Inspection on 06/06/06 for Fosse House

This inspection was carried out on 6th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 16/10/07

Fosse House 30/04/07

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 6th June 2006 10:00 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.V299220.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.V299220.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 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.V299220.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th November 2005 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 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 £485 - £565 per week depending on an assessment of care needs (correct on 6.6.06). A copy of the most recent inspection report is available from the home or company on request. Details about the home also appear on the company’s web site which at the time of this inspection was in the process of being updated. Fosse House DS0000019349.V299220.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report is based on an unannounced visit to the home by two inspectors who spent a total of 13 hours 40 minutes hours in the home. The report includes information provided by residents (8), visitors (2) and staff (7). (6) care plans were reviewed following discussions with the residents and staff. Information received about the home since the last key inspection on 8th November 2005 has been reviewed. Four additional monitoring visits have also taken place (23.12.06, 26.1.06, 21.2.06 & 4.4.06). These reports are available from Quantum Care or by contacting the CSCI Hertfordshire office. The lead inspector was also present at the annual residents / relatives forum held in the home on 11.4.06 when 14 relatives were present. The views of relatives and health care professionals have been included in this report. During May questionnaires were sent directly to 17 relatives. Five have been retuned to date. Questionnaires were sent to the 8 GP practices providing services at Fosse House. Responses have been received from 14 General Practitioners (GPs) and a Community Nurse. Following an unstable year this inspection has identified that the improvements identified in April have continued but there are inconsistencies in standards and care practices across the home depending on the skills, experience and commitment of staff on duty. The standards on medication and meals were not fully met. Quantum Care need to monitor this closely to ensure the progress made to date under the new manager is maintained. What the service does well: Service users and their relatives are positive about the support they receive from staff. A relative said ‘ the carers are extremely, caring, kind and cheerful. A resident confirmed that all staff spoke politely to them. Relatives experience a welcoming informal atmosphere. Service users receive regular support from local GPs. All GPs who completed questionnaires confirmed that they were satisfied with the overall care provided to residents. Ninety-eight per cent confirmed that the staff they had contact with had a clear understanding of the care needs of service users. There are robust recruitment procedures in place to ensure that suitable people are employed to work with older people. Additional staff have been provided at key times during the day increasing the number of staff on three out of four units to three during the day. Fosse House DS0000019349.V299220.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The manager needs to ensure that a consistent level of care and support is provided to service users by the whole staff team. Inconsistent practice on two of the units led to poor experiences for service users on the day of inspection. For example not protecting the dignity of service users unable to adjust their own clothing and inadequate support for service users who require assistance and prompting to eat and drink. The manager needs to ensure that the care records contain clear instructions for staff on how they manage identified risks and the indicators, which may alert them to changes in behaviour. The manager needs to ensure that medication is administered in line with the prescribing instructions and company’s policies and procedures. The management team and staff need to continue to develop the level of social care and stimulation provided to individuals in the home. Where hours allocated to an activity organiser remain vacant providing additional staff to provide extra support from within the staff team should be considered. The manager needs to review the dining arrangements on Dove unit to ensure there is adequate space available for the number of service users. Fosse House DS0000019349.V299220.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. Fosse House DS0000019349.V299220.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.V299220.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 – standard 6 does not apply to this service Quality in this outcome area is assessed as good. This judgement has been made using available evidence including a visit to this service. Service users are assessed and encouraged to visit Fosse House before making a decision about coming to stay. Fosse House is registered to admit older service users with dementia and this is reflected in the training staff receive. EVIDENCE: The manager or deputy manager visits 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 that day centre or been on respite stays before. Information is also obtained from other health & social care professionals who may be involved. Quantum Care have recently reviewed their admission process and monitoring of information received from social services to ensure that accurate information is obtained. All care staff receive basic dementia care training. Further in-depth training is taking place to increase the skills of staff in this area. Fosse House DS0000019349.V299220.R01.S.doc Version 5.2 Page 10 One relative confirmed they had visited the home and had been able to ask questions but in retrospect felt they ‘would have been preferred to have been more fully interviewed’. Four out of five relatives who returned questionnaires confirmed they had received enough information to decide if the home was right for their relative. At the time of this inspection Quantum Care were updating their information on the home. Three out of five relatives stated they were not aware of a contract being in place. This is an area for the manager to review to ensure that service users and their representatives are aware of the terms and conditions of their stay. Fosse House DS0000019349.V299220.