CARE HOMES FOR OLDER PEOPLE
Fosse House Ermine Close St Albans Hertfordshire AL3 4LA Lead Inspector
Sheila Knopp Unannounced 5 May 2005 09:30 & 11 May 2005 22.50 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 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 I52 s19349 fosse house v223886 050505 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Fosse House Address Ermine Close St Albans Hertfordshire AL3 4LA 01727 819700 01727 819768 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Quantum Care Limited Mrs Teresa Giddings Care Home 61 Category(ies) of DE(E) Dementia over 65 61 registration, with number OP Old Age 61 of places PD(E) Physical Disability over 65 61 Fosse House I52 s19349 fosse house v223886 050505 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 09 December 2004 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 one each floor. Three of the units have15 rooms and one has 16 rooms. Each service user has their own bedroom and each bedroom has en-suite toilet and washbasin. Each unit has its own lounge, dining room and kitchen. There is a hairdressing salon on the first floor and a sensory room with bubble lamps, soft lighting and relaxing music. 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. Alban’s Abbey. It is in a modern residential area, next to a small shopping parade and a ‘Waitrose’ supermarket. Fosse House I52 s19349 fosse house v223886 050505 stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection report is based on 2 unannounced inspections. The inspection on 5 May 2005 was carried out by two inspectors who were in the home for a total of 14.5 hours. The second inspection was carried out by one inspector who carried out a night visit starting at 10.50 pm on 11 May 2005. Before the visits took place the records of CSCI contact with Fosse House since the last inspection were checked. These included records of complaints and notifications of accidents, incidents and deaths. The focus of the inspection on 5 May was to follow through the standard of personal care being provided and check the requirements from the last inspection. Both inspectors spent the morning talking to residents and observing the interaction between residents and staff as they assisted residents to get up, have their breakfast and lunch later in the day. Discussions and contact was made with 15 residents, 2 visitors and 5 staff. Care and administrative records were checked. The focus of the night inspection on 11 May was to follow up a concern received from a member of the public regarding arrangements for shutting bedroom doors at night. No problems were identified as a result of this visit and the inspector was satisfied that residents were able to choose whether to lock their bedroom doors or not. The four staff on duty were very helpful and open in their contact with the inspector. What the service does well:
Residents and visitors were very complimentary about the care and support being provided at Fosse House. One relative said ‘they could not speak more highly of the home’. Their relative is looked after ‘magnificently, the staff are very good and they can visit at any time’. Another person said ‘it’s been like a holiday, top notch’. The residents all looked well care for and there was good interaction with staff. One person who had been receiving attention from a new member of staff said that the ‘staff were very good and very kind’. Residents were positive about the choice of meals provided and lunch was nicely served with staff providing support as required.
Fosse House I52 s19349 fosse house v223886 050505 stage 4.doc Version 1.30 Page 6 There was a relaxed unhurried atmosphere and staff appeared to be happy and well motivated. The managers and staff have greatly improved the running of this home since the last inspection. Quantum Care provide their staff with accredited dementia care training. What has improved since the last inspection? What they could do better:
The last two inspections and an inspection by a CSCI pharmacy inspector on 28 September 2004 have identified problems with the medication systems within the home. On each occasion the specific issues have been corrected promptly. This inspection identified a further problem with record keeping that needs to be addressed. An immediate requirement was sent to Quantum Care following the inspection and an action plan has been received. This will be followed up by CSCI at a further unannounced inspection. Continued breaches of this regulation may result in further enforcement action being taken. Staff need to ensure that specific information relevant to the care of each resident is recorded and developed into a plan of care with clear instructions to staff as to how that issue is to be managed. The care plans would benefit from having a clearer link with the approach being taken towards residents with dementia. In relation to the privacy and dignity of residents the manager was asked to remove an adhesive sticker from a bedroom door, which indicated the health status of the resident. Staff need to be reminded not to use derogatory language in relation to service users.
