Inspection on 30/04/07 for Fosse House

This inspection was carried out on 30th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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

Fosse House 16/10/07

Fosse House 06/06/06

Fosse House 08/11/05

Fosse House 05/05/05

Fosse House 09/12/04

Fosse House 01/07/04

Fosse House 26/02/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Fosse House Ermine Close St. Albans Hertfordshire AL3 4LA Lead Inspector Mrs Sheila Knopp Unannounced Inspection 30th April 2007 09:10 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 Fosse House DS0000019349.V336013.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. Fosse House DS0000019349.V336013.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fosse House Address Ermine Close St. Albans Hertfordshire AL3 4LA 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) 01727 819 700 01727 819 768 fosse@quantumcare.co.uk www.quantumcare.co.uk Quantum Care Limited Jennifer Barbara Gauthier Care Home 61 Category(ies) of Dementia - over 65 years of age (61), Old age, registration, with number not falling within any other category (61), of places Physical disability over 65 years of age (61) Fosse House DS0000019349.V336013.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 12th January 2007 Brief Description of the Service: Fosse House is a purpose built care home for 61 older people, including two rooms for short (or respite) stays. It is a two storey building, with two units on each floor. Three of the units have 15 rooms and one has 16 rooms. Each service user has their own bedroom with an en-suite toilet and washbasin. Each unit has it’s own lounge, dining room and kitchen. There is a hairdressing salon and a sensory room on the first floor. There is a day centre on the ground floor, which is separate from the residential accommodation. There is a large garden that has been creatively designed and landscaped, with paths and patio areas suitable for wheelchairs, an orchard and a pond. The home is close to the parkland leading to St. Albans Abbey. It is in a modern residential area, next to a small shopping parade and a Waitrose supermarket. The current fees for accommodation range from £505 - £590 per week depending on an assessment of care needs (correct on 30/04/07). A copy of the most recent inspection report is available from the home or company on request. Information is also available on the Quantum Care web site. Fosse House DS0000019349.V336013.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The information in this report is based on an unannounced visit to the service where the inspector had contact with 10 residents, one visitor and 6 staff as well as observing the care practices and routines taking place on the day. Relevant care, management and health & safety records were examined. Information received by the Commission between inspections has also been reviewed. The Commission sent survey forms to 18 residents, 7 General Practitioners (GP) surgeries covering 50 GP’s, 3 social workers and 1 community nurse so their views on the service provided at Fosse House could be considered. At the time of writing this report 2 surveys had been received from residents/relatives and 11 completed surveys from GP’s. What the service does well: What has improved since the last inspection? It was positive to note that an activity organiser has now been employed to develop opportunities for residents to increase the range of social interaction and stimulation available. Plans have been made for residents to go out on day trips during the summer. Fosse House DS0000019349.V336013.R01.S.doc Version 5.2 Page 6 The dining room on Dove unit has been extended to provide residents with more space at meal times. The lighting has been improved in the corridors throughout the home, which will make it brighter for older people with reduced vision. Quantum Care has continued to redecorate and replace carpets to maintain standards. Increasing numbers of staff have been able to attend dementia care courses and NVQ training programmes, which develop their skills and understanding beyond the basic introductory level. What they could do better: A resident on a respite break felt staff could provide more information about how the routines and systems of the home worked so that they could take a full part in what was on offer. The management team need to ensure all staff adopt a positive approach to residents that supports their rights to live in a culture which promotes their autonomy and dignity as individuals rather than contact which, in some cases was observed to cause distress, be task led, and institutional. Following recent adult protection referrals the management team must ensure that the ethos of the service provided continues to protect residents from losing personal possessions and ensure staff act responsibly at all times. The management team must ensure all staff administer medication according to the company procedures to maintain the safety of residents and support their dignity. The management team must ensure that staff consistently apply the company health & safety and infection control procedures to protect residents from accidental injury and infection. Quantum Care need to ensure they employ a full team of experienced care managers to promote good standards on each of the four units. Quantum Care must ensure adequate numbers of housekeeping staff are employed to maintain standards of cleanliness and provide a good laundry service. Quantum Care need to ensure that the tree root damage to the garden is addressed so residents can have access to all areas as soon as possible. Fosse House DS0000019349.V336013.