Inspection on 03/01/07 for Fosse House Nursing Home

This inspection was carried out on 3rd January 2007.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Fosse House Nursing Home 29/01/08

Fosse House Nursing Home 29/08/07

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Fosse House Nursing Home South Street Stratton on the Fosse Radstock Somerset BA3 4RA Lead Inspector Stephen Humphreys Unannounced Inspection 3rd January 2007 09:30 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 Nursing Home DS0000067689.V314907.R02.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 Nursing Home DS0000067689.V314907.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fosse House Nursing Home Address South Street Stratton on the Fosse Radstock Somerset BA3 4RA 01761 233018 01761 233632 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) TC Carehome Ltd Margret Donkin ( Acting) Care Home 37 Category(ies) of Old age, not falling within any other category registration, with number (37) of places Fosse House Nursing Home DS0000067689.V314907.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. An application must be made to the Commission for Social Care Inspection by the home manager to become the registered manager within 6 months following the registration date. Elderly persons of either sex, not less than 60 years, who require general nursing care. Up to 3 places for personal care. Date of last inspection 4th May 2006 Brief Description of the Service: Fosse House Nursing Home is set in the village of Stratton-on-the-Fosse approximately 5 miles from Shepton Mallett and the city of Bath respectively. Fosse House is a registered care home that provides nursing and personal care to elderly persons of either sex, not less than 60 years, who require general nursing care. The home is registered to accommodate up to thirty seven service users. Fosse House was developed from the conversion of a large character house with an additional newer accommodation extension. The accommodation is on two floors and bedrooms are spacious. The home comprises 31 single rooms and three double rooms, plus communal space. The upper floors are serviced both by a passenger lift and stair lift giving good access to the home. There are communal rooms on both floors. The large rooms are both lounge / diners. All services are provided in the home and the home is surrounded by wellmaintained accessible gardens. Registered nurses and carers staff the home 24 hours a day. Visiting health professionals include GP’s, chiropodist, and district nurses to provide care for the service users. The current fees charged are £475 - £600 per week. Fosse House Nursing Home DS0000067689.V314907.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Fosse House was acquired in May 2006 by TC Carehomes Ltd who are the current registered provider. The last key inspection was carried out on the 4th May 2006 prior to the take over. Major shortfalls were identified at that inspection. A considerable amount of time has been allowed between inspections to give the new provider time to assess the quality of the service and to make changes where necessary to improve the service delivery. An unannounced key inspection was carried out at Fosse House nursing home on the 3rd January 2007. Two inspectors carried out the inspection from 09.30am until 18.00pm. The registered provider was not in the home and the manager was on annual leave. The key inspection was carried out using the Commission for Social Care Inspection Inspecting for Better Lives methodology. The methodology is based on collecting evidence of compliance to meet the older persons national minimum standards and the Care Homes Regulations 2001. A pre-inspection questionnaire was sent to the home for completion and returned to the Commission for Social Care Inspection. The lead inspector also sent comment cards devised by the Commission for Social Care Inspection to visiting health professional such as GP’s and social care professionals. Questionnaire surveys were sent to service users. Four completed comment cards were received from visiting GP’s. Comments were received from other health and social care professionals. Twelve completed service user surveys were received. Comments from service users about the care received were mainly positive. This was evidenced during the site visit. Other comments included “very little care is taken with clothes, they are not put away properly, some disappear.” “If you want to ask a medical question you have to go and search for the registered nurse” Comments received from health and social care professionals were similar, in that they had concerns with the standard of communication. “ Communications are sometimes difficult due to the language barrier”. “Communication remains a problem”. The inspectors carried out the site visit and were able to observe the care delivery, talk to service users, relative and staff. A tour of the home to assess the décor and accommodation was carried out. Fosse House Nursing Home DS0000067689.V314907.R02.S.doc Version 5.2 Page 6 All the service users spoken to at length said they were happy with the standard of care they received. At the time of this visit there were 28 service users in the home. The nurse in charge reported that one service user was being nursed totally in bed. The outcome of this inspection was disappointing. The evidence collected by the inspectors from their discussions with staff, relative and review of records identified shortfalls that had been identified at the last inspection indicating that the home had not moved forward. The inspectors were told that “the home runs itself” and “situations are dealt with as they arise”. These comments express the change in management philosophy since the ownership of Fosse House changed. The inspectors were told that there was no business plan or evidence that the registered person has planned a way forward. The personal care delivered to service users was of a good standard although there was no evidence to show that the care needs of service users with complex needs were being met. Evidence of shortfalls in management