 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 15 The level of activities provided is satisfactory. Residents maintain good contact with the friends and families. EVIDENCE: Each resident has a weekly plan of activities. Boards outside their bedrooms provide information about the planned activities. One resident has been attending the Doyle day care centre on a regular basis. Changes at the day centre have caused some disruption, and Forton House staff have worked hard to overcome these difficulties. Activities provided by the home include walks in the local area, shopping trips, listening to music and games. Transport is provided. The home encourages good contact with families and friends. Residents are regularly taken to visit their families, and staff keep in contact by telephone.12, Forton House DS0000021938.V277103.R01.S.doc Version 5.1 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20 The residents’ health care needs are well met. The level of training provided to staff on the safe administration of medicines is unsatisfactory. EVIDENCE: Since the last inspection all staff, including agency staff, have received training on epilepsy and the administration of emergency medication. Discussion with staff and the manager, and evidence seen in the care plans showed that the home has ensured that all health needs have been carefully monitored and specialist health professionals have been regularly consulted. Medications were inspected at the last inspection. The home uses a monitored dosage system. Staff have not received training on the safe administration of medicines – this is required. Forton House DS0000021938.V277103.R01.S.doc Version 5.1 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Satisfactory procedures are in place to deal with concerns, complaints, and to prevent abuse, neglect or harm. The home must ensure that families and representatives are fully aware of these procedures. EVIDENCE: The complaints procedure is displayed in the hallway and in the rear lobby. This has been drawn up using both words and symbols and has also been explained to the resident. Families who responded to the inspection indicated that they were unaware of the home’s complaints procedures and therefore it is recommended that the home gives all families and representatives an updated statement of purpose/service user guide containing the complaints procedure. All staff have either recently undertaken, or will shortly attend training on the protection of vulnerable adults. The home has a copy of the Alerters’ Guidance, No Secrets video, and Trust Residential Services policies and procedures on the protection of adults. Forton House DS0000021938.V277103.R01.S.doc Version 5.1 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29, 30 The home has been well maintained and is comfortable and homely in appearance. There is adequate space and facilities to meet the residents’ needs. The decoration of the laundry walls must be addressed to provide a surface that can be easily cleaned. EVIDENCE: Forton House is a detached house situated in a residential area of Exmouth. There are good-sized gardens and car parking on site. The property has been regularly maintained and recently decorated throughout. On the landing there was a small patch of plaster that has recently fallen off by a bedroom door. Assurance was given that work is planned for the near future to address this. Each resident has their own bedroom that is above 12 square metres. Bedrooms have been decorated and furnished according to individual interests, needs and preferences. In the last year two residents have changed bedrooms and this has proved a success. Each of the bedrooms were bright, attractive
Forton House DS0000021938.V277103.R01.S.doc Version 5.1 Page 14 and comfortable. Decorations, pictures and possessions displayed in the rooms reflected the interests and tastes of each resident. The lounge and dining rooms have recently been redecorated and appeared comfortable, stylish and homely. There is a bathroom and separate toilet on the first floor and a toilet on the ground floor. These rooms were in good decorative order. There is a laundry room that is reached from outside the house. The machines were in good working order. The paint on the walls was flaking and it is recommended that the walls are repainted in order to provide a surface that can easily be kept clean. All areas of the home were clean and free from any odours. The hot tap in the bathroom is thermostatically controlled. Forton House DS0000021938.V277103.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34, 35 The home follows satisfactory recruitment procedures. Residents now benefit from a stable staff group. However, the level of training provided to staff is poor. EVIDENCE: No new staff have been employed by the home in the last year and therefore the staff files were not inspected. The home is in the process of recruiting permanent new staff to fill the hours that have been covered by agency staff. The home follows the Trust Residential services recruitment policies and procedures. At the last inspection requirements were made that the home obtains evidence of satisfactory recruitment procedures for all staff, including agency staff, and that all staff receive satisfactory training and instruction on the administration of emergency medications. These requirements have been met by providing training for the agency staff and by the imminent recruitment of permanent new staff. None of the staff currently hold NVQ qualifications. Evidence provided at the time of this inspection showed that no training has been provided to staff in the last year. Training is planned for all staff to receive training on the safe holding of vulnerable adults and the safe administration of medicines. The