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Fosse House DS0000019349.V336013.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Fosse House DS0000019349.V336013.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 (standard 6 does not apply to this service). People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are assessed before coming to live at Fosse House to ensure it is a suitable place for them and staff can provide the level of support they need. EVIDENCE: The manager or deputy manager visit individuals in their own home or hospital to carry out a full assessment of their needs. Individuals and their families are encouraged to visit and spend time in the home. They may have already attended the day centre or been on respite stays before so the home would be familiar to them. Information is also obtained from other health & social care professionals so that a plan of care can be put in place. Fosse House DS0000019349.V336013.R01.S.doc Version 5.2 Page 10 An individual staying in the home for a respite break felt staff could provide more information on how things worked, for example how to order a cooked breakfast and invitations to attend activities that were taking place. Fosse House DS0000019349.V336013.R01.S.doc Version 5.2 Page 11 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 & 1o People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Inconsistent care practices and record keeping mean that residents are not always getting the care their assessment says they need. In some areas the approach of staff does not promote the well being of residents. The management systems for ensuring residents do not run out of medication and stocks can be audited has greatly improved. However concerns were raised with the manager regarding poor administration procedures observed on Nightingale Unit, which did not demonstrate respect for the residents concerned. Fosse House DS0000019349.V336013.R01.S.doc Version 5.2 Page 12 EVIDENCE: The last inspection report referred to inconsistencies in care planning and recording which did not provide the evidence needed to demonstrate appropriate care is being carried out. It was also reported that the care managers on each unit were updating and reviewing the care plans. This inspection again identified inconsistent record keeping between the units. A newer style care plan completed by a temporary care manager provided easy to follow details of the care required to meet the needs of that individual. In contrast the files on another unit had not been reviewed monthly according to company policy and were disorganised and difficult to follow. On two of the units two residents were observed to have bruising on their heads. One person is known to have had a fall the other was identified as cause unknown. The records did not provide evidence that their health had been reviewed or their comfort or need for pain relief considered. The dependency of some residents is getting such that staff are not able to weigh them. The records of two residents indicate they had not been weighed since May & November 2006. The company need to consider making alternative arrangements such as providing a hoist attachment or wheelchair platform scales to assist this. Following re-admission to Fosse House after a hospital stay one person’s care plan had been reviewed and new plans introduced for risk of choking and monitoring nutritional needs introduced. The information advised staff to weigh this person weekly. There was no evidence that this had been done. The care plan to prevent choking provided guidance for staff but earlier records in the folder, which indicated they could eat a normal diet had not been updated. To protect residents who are using electrically adjustable furniture, such as recliner chairs or electrically adjustable beds, either by choice or as part of their plan of care, risk assessments should be recorded so that the competence of the person to continue to use the equipment is kept under review and the safety of the equipment is regularly checked. Where staff are using the control to position the resident, who is then unable to change their own position clear guidelines for staff and consent for its use to ensure residents are not being restrained needs to be in place. The approach to residents who are more able was observed to be positive with staff spending time talking with them about their daily lives and past experiences. The approach from staff observed towards residents less able to express their views was observed to be abrupt with staff talking over the individual concerned and carrying out tasks without consulting them. On two occasions the approach of staff left residents visibly distressed. One person Fosse House DS0000019349.V336013.R01.S.doc Version 5.2 Page 13 buried their head in their hands and another person calling for help was ignored until the manger intervened and made suggestions to aid this person’s comfort. No residents were reported to have pressure sores at the time of this inspection. Equipment to prevent them developing was in place Eight out of eleven GPs who completed survey forms said the health needs of residents were usually met. Two GPs said health needs were always met. Five GPs said that the