and record keeping were found. The inspectors were able to conclude from discussions with staff and comments from surveys that the staff groups do not work cohesively as a team. A comment from one of the registered nurse’s was “the carers don’t do as we tell them”. Comments from carers included “ the registered nurse’s are not involved, unless the manager is here”. One relative commented “The registered nurse’s seem to have their priorities mixed up”. The inspectors received evidence that is considered sensitive to the management of the home and has been omitted from the report to protect confidentiality and for legal purposes and informed to the provider in a separate letter. The inspectors’ also followed up on requirements and recommendations made at the last inspection visit and took an in depth review of the care delivered to service users with complex needs. Records examined were care plans, medication records, staff recruitment files, some staff training records, accidents records, staff rotas, fire records. What the service does well: Fosse House Nursing Home DS0000067689.V314907.R02.S.doc Version 5.2 Page 7 The service users spoken to said that the care staff are kind and always ensure privacy and dignity is maintained during any intimate care procedure. The home environment was pleasant and warm. All the staff in the home at the time of the visit were observed to be respectful to residents and greeted visitors in a pleasant manner. What has improved since the last inspection? What they could do better: Choice of Home – The registered person should review the information available to prospective service users to ensure up to date information is provided. Prospective service users will benefit from all the information being in the service user guide. The Registered person should review the terms & conditions of residency and be guided by the Office of Fair Trading report - guidance on terms and conditions for care homes. The manger must ensure that all the service users care needs are identified especially those service users with complex needs. Health and Personal Care – Service user care plans should identify individual person centred care needs that are outcome based and achievable. Specific evidence needs to be recorded in the care plan to show a collaborative approach with the service user or their representative. Fosse House Nursing Home DS0000067689.V314907.R02.S.doc Version 5.2 Page 8 Care staff need to receive appropriate training in using the new system to record personal care outcomes. Care need evaluations need to record the progress or regress in meeting the individuals care needs. Staff need to be aware of current palliative care practices and reflect the needs of service users needing palliative care in the care plan. Daily Life and Social Activities – The social care needs of service users need to be identified and recorded in the individual care plan. Social care needs to be planned and carried out in the home with the benefits recorded for each individual. The philosophy in the home needs to be more person focused and not controlling. Service users should be provided with more choices especially with regards to meals and snacks. Complaints and Protection – The registered person should ensure that all complaints and concerns received are investigated thoroughly with appropriate responses to the complainant. The registered person should review the complaints procedure to ensure the registered provider owns it. The registered person should review all complaint outcomes as part of a wider quality assurance system for improving service delivery in the home. The registered person must ensure through training and regular updates staffs awareness of the vulnerable adults procedures. Staffing - The registered person must ensure that any new staff are employed using a robust recruitment and selection policy. Referees for all applicants must include the last or previous employer. The registered person must ensure that all new staff receives a detailed induction training that is recorded and meets the skills for life standards. Service users with complex needs will benefit from having staff that are trained and experienced in caring for people with complex needs such as dementia. The registered person must take appropriate action to ensure communication between staff groups is effective. The registered person must also improve staffs abilities to communication with visiting health and social care professionals. The registered person must ensure a programme of staff training is developed to meet the individual personal development needs of the staff. Management and Administration – The registered person must ensure the day-to-day management of the home is robust. The registered person must ensure that there is a clear sense of leadership and direction that is understood by all staff groups. The registered person must ensure a good relationship with and support the home to ensure a quality service delivery. Fosse House Nursing Home DS0000067689.V314907.R02.S.doc Version 5.2 Page 9 The practices in the home must be open and transparent with the focus on service user outcomes. The home must be run for the benefit of the service user and not controlling. The registered person should ensure there is a business plan for the home that the management team follow based on a quality review system. The registered person should promote more service user involvement in the running of the home. Actions to ensure good teamwork and staff moral must be introduced to ensure the safety pf the service users. Staffs personal contractual issues need to be addressed by the registered person. Policies and procedures and record keeping needs to be reviewed with a view to improving administration systems. The manager and administrator would benefit from identified personal development plans with a view to developing further their management skills. The registered person must ensure formal staff supervision is introduced for all staff. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Fosse House Nursing Home DS0000067689.V314907.R02.S.doc Version 5.2 Page 10 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 Nursing Home DS0000067689.V314907.R02.