Inspection on 04/09/06 for Fosse House

This inspection was carried out on 4th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Fosse House 27/02/06

Fosse House 11/07/05

Fosse House 21/03/05

Fosse House 24/05/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Fosse House Hykeham Road Lincoln Lincs LN6 8AA Lead Inspector Elisabeth Pinder Unannounced Inspection 4th September 2006 09:15 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 DS0000002359.V309356.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 DS0000002359.V309356.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fosse House Address Hykeham Road Lincoln Lincs LN6 8AA 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) 01522 524612 manager.fosse@osjctlincs.co.uk The Orders Of St John Care Trust Mrs Susan I Green Care Home 42 Category(ies) of Old age, not falling within any other category registration, with number (42) of places Fosse House DS0000002359.V309356.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home is registered to provide personal care for service users of both sexes whose primary needs fall within the following category:Old age, not falling within any other category (OP) - 42 The maximum number of service users to be accommodated is 42. Date of last inspection 27th February 2006 Brief Description of the Service: Fosse House cares for older people needing personal care in a detached property situated on the outskirts of the historic City of Lincoln. The home stands in its own grounds and gardens with car parking facilities to the front. Local facilities include shops, churches, pubs, and a recreational centre. Transport is required to access the main city. The home has two floors and there is a passenger lift to the bedrooms on the first floor. There are a variety of aids and adaptations around the building to allow residents to move around the home more independently. All of the bedrooms are single, none have ensuite facilities. The home is one of 16 operated by the Order of St John Care Trust, which is a Registered Charity. The current weekly fee range is £335.00 £449.00. Additional costs are made for hairdressing, personal toiletries, newspapers, holidays and chiropody, these are all private arrangements and costs are met by individual residents. Fosse House DS0000002359.V309356.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit to the home was undertaken by one inspector and formed part of a key inspection. The visit lasted four and a half hours and took into account any previous information held by The Commission for Social Care Inspection (CSCI) including the homes pre-inspection questionnaire, previous inspection reports, their service history, records of any incidents that had been notified to the CSCI since the last inspection and reports of monthly visits by a company representative. Prior to the visit the manager contacted CSCI about the questionnaires sent to residents from us. As residents living in the home had just completed annual quality assurance questionnaires containing similar questions to CSCI ‘have your say’ she felt reluctant to ask them to complete more forms. It was agreed that if residents were in agreement the ‘Trust’ questionnaires could be used. The site inspection consisted of case tracking a sample of three residents’ records, talking to them and assessing their care. Some policies and procedures were seen together with some records concerning the safety of the home. A general conversation was held with residents as they were getting ready for lunch and all were very satisfied with their care and support given to them by staff. Two care staff were spoken to, one being the key-worker of one resident traced. The site visit focussed on key standards and checking whether issues raised at the previous inspection had been addressed. What the service does well: What has improved since the last inspection? Fosse House DS0000002359.V309356.R01.S.doc Version 5.2 Page 6 Action has been taken to address the one requirement made during the previous visit. The rolling maintenance programme is still in progress and recent improvements include the complete refurbishment of the dining room. Plans have been approved to re-surface the drive and this work is due to commence shortly. 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. Fosse House DS0000002359.V309356.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Fosse House DS0000002359.V309356.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, standard 6 is not applicable Quality in this outcome area is excellent. This judgement has been made using available evidence, including a visit to the service. This home clearly sets out what it intends to do for its residents and this information is freely available to residents and their relatives. Prospective residents are encouraged to take time before making the decision to move into the home on a permanent basis. EVIDENCE: The statement of purpose has recently been updated to show the change in Responsible Individual (RI) and the home is expecting to receive the final version shortly. This will then be given to all residents and available on display. A new brochure has been written in an easy to read format. Residents living in the home receive a copy of the Quarterly Trust magazine, which is also on display. Fosse House DS0000002359.V309356.R01.S.doc Version 5.2 Page 9 Care records examined showed that a full needs assessment had been carried out prior to admission and where social workers have been involved a copy of their care plan was available. Prospective residents are written to by the manager after the assessment confirming that they can or cannot meet the residents care needs. One resident spoken to had been admitted for a period of respite care and decided to stay as ‘the home is excellent’ and another resident said ‘I want to live here for the rest of my life’. Fosse House DS0000002359.V309356.