residents are always treated with dignity and their privacy is respected. Seven said this was usually the case. One GP said that good care had been provided to a terminally ill resident and their family. Four GPs added additional comments indicating that there was a ‘caring environment’, the ‘care always seems suitable and residents seem happy’, ‘cheerful supportive atmosphere, generally appear to know their clients well’. Two GPs raised concerns about poor communication and lack of information when staff are requesting visits from them. Following the last inspection a pharmacist employed by Quantum Care carried out a review and the systems have been reviewed to ensure medicines do not run out. Information is also available to staff to tell them the effects of the medication they are giving to residents. The inspector was satisfied that appropriate systems for ordering and storing medicines were in place. However very poor practice with regard to the administration of medication was seen on one of the units. This was brought to the attention of the manager who will ensure the member of staff concerned is re-trained and assessed before they are allowed to give out medication in the future. The medicines trolley was left unattended and unlocked, medicines were signed as given before they were given to the resident, medication was put directly in a residents mouth, drinks were not left with residents receiving medication and poor hand hygiene was observed. Fosse House DS0000019349.V336013.R01.S.doc Version 5.2 Page 14 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, & 15 People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are able to attend a range of planned activities and social events but opportunities to follow individual programmes and interest based on supporting and maintaining the skills of those with dementia is limited. A varied and nutritious diet is provided but in some areas little thought is given to ensuring meal times are an enjoyable experience. EVIDENCE: There have been some difficulties recruiting an activity organiser so it is positive to note that a new member of staff is now in post and receiving training and support by visiting other homes within the company. There is a developing programme of activities and trips out are planned for the summer. Two mobile residents able to express how they wished to spend their time said they ‘can drop in and out’ of activities and like being able to choose how to spend their time. Another person said ‘it’s dead here’. Fosse House DS0000019349.V336013.R01.S.doc Version 5.2 Page 15 The information available to staff to enable them to engage with residents who have dementia and provide meaningful activities based on their individual interests and abilities is variable across the home. The observations made on two units was that staff were focussed on physical tasks and routines and there was little social interaction during the day. Residents on one unit were not asked what they wanted to watch on television. The programme was set to a very loud confrontational talk show with people shouting and challenging relationships. Given the inspectors knowledge of the residents who were listening to this the content of the programme it could cause distress and demonstrated a lack of awareness by staff. Residents were positive about the quality of the meals they are provided with. Quantum Care have their menus nutritionally assessed and make seasonal changes. The staff on two units were badly organised at meal times. Interaction with residents was poor. A member of staff sat on the arm of a chair, which placed them above the resident to give them their lunch. They did not speak to them. No drink was offered. When another resident needed their clothing changed the member of staff went off leaving the meal uncovered and cooling. They then returned to finish the meal. The inspector observed that meal times on two units were taken over by the need to give out medication, which was done in an intrusive manner. A group of residents sitting at one table had finished their main course and were ready for dessert. The person serving the meals left to give out medication. The residents became restless and began causing distress to each other. A resident on another unit commenting about breakfast said staff ‘forget what we all want is a nice cup but they busy themselves with tablets’. Staff demonstrated a poor attitude to meals. They were not able to discuss what was for lunch with residents. When the inspector asked a member of staff what was for lunch the response was ‘I don’t know I wasn’t here yesterday’ (residents make their choice from the menu the day before). The response from another person as to why the residents on one unit did not have a cooked breakfast was ‘I wasn’t here yesterday’. It also appears that a puree meal wasn’t ordered as staff on the unit were having to prepare it. The view of the catering manager was that additional gravy would have been required to make it the right consistency and none had been supplied from the kitchen. Fosse House DS0000019349.V336013.