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4 Quality in this outcome area is adequate. Information is available for residents to make a choice about the services offered however it is not readily available. Service users cannot always be assured the home will meet all their individual care needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service user guide and statement of purpose has not been reviewed or updated by the present registered provider. Information about the home and the services is available in different documents. A copy of the service user guide that is a three-page document can be found on the door to the home. In Fosse House Nursing Home DS0000067689.V314907.R02.S.doc Version 5.2 Page 12 a separate folder are thank you letters and cards from relatives. The service user guide is brief and includes aims and objectives, facilities & services, terms & conditions of accommodation to y/e 2005. The main entrance displays the complaints procedure. A general information board is attached to the wall opposite the nurse’s station where the statement of purpose is displayed. Information for the benefit of residents and relatives is displayed, including names of agencies to contact such as Commission for Social Care Inspection. To meet this standard fully the registered provider should review the information and put it into one document. There was no evidence of a statement of purpose that meets this standard. The registered provider should ensure a statement of purpose is developed that contains information as stated in schedule one of the Care Homes Regulations 2001. The inspectors were informed that a copy of the service user guide is placed in each service users room however on a tour of the home the inspectors did not see a copy of the service user guide in any service users room. The service user guide is available in another format such as large print, but not available on audiotape or video. These would benefit prospective service users. The inspectors identified one service user who was registered blind in the home and others who had difficulty in hearing. Eleven of the twelve-service user surveys returned indicated that they felt they had received enough information about the home before they moved in. Fourservice users spoken to said they couldn’t remember reading the service user guide. All said they chose the home because it was convenient and near to were they lived. The inspectors reviewed the contract being issued to new service users. The administrator confirmed that the new registered provider had not changed the contract. The contract details refer to the previous owner with the name of the new provider in the paragraph headed definition and interpretation. The terms and conditions in this contract appear to be unreasonable in parts. The registered provider is encouraged to review the terms & conditions for the home in line with the Office of Fair Trading report - guidance on terms and conditions for care homes. Pre-admission assessments are carried out for each prospective resident. A social services assessment based on the activities of daily living is carried out before the service user is referred to the home. Fosse House Nursing Home DS0000067689.V314907.R02.S.doc Version 5.2 Page 13 Since the last inspection a new care planning system has been introduced into the home. This system has a detailed section for long term assessed care needs. The inspectors reviewed six care plans in detail. All of the care plans had a completed long-term assessment of care need. The inspectors identified and reviewed in detail the care plans of four service users with complex needs such as dementia and diabetes. The result is that service users with specialist needs receive a poor service of care through the lack of trained, knowledgeable staff. The lack of specific care needs and interventions in the care plans were evidence that the care team do not fully understand the particular individuals needs. The only specialist available is the diabetic nurse specialist who visits the diabetic service users. Comments received by visiting health care professionals about difficult communication attribute to the service users care needs not being met. The diabetic liaison nurse visits service users for regular checks and reviews. Unfortunately the care plans did not include care interventions that would be expected to meet the complex needs of an insulin dependant diabetic. The care plans only met the basic needs. Training records checked confirmed that inhouse training for staff on diabetes had been carried out but this is not reflected in the ability to develop a plan of care. Three of the care plans reviewed identified the service user had dementia however there was no specific dementia care needs or appropriate interventions recorded to enable care staff to meet their individual needs. The care needs assessment recorded the service user had lost the ability to communicate verbally. There was no evidence to show that other methods of communication had been developed. Nursing staff spoken to do not have the training, experience or understanding of persons with dementia to deliver specific dementia cares practices. No evidence was found to suggest that the nursing staff had made any effort to develop a communication tool for persons with dementia. A recognised tool of good practice is to develop a record of expressions or behaviours exhibited by the service users to communicate their needs. This will help care staff understand and communicate better. The registered nurse said she had requested dementia care training but as yet has not attended any. Training records checked confirmed a lack of dementia training amongst the staff groups. Fosse House Nursing Home DS0000067689.V314907.R02.S.doc Version 5.2 Page 14 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate Each service user has a care plan that identifies basic care needs. Service users are assessed for their ability to self administer their medicines. Service users confirmed they are treated with dignity. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The standex care planning system has been introduced since the last inspection. This is a detailed system that if used appropriately can be a working plan of care. Six care plans were reviewed in detail of service users with special care needs. Four other care plans were reviewed of service users who had between four and six accident records in the last four months. Fosse House Nursing Home DS0000067689.V314907.R02.S.doc Version 5.2 Page 15 Generally the care plans all contained an assessment and brief life history. The daily records related to personal care only. There were records of doctor’s visits and brief social records. The activities of daily living model of care is used to define care needs. There was evidence in four care plans of risk assessments pertaining to falls, nutrition and skin integrity. Each had a moving and handling assessment. None had any psychological needs identified which indicates a lack of knowledge in this area by the registered nurse’s. The in depth review of service users care carried out by the inspectors was of service users who were not able to express opinions other than by expression or behaviours. The inspector observed a service user taking lunch who for most of the time struggled to eat as they kept falling asleep. The other service users sitting near said that this always happens because the person is awake all night. At no point was this service user offered assistance other than the registered nurse saying “come on eat your dinner” The service users care plan did not mention anything about falling asleep in their diner. The care plan did identify a need “to prevent falls and maintain safety”. The care plan recorded “ hasn’t fallen for a long time”. On visiting the service users room there was a sensor mat on the floor. The service user had four falls recorded in the accident book between October 2006 and January 2007. The evaluations did not identify or link the number of falls to any specific intervention. There was no evidence in the care plan to show that staff had reviewed the plan to maintain service user safety. The inspectors concluded that the service users care need is not being met. Another service user had a risk of falls identified in the care plan. This service user had six falls recorded in the accident book. On checking the service users accommodation there was a pressure mat on the floor that activated the nurse call system. The mat was situated in the middle of the floor with exposed trailing wires, putting the service user at further risk to harm. The evidence indicated that the health and safety of the service users was not a priority in this home. Another care plan identified a service user as wandering at night however there was no specific person centred care plan to ensure the service users safety when they were walking about. The care plan recorded; promote independence by allowing the service user to go to the toilet. If they wander out of room persuade to go back. This regime is clearly not good practice however it is clear of the lack of understanding towards person centred care and dementia practices. Fosse House Nursing Home DS0000067689.V314907.R02.S.doc Version 5.2 Page 16 Each care plan reviewed had regular weight recordings. Two care plans reviewed recorded weight loss in the service user. One service users care plan identified the need for high calorie drinks to be given. The inspector observed the service user sitting in the lounge. Drinks of tea and juice were given during the day. The inspector visited the kitchen to review the stock level. There were high calorie ensure drinks on the shelf however the inspector did not observe the service user receiving a high calorie drink during the time in the home. A statement from the kitchen assistant confirms that supplement drinks are given to service users. The service user surveys and relatives comments included “the family are satisfied with the care given by the carers”. Generally those service users who voiced an opinion said they felt their needs were met however it is recognised that the service users who where able to voice an opinion did not appear to have complex care needs. At least three of the service users with complex needs could not communicate verbally which the registered nurse on duty confirmed. Communication was mainly by what the staff thought they understood the service user needed. There was no record of any expressions or behaviours used by the service users to communicate their wishes and feelings. It is recognised good practice to identify a communication aid and a record of expressions and behaviours for staff to promote positive communication. The inspectors reviewed the care plan of a service user receiving wound care. The care plan recorded the events of the wound and included a wound caremonitoring chart. There were inconsistencies in the recording of the wound care in the care plan and the wound care chart. The wound care charts did not record the progress of the wound. It appeared from the wound care records that the dressings were based on the individual’s professional experience. This was further evidenced during a discussion with carers. “Wounds could be treated differently by each registered nurse”. The inspectors were informed that access to and advise from the nurse specialist is not readily available to the home. The GP and practice nurses do advise on wound care however there was no evidence recorded in the care plan to support this. The evidence found during the detailed review of care plans of service users with complex care needs was that the service users could not be sure that their individual nursing care needs would be met fully. Fosse House Nursing Home DS0000067689.V314907.R02.S.doc Version 5.2 Page 17 The medication procedures where checked, storage, receipt, administration and disposal were all reviewed. The medicine administration records checked contained all the required details of service users. A specimen signature list was included in the file along with a homely remedy list signed by the GP. One medicine administration record had hand written prescriptions on. The inspector recommended that hand written prescriptions be initialled by the writer and witnessed. As a matter of good practice the hand written prescriptions should be printed clearly on the medicine administration record. Records of receipt and disposal were completed. The controlled drugs were checked with the registered nurse in charge. All records and tablet counts were correct. Fosse House Nursing Home DS0000067689.V314907.R02.S.doc Version 5.2 Page 18 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is adequate. Service users cannot guarantee the life style in the home matches their expectations. The daily life style in the home does not promote choice but control. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspectors observed the carers and registered nurse during the day carrying out care practices. The daily routines take place in the communal lounges and dining areas. Service users are sat in the chairs around the edge of the room. All have an over knee table placed in front of them with drinks, magazines and newspaper of their choice. Apart from the few service users who sit at table for lunch all the others sit in one place until bedtime. There are two televisions in the ground floor lounge / diner, one at either end. Fosse House Nursing Home DS0000067689.V314907.R02.S.doc Version 5.2 Page 19 Service users are placed so as they can see the television however they may not have chosen to watch it. The home did not have an activities person at the time of this visit. The inspectors did not witness any activities going on during the day. The inspectors were told that a carer is allocated to do activities during the afternoons however no one was allocated on this day. Ten of the twelve-service user surveys received indicated that there were usually activities in the home they took part in. Two replies indicated they did not take part in any activity. The home does not have an activities co-ordinator at the time of this visit. There was no evidence of any activities programme however activities when provided are chosen by the carers. Residents are not asked for their choices. Carers do try and provide activities to suite service users social preferences. The care plans reviewed did not identify fully the social care needs of the service user and did not identify any form of intervention relating to social care. Separate activity records are completed to show group involvement. The routines in the home appear to be rigid and not flexible to meet individual preferences and wishes. There was no evidence that service users are consulted about their daily life style. There was no evidence of any service user meetings. Comments on the life style in the home from staff included “service users are got up”. One service user is assisted to self-administer medicine, during a discussion with another service user they expressed a wish to self-administer their medicines. When the inspectors discussed this with the registered nurse they were told the self administration assessment indicated the service user was not capable, however there was an assessed care need to promote independence in the service users care plan. This was evidence of controlling practices and indicates the home is not run for the benefit of the service users. The home has open visiting arrangements and service users know they can see their family and friends in their own rooms. Two visitors were observed to sit with their relatives in the lounge and one visitor took their relative out in a wheelchair for a time. The inspectors observed service users taking lunch. Only eight were able to eat at the dining table. Four on each floor. The food quality in the home is Fosse House Nursing Home DS0000067689.V314907.R02.S.doc Version 5.2 Page 20 generally good. Confirmed by service users and relatives. Eight of the twelve surveys said they always liked the meals and four said they usually liked the meals. The cook is experienced and tries to produce meals to meet the preferences of the service users. There is a four-week cycle of menus however this is not always followed. Discussions with staff indicated that food variety had been reduced. The inspector visited the kitchen to review the stocks. The food stock appeared to have nutritious products and it was evident from the stock of ingredients that meals are home cooked. The menu of the day is written on a board in the dining area. Not all service users would be able to see it or read the menu. On the day of the visit the main cause was roast chicken. The alternative was salad. At the last inspection in May 2006 the alternative choice on that day was salad. The inspectors did not observe any service user eating the salad. Four of the carers and a relative commented that they felt salad in the winter months is not a good choice. The evening meal according to the menu board was egg and chips however the meal served to service users was cheese and potato pie because there was a relief cook on duty. Staff commented that they felt the food for service users needing a special diet was not adequate. At least five service users were observed to be assisted to eat their meals at lunchtime. The staff were observed to help them sensitively. One carer was explaining to the service user each time what was on the spoon to help her enjoy the meal. This is further evidence of a controlling practice as no one is likely to opt for a salad. No other choices were available. One relative commented “the food is good but there is not a lot of choice”. One member of staff commented “those on liquidised meals don’t get a choice if they don’t like it”. Fosse House Nursing Home DS0000067689.V314907.R02.S.doc Version 5.2 Page 21 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18. Quality in this outcome area is adequate Service users can be assured that any concerns or complaints will be investigated. The home has a complaints procedure that generally meets the national minimum standards. Not all staff have an awareness of the vulnerable adults process therefore service user may