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is excellent. This judgement has been made using available evidence, including a visit to the service. The home’s records give a clear indication of the needs of residents and enable staff to meet their needs with sensitivity and regard for their privacy and dignity. EVIDENCE: Care plans set out clear information on how residents’ needs should be met. These are signed and dated by care staff and residents showing their involvement in this process. One resident confirmed that her present needs are being met and another resident shook my hand and said he was ‘very happy living here’. There is a detailed medication policy and the last visit from the pharmacist was in June 2006 and there were no issues from this. Medication is stored and recorded correctly, risk assessments have been written for residents who self medicate detailing their responsibility for safe storage and administration. Fosse House DS0000002359.V309356.R01.S.doc Version 5.2 Page 11 Staff members were observed carrying out their duties with kindness and sensitivity towards the residents, especially when attending to their personal needs. A contract monitoring visit undertaken by Lincolnshire County Council on 25/08/06 found ‘care plans to be well managed’. Fosse House DS0000002359.V309356.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to the service. Residents are able to express choices in their daily lives and receive a nutritious, varied diet meeting individual preferences and health requirements. EVIDENCE: The home has a designated activity room and residents creations are on display all around the room. However, the home’s activity co-ordinator has recently left her post and the manager is currently advertising for a replacement. A member of the care staff is overseeing activities although these are limited at the moment. During the visit no activities were taking place, however, notices were on display regarding weekly movement to music and residents confirmed that they are still enjoying bingo sessions. One resident was expecting a visit from a representative of the local Methodist chapel later that day. Care records identify residents’ likes and dislikes and any health requirements. Menus supplied showed that a varied, well balanced diet is offered and the midday meal was observed to be nutritious. Residents said how much they enjoyed the meals and confirmed that they have a good choice. Tables were Fosse House DS0000002359.V309356.R01.S.doc Version 5.2 Page 13 nicely laid with tablecloths/napkins and condiments and each table had a written menu. Residents confirmed that they were frequently asked for their choices of future meals and new ideas are often tried out. Information taken from quality assurance questionnaires identified that one resident would like tea served in their own room and three residents requested their favourite food more often. The manager confirmed that these have been addressed. Fosse House DS0000002359.V309356.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to the service. The home’s complaints procedure is clear and gives residents and their relatives the confidence that comments and concerns will be listened to; there is a robust adult protection procedure. EVIDENCE: Residents spoken to said they did not have any complaints but knew who to speak to and how to make a complaint if necessary. There have been two complaints since January 2006; both have been responded to appropriately and within the given time. Information taken from residents quality assurance questionnaires identified that one resident did not like the way a carer spoke to them. The carer has since been spoken to and the matter has been resolved. There is a clear adult protection procedure, linked to the Local Authority procedures. Since the previous inspection there has been one referral made under adult protection, the resident involved no longer resides in the home and the manager said she is still waiting for the outcome of the investigation. All staff members spoken with had received training on adult abuse and were knowledgeable about complaints. Fosse House DS0000002359.V309356.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to the service. Residents living in this home live in a clean, pleasant and hygienic environment but priority should be given to the redecoration of the first floor corridors. EVIDENCE: The home has a rolling maintenance programme and recent improvements have included the refurbishment of the dining room. Overall the standard of decoration internally was good although the first floor shows signs of wear and tear. During the visit a building audit was being carried out by the ‘Trust’. Risk assessments have been carried out on the premises to ensure that residents are safe from any potential hazards, however, two first floor bedroom windows were noted to open very wide. This was brought to the attention of the manager who said she would deal with this immediately. Fosse House DS0000002359.V309356.R01.S.doc Version 5.2 Page 16 The grounds are attractive with seating areas around the garden including a covered marquee area erected throughout the summer. Two bedrooms were viewed and these were well personalised, however, one of the rooms was small but the resident said she was quite happy with this room. Information taken from residents quality assurance questionnaires identified that two residents had requested their room to be re-decorated and the manager confirmed that these have been put on the list. Fosse House DS0000002359.V309356.R01.S.doc Version 5.2 