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 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 assessed as adequate. This judgement has been made using available evidence including a visit to this service. There has been a continued improvement in the personal care provided to service users. However an inconsistent approach among the staff team to providing good standards of care in line with the training provded by Quantum Care is leading to poor experiences for some service users. A good service is provided to the home by local GPs and Community Nurses. The increased involvement of the local mental health team has been positive in supporting the needs of service users and providing advice and guidance to staff. Staff were not able to demonstrate in all cases that service users are receiving their medication as prescribed and in accordance with company policies and procedures. Fosse House DS0000019349.V299220.R01.S.doc Version 5.2 Page 12 EVIDENCE: The interviews with service users, their visitors and responses to the questionnaires confirmed staff were kind and gentle but things did not always get done. One person mentioned repeated requests for chiropdy and hairdressing. Another person said that the frequency of baths could be eratic and in some cases there had been gaps of 10 days. Staff also spoke of a lack of team work and flexibility in relation to bathing service users. The records of bathing and personal care had not been completed in al cases The inspectors observed an inconsistent approach across the home. Service users on two units were well supported by staff who moved beyond the routine tasks of the morning to spend time with service users and create a cheerful atmoshere. In contrast on the other two units, the staff approach to service users was mechanical and lacked focus (refer standard 15).Some staff said they did not have time to talk to service users. Staff did not respond to support the dignity of a service user sitting in the lounge who had become uncovered. Inconsistent responses to an anxious service user by different staff visibly increased their level of distress. Prior to the inspection in April a lot of work had gone into reviewing and updating care plans. Overall this improvement had been maintained. There are opportunities for service users and their representatives to be involved in developing and reviewing their care plans. Senior staff need to ensure that where risks such as challenging behaviour are identified, clear instructions are provided for staff on the action they should take to manage situations that may arise. This information needs to be easily accessible in the care plan. The information provided to the Commission indicates staff are good at getting service users medically examined by their general practitioner if they are unwell or after a fall. The relatives who completed questionnaires also confirmed service users received all the medical support they needed. Details of treatments and advice given to staff by health care professionals to ensure there is continuity of care is now recorded in more detail. A planned change in delivery arangments on the day of inspection resulted in some service users not receiving their medication at the time prescribed. This was being addressed by the mananager. However it was also identified from the previous months medication charts that not all medicines adminstered had been signed for and the daily audit carried out to monitor standards had not picked up that certain items of medication had not been given over a number of days. In one case the instructions on the adminstration chart did not match the details on the medication pack. Although stocks were available one service user was not given their morning pain relief on the day of the inspection causing distress. Fosse House DS0000019349.V299220.R01.S.doc Version 5.2 Page 13 Staff receive training in the adminstration of medicines. The care team managers attend accredited medication training. Two staff felt they needed clearer information on what each medicine was for so they could answer questions from service users. It was reccomended that this is reviewed. A requirement from the last insepction to record the temperature in medication storage areas has been met. Fosse House DS0000019349.V299220.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 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 assessed as adequate. This judgement has been made using available evidence including a visit to this service. Providing service users with a stimulating environment which meets their individual needs and preferences is an area for further development, particularly in relation to promoting a sense of well-being and purpose for service users with dementia. A requirement has not been made at this stage as an activities organiser was about to be recruited and staff are getting more confident at interacting socially with service users. This inspection identified an inconsistent approach among the staff team on two of the units on the day of inspection which resulted in poor experiences at lunch time for some service users, which did not support their dignity or demonstrate an understanding of the needs of service users with dementia. EVIDENCE: The inspection in April identified that an activity organiser had been recruited. This person has now left and the manager is in the process of recruiting another person to fill this post. Group activities and visiting entertainers are arranged. Fosse House DS0000019349.V299220.R01.S.doc Version 5.2 Page 15 There is a weekly plan of activities on each unit to encourage staff to plan a short activity during the morning and afternoon with service users. Staff demonstrated their confidence in this area is increasing. It was felt that more familiar objects to hold and touch could be provided for service users on the dementia care units. Examples of staff responding to individual needs were seen. A new service user was being supported to continue with activities outside the home. Some service users are able to walk across to Waitrose. There was an action plan and risk assessment in place to enable a service user to become more independent in relation to managing shopping and finances. One person living on Dove Unit, who did not receive their morning pain relief struggled across the lounge to the dining room using their zimmer frame to be met by a carer who said they couldn’t come into the dining room because it was full (refer to standard 19). They returned to the lounge and were served their lunch at a small table without comfort or explaination for what had happened. This person did not eat their lunch. Another person on the same unit was brought into the lounge in their wheelchair and their lunch was put in front of them on a low coffee table which they could not reach. This person also did not eat their lunch. The inspector asked the manager to visit the unit to review the issues. Alternative meals were provided. Staff caring for