be at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a complaints procedure available in the home. Displayed by the main entrance and attached to the service user guide. The Commission for Social Care Inspection has received one anonymous complaint since the last inspection. This was investigated by the registered person to a satisfactory outcome. The home has received six complaints since the last inspection, all investigated by the manager. One was a vulnerable adult issue involving police investigation. Fosse House Nursing Home DS0000067689.V314907.R02.S.doc Version 5.2 Page 22 The inspectors reviewed the documentation on each of the complaints investigated. The complaints had been received and completed within the procedures timescale. There was no evidence of any investigation notes in any of those reviewed by the inspectors. The final outcome letters to the complainant were written in a defensive manner and did not identify actions for improvement or acknowledge the gratitude of the home for bringing the issues to its attention. The procedure could be improved and made clearer by reviewing the timescales and including the persons who are responsible for carrying out investigations and responding to complainants in a manner that provides the complainant with a sense that the concerns were taken seriously by the home. Three of the staff on duty who were spoken to by the inspectors said they had not received any training regarding vulnerable adults. Two said they were not aware of the homes whistle blowing procedure. Two said they would contact the police or the Commission for Social Care Inspection if they witnessed and abuse of service users. The registered person must ensure that all staff receive regular training in vulnerable adult procedures to ensure the safety of service users. Fosse House Nursing Home DS0000067689.V314907.R02.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is good. The environment of Fosse House Nursing Home was clean and warm on the day of the inspection. The main entrance was secure and there is an on going maintenance programme. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two housekeeping and one laundry person are rostered on duty daily to keep the home clean. A tour of the home found the home clean and warm throughout. Residents confirmed that the home is comfortable. No malodours were noticeable. The laundry was clean and tidy containing two washers and two driers. The COSHH data sheets were displayed. Fosse House Nursing Home DS0000067689.V314907.R02.S.doc Version 5.2 Page 24 Carpets through out the home appeared clean and in good condition along with the furnishings and fittings. Grab rails are fixed to walls, a stair lift and passenger lift are installed for residents. There are two sluices, one on each floor. The sluices are of the slop hopper type. The registered provider has replaced one slop hopper with a closed sluicing system to ensure good infection control and safety for staff. No metal pedal bins are in use in the home. For fire safety and as part of good infection control practice metal pedal bins need to be sited in sluice rooms. Since the last inspection the registered provider has installed regulator valves to the flowing hot water outlets and renewed carpets to some bedrooms. The maintenance person continues to redecorate the home as part of the planned maintenance programme. Fosse House Nursing Home DS0000067689.V314907.R02.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. Quality in this outcome area is adequate. The number and skill mix of nurses and carers appears adequate to meet the needs of the residents however the training and development of staff needs to be recognised to meet the personal development needs of the staff groups. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has experienced trained nursing staff on duty twenty fours hours a day, seven days a week. At the time of this inspection there were two registered nurses and seven carers on duty in the home along with two housekeepers, one laundress, three catering and an administrator. Copies of duty rotas were sent to the inspectors as part of the pre-inspection planning. Comments made to the inspectors during the visit by staff indicated that there might be instances at weekends when the staffing numbers drop due to absence. The manager is encouraged to monitor this and forward plan if possible. The records and discussion with the registered nurse and administrator indicated a stable work force with very little turnover in staff. Many of the care Fosse House Nursing Home DS0000067689.V314907.R02.S.doc Version 5.2 Page 26 staff are from local surrounding areas. No agency staff are used in the home. The registered nurse confirmed that there is a nurse bank system in the home should staff be needed to cover any absences. Four new staff have been recruited for the homes staff bank list since the last inspection. The inspectors reviewed the staff files and were satisfied that all were complete with the information stated in schedule 4 (6) of the Care Homes Regulations 2001. At the last inspection it was reported that the manager had introduced a new induction training package that will meet the skills for life standards however no induction training records were available to the inspectors at this visit. The home has a recruitment procedure that is robust but at a basic level. Only two of the four new staff had given their last employer as a referee. The two others used friends as referees and one used a parent’s legal and health care professional. One of the staff did not have any previous care experience before joining Fosse House. The manager should always take up a reference from the candidate’s last employer and not rely on character references from friends or professionals that have no dealings with the person. The manager is encouraged to improve the recruitment procedure to ensure the safety of the service users. The inspector spoke to one of the new staff at the time. When asked about induction they said “I was put to work with another for two days and then left on my own”. The only evidence of