Fosse House I52 s19349 fosse house v223886 050505 stage 4.doc Version 1.30 Page 7 One of the inspectors overheard a member of staff talking loudly in a corridor about a service user being ‘naughty’. To promote good infection control practices staff need to ensure that the soap and paper towel dispensers are refilled. There has been a delay in upgrading the kitchens on each unit within the agreed timescales. Staff on Swallow unit need to take more pride in the environment they are creating for residents. The shower room needs to be re-instated, broken furniture removed and extra items such as the seat raisers on the lounge window sill, cushion and toilet seat under the staff desk, items stopping cupboard doors from shutting, cluttered bathroom and stained tea trolley need to be attended to. 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 I52 s19349 fosse house v223886 050505 stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Fosse House I52 s19349 fosse house v223886 050505 stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 Residents are assessed by a manager from Fosse House before they are admitted to check that the home is able to provide suitable care. The process involves gathering information from other health and social care professionals involved with the person. Visits to the home are arranged so prospective residents can see what is being offered. A plan of care is developed from the initial contact and following admission to the home. EVIDENCE: The records of new service users were checked to see that a detailed assessment had been completed by staff from the home prior to agreeing that they could be looked after at Fosse House. Some care planning issues following admission were identified and these are referred to under Standard 7. No issues were identified by residents, visitors, staff or the inspectors, which would indicate people were being admitted outside the home’s registration categories. Fosse House I52 s19349 fosse house v223886 050505 stage 4.doc Version 1.30 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 standard(s) 7, 8, 9 & 10 Each resident has a care plan. However it was identified that important information affecting the care and support required by specific individuals was missing. This meant while inspectors could observe that the personal care needs of residents were being met the records did not indicate how staff were to provide the specific care required by four residents in relation to their dementia, pressure area and psychological care. EVIDENCE: The morning was relaxed and residents were having breakfast as the inspectors arrived at 9.30 am. Residents confirmed they could get up and go to bed when they wanted. Residents had been assisted to achieve a good standard of personal care and hygiene. Residents were observed to be relaxed and alert. No restrictions were placed on individuals who wished to walk about the home and gentle direction and encouragement was given to reduce anxieties arising from confusion. Residents were observed to be smartly dressed and had received attention to their hair, mouth care, nail care and shaving.
Fosse House I52 s19349 fosse house v223886 050505 stage 4.doc Version 1.30 Page 11 Following discussion with a resident and a community nurse various issues were raised with the manager which included checking the pressure of the pressure relieving mattress and provision of an alternative commode to achieve comfort. This person’s room had also been overtaken by the amount of dressing stored there and it was requested that a suitable cupboard be provided to hide them from view. Another person raised concerns regarding the discomfort caused by a hoist sling and the manager was asked to review this. Information reported to have been passed on to staff by a community nurse in relation to the psychological condition of a resident did not appear to have been acted upon or recorded. The manager was asked to follow this up. There was no plan of care in place for a resident admitted with a pressure sore. Details were recorded in the admission information but had not been developed into a plan of care. This sore appears to have healed although there is little information on the care records about the reports received from the community nurses on the progress of their treatment. The records indicated that a heel blister had appeared and the community nurses had seen it. This person had also been identified as being at risk of falls prior to admission and had had falls following admission but there was no specific risk assessment in relation to falls. Staff reported another resident who had a pressure sore was being treated by a community nurse. Again there was no information regarding this persons care in relation to managing their pressure area care. The care records for people with dementia gave very little detail of how their specific needs were to be met. One person’s records stated that staff needed to be aware of triggers to challenging behaviour but no details were given. The medication systems were checked on two units and the central storage area. Issues identified at the previous inspection had been met and overall there was an improvement in the storage and organisation of medicines. However, it was identified on one unit that the number of tablets for 3 residents which was not contained in the monitored dose system did not match the records of medicines received on the administration chart. Fosse House I52 s19349 fosse house v223886 050505 stage 4.doc Version 1.30 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 standard(s) 15 Residents are provided with a varied and interesting diet served in the dining room on each unit or in their bedroom as required. EVIDENCE: In response to issues identified at the last inspection the arrangements for serving meals and the quality of meals was checked. Residents had a choice of lunch and it looked hot and appetising. This was confirmed by the inspectors who tasted the meal. The 4 week rotating menu provides an interesting and varied diet. Good examples of residents having extra snacks between meals to increase their calorific intake was seen. Soft and pureed diets are available for those who require them. Residents had access to drinks throughout the day. The manager was asked to review the breakfast arrangements for one resident with eating difficulties. Staff need to pay attention to matching cups and saucers when serving drinks and encouraging residents to add their own sugar rather than doing it for them. Fosse House I52 s19349 fosse house v223886 050505 stage 4.doc Version 1.30 Page 13 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 standard(s) 16 & 18 A complaints procedure is in place. Overall the residents and relatives we spoke to were confident that any issues they raised would be dealt with. It was polling day and staff were helping residents to visit the polling station. Policies and procedures are in place for the protection of service users. EVIDENCE: The complaint records were examined and demonstrated that the home receives relatively few complaints, which are managed according to the procedure in place. Some residents raised issues in discussion which they may not have spoken to staff about and these were passed on to the manager with their agreement. The night visits was prompted by the need to verify information received by a member of the public. It appears they had come to the view following a visit to the home that residents were locked in their rooms at night. This was not found to be the case. The doors in the home are linked up to the automatic fire detection system and shut at night. Residents can have their own key and choose to lock their door if they wish. Staff receive training in the protection of vulnerable adults and were able to describe what this meant in practice and confirmed that they would be able to raise issues with a manager if the need should arise. Staff during were asked directly during both visits if they had any concerns or had observed anything that they felt uncomfortable with. No concerns were raised.