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): Standards 16 & 18 People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service can be confident that things brought to the attention of the management team or company will be listened to and acted upon. Recent experiences of people who use the service indicate they are not always protected from inconsistent and inappropriate care practices or loss of personal possessions. EVIDENCE: The records in the home indicate 5 complaints have been received by the manager since the last inspection. The information provides evidence that the company complaint procedure is being followed and a written response on the outcome of any investigation is provided including an invitation to meet. Quantum Care are pro-active in making referrals under the Hertfordshire Safeguarding Adult procedures regarding issues brought to their attention so that they can be investigated by an independent agency. Incidents are also reported to the Commission as required. This demonstrates an open and transparent approach. Fosse House DS0000019349.V336013.R01.S.doc Version 5.2 Page 17 The Commission is aware of two referrals under the Hertfordshire Safeguarding Adult Procedure since the last inspection on 12/1/07 and the completion of a review into a series of thefts detailed in the last inspection report. Follow up meetings are held to share information and ensure systems are in place to protect individuals where required. The meetings include representatives from Hertfordshire Police and Social Services department who are involved with the reviews and investigations that take place. Allegation made by a resident – The conclusion reached was that the alleged incident had not taken place but a further review was required to look at future management and support. This had not taken place by the time of this inspection. It was the view of the inspector that the care plan should have been updated pending the full review to include clear instructions for staff on the approach they should take. Abuse reported by a relative – The investigation concluded no criminal act had been committed and the incident in which a resident had their hair cut inappropriately was referred back to the manager to deal with under the company disciplinary procedure. Missing property - Jewellery and money belonging to four residents was reported to have gone missing. These incidents had been individually reported to the police as they became known and meetings were held with the families concerned. The home were not able to pinpoint specific times when the items went missing which could provide links to specific days or shifts. The meeting concluded that Quantum Care had done everything it could do within reason to locate the missing items. Letters were sent to families and staff advising them of the situation. The local police have made visits to the home and gave a crime prevention talk. A CCTV camera has been installed in a public area of the home so that the movement of people in and out of the building can be monitored. The company need to look at whether an advisory notice needs to be displayed and include details in the home’s information pack so people are aware of the situation. These incidents appear to have stopped although information from relatives in a survey carried out by Quantum Care also raises issues regarding the loss of personal possessions. Observations made at this inspection – While positive interaction between residents and staff was observed in some of the areas of the home there was evidence in other areas that staff were not responding to residents who were expressing feelings of unhappiness or discomfort. A member of staff pushing a resident towards the dining table in their wheelchair was observed to sharply tap the back of their hand from behind with straight fingers so they would raise it and not get it caught under the table. This occurred without any warning or discussion. Fosse House DS0000019349.V336013.R01.S.doc Version 5.2 Page 18 A resident expressed concern that the member of staff who got them up had been rough and given them ‘a look’ when they complained. The resident’s social worker has been made aware of this concern. The poor care practices and lack of a positive approach to residents by some staff detailed in this report could be described as abusive and must be challenged. Fosse House DS0000019349.V336013.R01.S.doc Version 5.2 Page 19 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): Standards 19 & 26 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Fosse House is a well-maintained home, which provides aids and equipment to meet the care needs of the people who live there. Residents are able to walk and sit in a large secluded garden, which can be reached from the ground floor units or via the sun lounge. An area of the garden is currently fenced off while work is carried out to repair pathways, which have been damaged by tree roots. On the day of this inspection there were concerns regarding the general cleanliness of the home and equipment being used by residents and infection control practices. The manager is taking steps to address the concerns raised by relatives regarding the quality of the laundry service. New washing products and an evening laundry service are to be introduced. Fosse House DS0000019349.V336013.R01.S.doc Version 5.2 Page 20 EVIDENCE: All service users have the privacy of single rooms with en-suite toilets. The rooms are big enough to allocate couples two rooms to use as a bedroom and the other as a sitting room. Each of the four living units has a lounge, dining room and kitchen. Service users and their visitors also have access to the communal lounges, seating areas and secure garden. The dining area on Dove Unit has been extended to provide more space. Service users are encouraged