induction in this persons file was a fire questionnaire. No other statutory training record was found. During the discussions with staff two members voiced concerns about the lack of understanding and lack of training for some staff. They were concerned that a bank staff member did not know how to operate the mobile hoist. They voiced a concern about two new bank staff whose induction was carried out by a senior carer only before being put on shift unsupervised. None of the staff spoken to said they were receiving formal supervision. No supervision records could be found. The service user surveys generally recorded satisfaction with the standard of care from the carers. Relatives felt the registered nurse’s had different views on how much support to give the carers. One service user was concerned about the times the registered nurse’s told carers off in front of them. Two carers said they were about to start NVQ training. One registered nurse said they would welcome some training in dementia care. The training records Fosse House Nursing Home DS0000067689.V314907.R02.S.doc Version 5.2 Page 27 reviewed indicated that some training had taken place since the last inspection however it was difficult to tell whether all staff had received statutory training in the last twelve months. The manager is encouraged to develop a training matrix for ease so that statutory training can be monitored and provided for all staff The registered nurse, carers and ancillary staff confirmed that they receive the statutory training along with other suitable and appropriate training to promote clinical knowledge and experience. Two of the five service user survey questionnaires returned to the Commission for Social Care Inspection included comments on staff interactions. These comments will be passed on the homes manager for action. The inspectors did not witness any carers moving any service users during the day therefore cannot comment of safe practice. Fosse House Nursing Home DS0000067689.V314907.R02.S.doc Version 5.2 Page 28 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,36,37,38 Quality in this outcome area is poor. The home manager is not providing strong leadership to staff in the home. The home is not run for the benefit of the service user This judgement has been made using available evidence including a visit to this service. EVIDENCE: It is unfortunate that no specific improvements were evidenced at this inspection. At the last inspection staff discussed their concerns with regards to the poor communication between the staff groups. The carers spoken to at this visit once again voiced the same concerns. Fosse House Nursing Home DS0000067689.V314907.R02.S.doc Version 5.2 Page 29 Carers are of the opinion that they are not listened to. On the holding of staff meetings carers said “the home manager only has a staff meeting if something has to be said”. Carers said “we tell the manager but nothing gets done”, this feeling was also felt by the registered nurse’s spoken to. Both registered nurses spoken to felt communication between the staff groups had improved however the evidence from discussions and comment cards indicates that it is still a problem. The evidence suggests that the home is not run by a cohesive team of staff. The staff groups appear to function independently lead by who ever is in charge. Other comments received indicated that since the change of ownership the home managers role had changed significantly requiring a lengthy time to evaluate and make changes to the running of the home. There is no evidence of a long term view or strategy for improving teamwork. Staff were not aware of any business plan for the home. The administrator said “We deal with things as they arise”. The evidence made available to the inspectors was sufficient to conclude that the home runs on crisis management outcomes. Staff spoken to informed the inspectors that they did not receive formal supervision although one of the registered nurses’s said they had an appraisal. It is possible that staff do not fully understand the process of supervision and its benefits. The registered nurse in charge of the home said “she was in control of things”. Staff voiced their concerns about contractual issues and working hours to the inspectors. The comments and concerns regarding contractual issues will be forwarded to the registered provider in a separate letter. Staff and service users said that the manager does not tackle the problems put to her. There was no evidence of formal quality assurance systems in place. There was a monthly record of the number of accidents occurring in the home, but no record of any actions taken to reduce the number. There was no evidence of any monitoring to assess whether the home was achieving its aims and objectives. There was no evidence of any medicine audits or care plan auditing to help improve the quality of service delivery. Fosse House Nursing Home DS0000067689.V314907.R02.S.doc Version 5.2 Page 30 The fire logbook was checked. The home also has a fire risk assessment. Emergency lighting, hot water temperatures, risk assessments on the environment were all completed and up to date. The kitchen was clean and the daily records up to date. The fly killer was dirty and needed cleaning. During a tour of the home the inspectors noted adequate number of pressure relief equipment, mobile hoists and records of service maintenance were up to date. Fosse House Nursing Home DS0000067689.V314907.R02.S.doc Version 5.2 Page 31 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 2 2 3 2 X x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x 1 1 X X 1 2 3 Fosse House Nursing Home DS0000067689.V314907.R02.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 4(1)(a)(b) (c) Requirement The registered person shall compile in relation to the care home a written statement (in these Regulations referred to as “the statement of purpose”) which shall consist of— (a) a statement of the aims and objectives of the care home; (b) a statement as to the facilities and services which are to be provided by the registered person for service users; and (c) a statement as to the matters listed in Schedule 1. This refers to putting all available information into one document. 