Fosse House I52 s19349 fosse house v223886 050505 stage 4.doc Version 1.30 Page 14 No incidents have been reported to CSCI under the Hertfordshire Vulnerable Adult procedure since the last inspection. Fosse House I52 s19349 fosse house v223886 050505 stage 4.doc Version 1.30 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 standard(s) 19 & 26 Overall Fosse House provides residents with a safe and comfortable environment. Residents all have single rooms. Arrangements have been made for couples to use one room as a bedroom and another as a lounge as the rooms are big enough to fit a double bed. The gardens provide a pleasant safe area with mature trees, pathways, pond and ducks. The laundry has recently been upgraded providing safe working environment for staff. Liquid soap and hand towel dispensers were empty in some key areas raising issues about good infection control practices. The shower room on Swallow unit needs to be re-instated and items of broken furniture and equipment removed. EVIDENCE: As part of a planned refurbishment areas have been redecorated and carpeted to maintain the appearance of the home. There are plans to refit the unit kitchens and one has been finished. Following the inspection Quantum Care have advised that 2 further kitchens will be completed by the end of June. This was subject to a previous requirement as these areas are in a poor state of repair. Fosse House I52 s19349 fosse house v223886 050505 stage 4.doc Version 1.30 Page 16 The home was found to be fresh and clean following attention by the cleaners during the morning. Residents were warm and there was a comfortable atmosphere. Window restrictors and low surface temperature radiators are provided to protect residents from accidents. The hot water temperatures were found to be within the required safety limits. A portable radiator that did not have a low surface temperature has been removed. Moving and handling equipment has been serviced. The manager agreed to replace a stained hoist sling. Fosse House I52 s19349 fosse house v223886 050505 stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 The number and mix of staff provided during the day was sufficient to provide support for the residents at an unhurried pace. Staff were familiar with the needs of the residents and two new staff had been well received by them. EVIDENCE: In addition to the management, housekeeping and catering staff there were 10 care staff on duty. This reduces to 8 in the afternoon and reverts to 10 in the evening with 4 night staff. Three staff work on the 2 units providing care to people with dementia. The rotas for March and April confirm that this pattern of shifts is supported during the week and at weekends. A mix of male and female staff are employed on each unit. Quantum Care have advised that 31 of staff at Fosse House have NVQ qualifications with a further 33 of staff working towards the award. Staff confirmed that they receive regular supervision. Fosse House I52 s19349 fosse house v223886 050505 stage 4.doc Version 1.30 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 & 35 Staff confirmed that the management team were approachable and that they spent time out and about in the home talking with residents, relatives and staff. Questionnaires are used to gather feedback from residents and relatives on the quality of the service being provided. EVIDENCE: The overall management of systems within the home had improved since the last inspection. Regular visits are made to the home by a representative of the company. Quantum care have quality monitoring systems in place, which includes consultation and feedback to residents and relatives Residents are able to deposit small amounts of money for safekeeping. The records confirmed that details of money paid in an out are recorded and countersigned. Receipts were also available for cross checking. Fosse House I52 s19349 fosse house v223886 050505 stage 4.doc Version 1.30 Page 19 The fire records were checked and confirmed that regular tests and fire drills are carried out. A risk assessment under the Fire Precautions (Workplace Regulations) 1997 is in place. Fosse House I52 s19349 fosse house v223886 050505 stage 4.doc Version 1.30 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 3
COMPLAINTS AND PROTECTION 2 x 2 x x x x 2 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x 3 x 3 x x x Fosse House I52 s19349 fosse house v223886 050505 stage 4.doc Version 1.30 Page 21 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 7.2 & 8.4 Regulation 15(1) 17(1)(a) schedule 3 (3)(k) Requirement Timescale for action 30.6.05 2. 7 37(1)(d) 3. 9 13(2) 4. 19 23(2)(b) Ensure each residents care plan sets out in detail the action required by staff in relation to health, personal and social needs. Particulalry in relation to falls, pressure area care, guidance and information issued by the community nurses, dementia care, behavioural triggers and emotional state. A record of any nursing provided to a resident including a record of their condition and any treatment is required. CSCI guidance advices that 30.6.05 pressure sores of grade 2 and over should be reported under this regulation. Ensure accurate records of stock 12.5.05 levels and medication given are kept. This requirement has been brought forward from previous inspections. 30.9.05 Advice CSCI when the unit kitchen refurbishment programme has been completed. This requirement has been brought forward from previous inspections as progress has been delayed beyond the timescales given.
Version 1.30 Fosse House I52 s19349 fosse house v223886 050505 stage 4.doc Page 22 5. 21 23(2)(b) 6. 26 13(3) Re-instate shower room on Swallow unit, remove broken furniture and paint splashes on floor Ensure liquid soap and disposable towels are available to staff in all the required areas. 30.6.05 5.5.05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 1&4 Good Practice Recommendations Quantum Care may wish to consider developing their information for service users and care plans to demonstrate the approach / model being used to support residents with dementia. Remind staff of the importance of their approach to residents and care of the environment in relation to the dignity of residents. Review storage of dressing packs for identified resident and consider providing a suitable cupboard to reduce their impact on the residents environement. 2. 3. 10 10 Fosse House I52 s19349 fosse house v223886 050505 stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire Al7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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