Forton House DS0000021938.V277103.R01.S.doc Version 5.1 Page 16 Acting Manager and Deputy Manager are due to undertake a 4-day course on first aid. Forton House DS0000021938.V277103.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 While the management of the home is generally running smoothly the lack of a registered manager is a matter of concern. The maintenance of equipment at the home is satisfactory. However, the lack of regularly updated risk assessments on the building and failure to provide regular training for staff on all health and safety related subjects places both residents and staff at risk of harm. EVIDENCE: At the last inspection a requirement was made that a manager must be appointed by 1st November 2005. Hugh Akiba Jones has been appointed as the Acting Manager, but his position remains temporary. No application for registration had been received at the time of this inspection – this must be addressed. Staff interviewed during the inspection indicated that the home is running smoothly and there are good working relationships within the home. Information provided for this inspection showed that maintenance and safety checks have been carried out regularly on all equipment including fire safety
Forton House DS0000021938.V277103.R01.S.doc Version 5.1 Page 18 equipment. However, Hugh Akiba Jones was unaware of any risk assessments on the building, or COSHH assessments, and therefore these have not been reviewed and updated as required. There is a manual on infection control in the office but staff have not had training on this subject. The fire logbook showed that all regular fire safety equipment checks have been carried out as recommended. However, staff have not received training or drills as required. Training has been booked for near future with the health authority’s fire training officer. Forton House DS0000021938.V277103.R01.S.doc Version 5.1 Page 19 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 2 2 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 2 STAFFING Standard No Score 31 x 32 x 33 x 34 3 35 1 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 X X X X LIFESTYLES Standard No Score 11 X 12 3 13 X 14 X 15 3 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 3 2 x 1 x 3 x x 1 x Forton House DS0000021938.V277103.R01.S.doc Version 5.1 Page 20 yes 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 YA1 Regulation 6 Requirement The registered person must keep the statement of purpose and service user guide under regular review and must notify the Commission of any such review within 28 days. The registered person must ensure that the persons employed to work at the care home receive training appropriate to their work. (This relates to the training of staff in the safe administration of medicines) The registered person must ensure that the persons employed to work at the care home receive training appropriate to the work they are to perform. (The home must submit a plan to show how the training needs of the staff, including all relevant health and safety related training, will be met in the next year.) The registered provider must appoint a manager as a matter of priority. The registered person shall after consultation with the fire
DS0000021938.V277103.R01.S.doc Timescale for action 01/04/06 2 YA20 13(2)18 (1)(c)(i) 01/08/06 3 YA35 18(1) 01/04/06 4 5 YA37 YA42 8 23(4) (d)(e) 01/11/05 01/04/06 Forton House Version 5.1 Page 21 6 YA42 13 (4) authority make arrangements for persons working at the care home to receive suitable training in fire prevention and to ensure by means of fire drills and practices that person working at the care home are aware of the procedures to be followed in case of fire. The registered person must 10/04/06 ensure that all unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. (Risk assessments must be carried out on all parts of the home and kept under regular review.) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2 3 Refer to Standard YA14 YA22 YA30 Good Practice Recommendations It is recommended that the cost of holidays is included in the contract price. (This was not discussed at this inspection and will be covered at the next inspection) The home should provide families and representatives with an updated copy of the statement of purpose/service users’ guide and the complaints procedure. The laundry walls should be repainted to provide a surface that can be easily cleaned. Forton House DS0000021938.V277103.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY 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 Forton House DS0000021938.V277103.R01.S.doc Version 5.1 Page 23 - 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!