to add personal possessions and furnishings to their rooms so they have familiar things around them. Since the last inspection areas have been redecorated and carpets replaced to maintain standards. In conjunction with the Community Nursing team specialist aids to mobility and independent living are made available in addition to the equipment already provided. Service users have access to call bells in their bedrooms, bathrooms and day areas. No concerns were raised regarding staff responses. Where required, pressure pads have also been provided to alert staff when service users, who may be at risk of falls, get out of bed. The lighting throughout the home has also been improved. The hot water supplies are regulated, first floor windows are fitted with restrictors and low surface temperature radiators are provided to ensure the safety of service users. The water temperatures tested on the day of inspection were within the required safety range and records of regular checks by maintenance staff were available. The first sight to meet the inspector on Dove Unit was the view through an open bedroom door of used bed linen, clothing and a discarded latex glove on the floor. This is poor infection control practice but also shows a disregard for the dignity of residents and their visitors. There were no domestic staff in the home during the morning of the inspection. Swallow lounge had a stale odour. The kitchen cupboards on Dove unit were grubby. A relative describing one unit said the lounge furniture was ‘grubby’ and the ‘kitchen often looks like it could do with a clean’. Two residents on one unit were sitting in dirty wheelchairs with dried on food spills. Hand towels had run out in key areas including resident toilets and sluices. This meant that staff and residents using these areas were not able to apply good hygiene standards before moving to other areas of the home. Relatives who completed a survey for Quantum Care raised concerns about the laundry service, particularly clothes not being returned to the correct rooms. A Fosse House DS0000019349.V336013.R01.S.doc Version 5.2 Page 21 relative who completed a questionnaire for the Commission said they had seen ‘people of the opposite sex to their relative wearing their jumpers, despite them being labelled’. Fosse House DS0000019349.V336013.R01.S.doc Version 5.2 Page 22 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): Standards 27, 28, 29 & 30 People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. While Quantum Care demonstrate a commitment to providing a well trained workforce inconsistencies in the approach and attitude of staff meant not all residents were receiving the high standard of care they are entitled to. The company have taken the positive step of increasing the number of staff in the afternoon on three out of the four units to provide residents with extra support. Despite extra numbers poor teamwork in some areas meant staff were responding to tasks rather than the individual needs of residents. EVIDENCE: The poor quality of care detailed in previous sections of this report do not support good quality outcomes for residents or reflect the aims of the home. Poor teamwork and communication between staff working shifts together led to a task based focus rather than one centred on the needs of the individuals concerned. This was not the case in all areas and two of the units were being run well with staff having enough time to sit with residents and make extra cups of tea on request. The staffing information provided by the manager indicates that 30 of the permanent staff have been employed in last year. When issues of staff Fosse House DS0000019349.V336013.R01.S.doc Version 5.2 Page 23 turnover have been raised with the company it has been confirmed that this is kept under review. The reliance on agency care staff is reducing and a full team of night staff has been recruited. A permanent team of care managers to cover each of the units is not yet in place and this may be having an effect on applying consistent standards across the whole home. Domestic staff are not currently available in sufficient numbers to maintain the standards required. New staff are being recruited. New staff receive induction training, which then leads on to NVQ training. Information from the company indicates that the number of staff with NVQ qualifications has not yet reached the 50 target level but progress is being made to achieve this. In the last year increasing numbers of staff have completed more in depth dementia care training to gain greater insight and knowledge into this area of care. Training records for staff were available and the manager has a put a training plan in place so that any gaps can be identified and rectified. The records of four newly recruited staff were reviewed. This confirmed that the required procedures are being followed to check the suitability of staff before they are employed. Fosse House DS0000019349.V336013.R01.S.doc Version 5.2 Page 24 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): Standards 31, 33, 35 & 38 People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Mrs Gauthier has the experience and qualifications required to run this home but needs to ensure, alongside the recruitement of experienced care managers for each unit, that residents receive consistent standards of person centred care in keeping with the aims of the company. While Quantum Care demonstrates an open and transparent approach