service users on one of the dementia care units (Swallow) lacked organisation and direction. Service users were brought into the dining room 20 minutes before lunch was ready. This didn’t demonstrate an individual approach and as service users became restless, staff had to go and encourage them back several times. Staff were not preparing service users appropriately for a calm experience and created additional work for themsleves when they could have been interacting positvely with service users and involving them. Prior to lunch the tables were set and a chair placed across the dining room door to stop service users entering. Staff did not use the skills and strategies required to encourage people with different stages of dementia to eat their meals. The manager needs to look at the management of meal times and the frequency with which individual service users have their meals to ensure this is by choice, meets their nutritional needs and is not due to inflexible routines. For example one service user who needed assistance was helped to get up by staff at 11am. Their breakfast was prepared and they then had lunch at 12.30pm. Another visitor said that staff gave the service user as many as 6 bowls of crispies and 6 slices of toast in the morning and then they are unable to eat their lunch. A snack meal should be offered in the evening and the interval between this and breakfast should be no more than 12 hours. Fosse House DS0000019349.V299220.R01.S.doc Version 5.2 Page 16 Drinks and fruit and savoury snacks are now freely available to service users during the day. Staff need to ensure that these are offered to those who are unable to help themselves. Service users have a choice of meals and were generally positive. In discussion with the manager it was suggested staff should know more about the meals being served so they could discuss them with service users and encourage them. One carer described a beef curry as a beef stew and staff did not know what was for lunch without looking it up. They were not therefore in a position to chat to service users about this important aspect of the day. The catering staff do not currently appear to meet regularly with service users or meet new arrivals to discuss their preferences. Quantum Care report their menus have been nutritionally assessed. A new system for monitoring changes in weight using Body Mass Index calculations has just been introduced. Fosse House DS0000019349.V299220.R01.S.doc Version 5.2 Page 17 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 assessed as good. This judgement has been made using available evidence including a visit to this service. The company does not receive an undue number of complaints about Fosse House. The complaints procedure is followed which ensures that individuals making a complaint receive a written response within set timescales. Quantum Care work closely with social services and the managers in the home have got better at identifying issues which require referral to the statutory services in order to support and protect service users. EVIDENCE: Information about the company’s complaint procedure is displayed and is available with the information provided to new service users. Seven out of 8 relatives who returned questionnaire stated they knew how to make a compliant. One person felt that problems arose if information was not handed over between shifts. Overall, service users and their relatives felt safe and supported. Where issues had arisen the Inspector was satisfied that the company had acted on behalf of individual service users in ensuring their rights were respected and opportunities given to explain the actions taken. Staff receive training in the protection of vulnerable adults. Fosse House DS0000019349.V299220.R01.S.doc Version 5.2 Page 18 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 assessed as good. This judgement has been made using available evidence including a visit to this service. Fosse House is a well-maintained safe home, which provides aids and equipment to meet the care needs of the service users. Quantum Care need to review the dining room provision on Dove Unit as it was too small for the number of service users wishing to use it on the day of inspection. EVIDENCE: All service users have the privacy of single rooms 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. Fosse House DS0000019349.V299220.R01.S.doc Version 5.2 Page 19 Service users are encouraged to bring in personal possessions and furnishings so they have familiar things around them. In conjunction with the Community Nursing team specialist aids to mobility and independent living are made available in addition to the equipment already provided. Some of the service users have been provided with height adjustable beds. Staff receive training in the use of equipment such as hoists and servicing contracts are in place. 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 falling get out of bed. 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 dining room on Dove unit is smaller than on the other units. It was not able to accommodate all the service users wishing to eat their lunch there on the day of the inspection and this situation was badly managed by staff. Increasingly service users are less mobile and use wheelchairs and other mobility aids, which require more space. It is understood that Quantum Care have been discussing plans for the development of this area with Hertfordshire County Council who own this building but progress to date has been slow. Overall, the home was found to be fresh and clean on the day of inspection. The housekeeping staff dealt with problem areas as they arose. The responses from relatives who completed questionnaires to whether the home was fresh and clean ranged from ‘always’ to ‘usually’ to concerns about their being offensive odours in the corridors. The laundry is run in accordance with current infection control practices. Hand washing facilities and protective equipment for staff to comply with infection control procedures is freely available around the home. Fosse House DS0000019349.V299220.R01.S.doc Version 5.2 Page 20 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 assessed as good. This judgement has been made using available evidence including a visit to this service. Responding to increases in the dependency of service users Quantum Care has increased the staffing levels during the day. Three staff are now being provided during the day at peak times on three out of four units. There have also been occasions when additional staff have been allocated to provide one to one supervision of individual services users. Variable practice in relation to the skills of staff was observed. Some staff are well organised and able to spend time with service users while other staff remain task orientated struggling