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to the service. Staff numbers are in sufficient quantity for them to be able to care for the residents. Staff members are suitably trained, qualified and competent. EVIDENCE: The staff rota showed that there were enough staff on duty to meet the current needs of residents and staff and residents spoken to confirmed this. A specific comment was ‘there is always someone to help you when you need them’. One resident said she knew who her key-worker was and had a good relationship with them Records of staff recently employed showed that they had been recruited using robust procedures based on equal opportunities. Satisfactory criminal record checks had been received prior to their employment and one member of staff confirmed that she had undertaken a two and a half day induction programme before commencing work. Information supplied in the pre-inspection questionnaire showed that 48 of care staff have achieved the National Vocational Qualification at Level 2 or above and thirteen staff hold a current first-aid certificate. The report written after the contract monitoring visit read ‘there is a small turnover of staff which Fosse House DS0000002359.V309356.R01.S.doc Version 5.2 Page 18 provides stability to the residents and creates the professional efficient atmosphere within the home’. The pre-inspection questionnaire also identified that all statutory training has been undertaken i.e. moving and handling, food hygiene, health and safety, fire training and first aid at work. Other courses held within the last twelve months include care planning, risk assessments, dementia care and computer training. A discussion was held with the manager in relation to training in equality and diversity. Staff spoken to said that although equal opportunities is covered in their induction they have not had any specific training and had limited knowledge of this subject. Future training is to include control of substances hazardous to health (COSHH), infection control and dementia awareness for non-care staff. Fosse House DS0000002359.V309356.R01.S.doc Version 5.2 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is excellent. This judgement has been made using available evidence, including a visit to the service. The home is managed competently and the staff are supported and supervised in carrying out their respective roles. The audit and policy systems ensure that residents’ views are listened to and acted upon. EVIDENCE: Residents were aware of the management arrangements in place and said that they felt able to talk over any problems they had with the manager or staff. The manager has been in post for many years and has achieved the registered managers award. Residents meetings are held and residents spoken to said they feel comfortable to raise matters at them. Two relatives are running a ‘Fosse Friends’ group Fosse House DS0000002359.V309356.R01.S.doc Version 5.2 Page 20 where fund raising events are discussed and decisions made on how monies raised from these events are spent. All residents financial arrangements are handled by families and advocates. Monies held in the home are for safekeeping purposes only and are managed by the home’s administrator with regular audits being carried out and submitted to the headquarters in Wellingore. A requirement was given during the previous inspection regarding the Commission receiving a report of the review of the quality of care provided at the home. This has now been completed and the quality assurance methods undertaken demonstrated a positive approach to seeking the views of residents. Residents spoken with said they were constantly asked for their views on matters concerning the running of the home. Copies of quality assurance questionnaires were forwarded to us before the visit and the overall rating of these found that 21 thought the service was excellent, 17 good and 3 fair. These have been sent to the quality assurance manager at headquarters. A discussion was held with the manager regarding seeking the views of all other people involved in the service, for example; General Practitioners (GP’s), district nurses and social workers and she said that she had developed a questionnaire for GP’s and agreed to raise this matter with the ‘Trust’. Monthly reports of visits by a representative of the organisation who monitors the service are forwarded to us and we are informed of all events affecting the well being of residents. The Trust has a training manager, who organises an extensive programme of training for all staff. The home has two recognised quality monitoring awards, one being the Investors in People award. The organisation has a range of policies and procedures and these are regularly reviewed and updated. Pre-inspection information provided identified that equipment is regularly checked and serviced and records kept at the home showed that there are systems in place to monitor any maintenance issues. However, recommendations after the fire equipment manufacturers check have not been addressed and the manager explained the ‘Trust’ are liaising with Lincolnshire fire brigade about some of the recommendations. Residents comments on the day of the visit were that they felt safe at the home. Fosse House DS0000002359.V309356.R01.S.doc Version 5.2 Page 21 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 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 4 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X 3 X X 3 Fosse House DS0000002359.V309356.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Fosse House DS0000002359.V309356.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN 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. 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