to seeking the views of the people who use the service and monitoring the running of the home this inspection has identified poor outcomes for residents, which have not been addressed. While there are appropriate health & safety policies and procedures in place to protect service users and staff there is evidence that these are not consistently applied putting residents at risk. Fosse House DS0000019349.V336013.R01.S.doc Version 5.2 Page 25 EVIDENCE: Mrs Gauthier has completed the qualifications that are the standards set for care home managers. She is supported by Quantum Care senior managers who make regular visitors to the home. While there are good company management systems in place the management team in the home need to ensure that the ethos of providing a person centred approach to dementia care is clearly communicated to staff and poor practice challenged. The views of service users and their relatives are obtained and the findings of surveys are reported back at an annual forum. Providing feedback to a wider audience in a newsletter style format could be used to increase the level of involvement and interest. The manager is hoping to set up a ‘friends’ group to increase participation in the life of the home. Monthly health & safety visits and audits are completed to check the safety of systems. Clear, well organised, up to date records of safety checks and fire safety checks are maintained. Policies and procedures are regularly reviewed in line with changing legislation and good practice advice. Although the training records demonstrate that staff receive regular updates in their statutory health & safety training this inspection identified that infection control procedures were not being followed. A report handed to the inspector during this visit indicated that a resident had put dishwasher powder on their cereal. This demonstrates a lapse in health & safety procedures that put a resident at risk. Chemical products were locked away as required on the day of inspection. Previous inspections have confirmed there are suitable systems in place to enable residents to have access to small amounts of money deposited on their behalf. The accounts are regularly audited. Fosse House DS0000019349.V336013.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 1 8 2 9 1 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 1 3 x x x x x x 1 STAFFING Standard No Score 27 1 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 3 x x 1 Fosse House DS0000019349.V336013.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 OP7 Regulation 12 Requirement Ensure staff consistently meet the needs of service users according to their plan of care in a manner, which promotes their dignity and individuality. Timescale to meet previous requirement 6/6/06 1. Monthly reviews should be completed according to company policy. 2. Instructions in care plans must be followed and accurate records maintained. Ensure a multidisciplinary risk assessment is in place for the safe use of equipment, such as the electrically operated bed. The outcome of the assessment and action required needs to documented in the service user plan. CSCI guidance – ‘The assessment process for use of safety equipment and furniture’. Ensure accidents and bruises are fully investigated and staff record the action taken to assess the comfort and well being of residents following injuries. DS0000019349.V336013.R01.S.doc Timescale for action 31/07/07 2 OP7 13(7)(8) 30/06/07 3 OP8 12 30/06/07 Fosse House Version 5.2 Page 28 4 OP15 12(4) Ensure staff make meal times a pleasant experience, which offer service users the support they require based on a flexible person-centred approach. Timescale for previous requirement 31/7/06 1. Review the management of medication at meal times Residents must be protected from inappropriate practices and abuse. To protect residents and staff from infection: 1. Disposable paper towels need to be available in all areas where people are required to wash their hands. 2. Soiled and used linen needs to managed in accordance with Department of Health Guidelines and not left on the floor. 3. All areas and equipment need to be kept clean. Ensure suitably qualified and experienced care managers are recruited to monitor and improve standards on each unit. Ensure domestic staff are provided in sufficient numbers to maintain hygiene standards in the home. Review the quality of dementia care being provided and ensure suitably experienced and competent staff are available at all times to ensure residents are receiving appropriate care 31/07/07 5 6 OP18 OP26 13(6) 13(3) 30/06/07 30/06/07 7 OP27 18(1)(2) 30/09/07 8 OP33 24(1) 31/07/07 Fosse House DS0000019349.V336013.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. 1 2 OP8 Consider providing equipment to weigh residents who are unable to sit on conventional chair style weighing machines. Ensure the use of CCTV complies with relevant legislation and information about its use is available to residents & visitors to the home. OP19 Fosse House DS0000019349.V336013.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Hertfordshire Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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. Extracts may not be used or reproduced without the express permission of CSCI Fosse House DS0000019349.V336013.R01.S.doc Version 5.2 Page 31 - 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. 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