to complete the daily routines. This has a direct impact on the quality of life experienced by the service users and needs to be kept under review. The manager has implemented a robust recruitment procedure which ensures the suitability of staff to work with older people is checked before they are employed. New staff receive induction training, which then leads on to NVQ training. Based on the information provided by the manager the number of staff with qualifications at NVQ level 2 has reached the required 50 of care staff. Quantum Care have good staff training systems in place but certain areas had slipped under previous managers and this is now being addressed particularly in relation to providing staff with more in-depth dementia care training. Fosse House DS0000019349.V299220.R01.S.doc Version 5.2 Page 21 EVIDENCE: Rotas are available together with details of which unit staff have been allocated to work on. To provide consistency while covering long term sick leave and vacancies the manager has allocated shifts on the rota to regular agency staff. With reference to the observations made in previous sections of this report and discussions with staff, there is still work to do in developing the skills and commitment of staff towards team working and providing service user focussed care. The care managers identify that they do not have enough time on their own units to monitor and develop practice as they are covering vacancies on the duty manager rota. This was acknowledged by the manager and should change when all the care team managers are in post. Thirteen out of the fourteen GPs who returned questionnaires confirmed that staff demonstrated a clear understanding of the care needs of service users. Training records for staff were available and the manager has a put a training plan in place so that any gaps can be easily identified and rectified. The care team managers receive certificated first aid training so there is a qualified firstaider on each shift. Fosse House DS0000019349.V299220.R01.S.doc Version 5.2 Page 22 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 assessed as good. This judgement has been made using available evidence including a visit to this service. The suitability of Mrs J Gauthier to be the Registered Manager as defined by the Care Standard Act 2000 has been confirmed by the Commission. Standard 31 will be fully met when she has completed her NVQ 4 in Care & Registered Managers Award (RMA). Quantum Care have quality monitoring systems in place, which include seeking the views of service users and their relatives. Senior company managers and board members also visit the home. Residents are given support to continue to manage their own money or are able to access small amounts of money deposited on their behalf. The health & safety of service users and staff is maintained by the company health & safety policies and systems. Fosse House DS0000019349.V299220.R01.S.doc Version 5.2 Page 23 EVIDENCE: The current manager has had to make some difficult changes within the staff group to ensure that their skills and experiences are evenly spread throughout the home. During this difficult period the management team within the home and company have worked positively with the Commission to implement an agreed action plan to improve the service. Both relatives and staff confirmed the positive effect the changes are having. Staff felt that they could raise concerns with the management team but that between some care staff there is a lack of teamwork. Quantum Care senior managers and Director of Care are regular visitors to the home. Monthly health & safety visits and audits are completed and reported to the Commission under Regulation 26. The views of service users and their relatives are obtained and the findings of surveys are reported back at an annual forum. Policies and procedures are regularly reviewed in line with changing legislation and good practice advice. An example of this is the introduction of monitoring nutritional needs by calculating each service users body mass index. A record of accidents is maintained and audited to identify any underlying trends. Accidents and incidents are reported to the Commission as required. The quality of the information provided by the care managers has improved. There is a system in place to enable service users to have access to money deposited on their behalf. The records seen include signatures and receipts for money deposited and withdrawn which enables individual accounts to be tracked. Staff receive annual updates in their statutory training. The manager has recently reviewed the training programme to ensure the required areas have been covered for all staff. The records for annual safety checks and fire safety checks were found to be in order. A requirement made following the last inspection to ensure chemical products are locked away has been met. Fosse House DS0000019349.V299220.R01.S.doc Version 5.2 Page 24 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 2 8 3 9 1 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 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 2 x 3 x 3 x x 3 Fosse House DS0000019349.V299220.R01.S.doc Version 5.2 Page 25 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 OP7 OP10 Regulation 12(1)&(4) 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. Ensure individual care plans provide clear and accessible instructions for staff regarding the management of identified risks. Ensure service users are given their medication as prescribed and signatures are recorded for all medication given. Ensure staff make meal times a pleasant experience, which offer service users the support they require based on a flexible person-centred approach. Review the dining arrangements on Dove Unit to ensure that there is adequate space for each service user to be able sit comfortably at a dining table to eat their meals with other service users if this is their choice. Confirm planned action & timescales for increasing the DS0000019349.V299220.R01.S.doc Timescale for action 06/06/06 2. OP7 15(1) 31/07/06 3. OP9 13(2) 06/06/06 4. OP15 12(2) &(13) 31/07/06 5. OP15 12(3)&(4) 31/07/06 6. OP19 23(2) 31/07/06 Fosse House Version 5.2 Page 26 dining space available to service users on Dove Unit. 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 OP9 Good Practice Recommendations Provide clear accessible information to staff about the use and effects of medication they are administering. Fosse House DS0000019349.V299220.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Hertfordshire Area Office 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 © 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.V299220.R01.S.doc Version 5.2 Page 28 - 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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