2 OP1 5 (1) The registered person shall (1)(a)(b)( produce a written guide to the c)(d)(e)(f) care home (in these Regulations referred to as “the service user’s guide”) which shall include— (a) a summary of the statement of purpose; (b) the terms and conditions in Fosse House Nursing Home DS0000067689.V314907.R02.S.doc Version 5.2 Page 33 Timescale for action 01/03/07 01/03/07 respect of accommodation to be provided for service users, including as to the amount and method of payment of fees; (c) a standard form of contract for the provision of services and facilities by the registered provider to service users; (d) the most recent inspection report; this refers to ensuring prospective service users receive all the necessary information. The registered person shall not provide accommodation to a service user at the care home unless, so far as it shall have been practicable to do so— 3. OP4 14 (1)(a)(c) 30/03/07 4 OP8 13 (4)(a)(c) (a) needs of the service user have been assessed by a suitably qualified or suitably trained person (c) there has been appropriate consultation regarding the assessment with the service user or a representative of the service user. The registered person must ensure that the complex needs of residents are fully identified. Not met from last inspection. 30/03/07 The registered person shall ensure that— (a) all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety. (c) unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. This refers to the trailing wires from the senor mat in the Fosse House Nursing Home DS0000067689.V314907.R02.S.doc Version 5.2 Page 34 5 OP8 12 (3) 6 OP8 12 (1)(a) service users room. The registered person shall, for 30/03/07 the purpose of providing care to service users, and making proper provision for their health and welfare, so far as practicable ascertain and take into account their wishes and feelings. This refers to the need for a list of expressions and behaviours to aid communication. (1) The registered person shall 30/03/07 ensure that the care home is conducted so as— (a) to promote and make proper provision for the health and welfare of service users; this refers to the need for consistency in wound care. 7 OP18 13(6) 8 OP29 18 (1)(a)(c) The registered person shall make 30/03/07 arrangements, by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. This refers to staff training needs. Not met from last inspection. (1) The registered person 30/03/07 shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users— (c) ensure that the persons employed by the registered person to work at the care home receive— (i) training appropriate to the work they are to perform including structured induction training; 2) The registered person shall ensure that— Fosse House Nursing Home DS0000067689.V314907.R02.S.doc Version 5.2 Page 35 (a) persons working at the care home are appropriately supervised; and (b) for the duration of a new worker’s induction training— a member of staff (“the staff member”), who is appropriately qualified and experienced, is appointed to supervise the new worker. (g) a record of all training undertaken, including induction training. This refers to all staff having induction training required to meet the skills for life standards and set up and introduce formal supervision with staff at regular intervals. 9 OP32 18(1)(a)(c (5) ) The registered provider and registered manager (if any) shall, in relation to the conduct of the care home— 30/03/07 (a) maintain good personal and professional relationships with each other and with service users and staff; and encourage and assist staff to maintain good personal and professional relationships with service users. This refers to relationships between staff groups. (5) The registered provider and registered manager (if any) shall, in relation to the conduct of the care home— 10 OP32 12(5)(a)( b) 30/03/07 Fosse House Nursing Home DS0000067689.V314907.R02.S.doc Version 5.2 Page 36 (a) maintain good personal and professional relationships with each other and with service users and staff; and (b) encourage and assist staff to maintain good personal and professional relationships with service users. This refers to the need to ensure a clear sense of leadership and direction to which all staff understand and relate to. (5) The registered provider and registered manager (if any) shall, in relation to the conduct of the care home— (a) maintain good personal and professional relationships with each other and with service users and staff; and (c) encourage and assist staff to maintain good personal and professional relationships with service users. This refers to the need to address the diversity issues amongst the staff to ensure a cohesive staff team (1) The registered person shall establish and maintain a system for— (a) reviewing at appropriate intervals; and 11 OP32 12 (5)(a)(b) 30/03/07 12 OP33 24 (1)(a)(b) 28/02/07 Fosse House Nursing Home DS0000067689.V314907.R02.S.doc Version 5.2 Page 37 13 OP36 18(2) (a) 14 OP37 17(1)(a)3 (a) (b) improving, the quality of care provided at the care home, including the quality of nursing where nursing is provided at the care home. This refers to the need for a quality assurance system in the home. The registered person must ensure persons working at the care home are appropriately supervised. This refers to formal staff supervision. Not met from last inspection The registered person must ensure that all care records are completed in detail and kept up to date. Not met from last inspection. 30/03/07 30/03/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP1 OP2 Good Practice Recommendations The registered provider should make the service user guide available in other formats such as large print, audiotape or video The registered provider is encouraged to review the terms & conditions for the home in line with the Office of Fair Trading report - guidance on terms and conditions for care homes. The registered person should ensure all staff receive appropriate training to make the care plans a working tool. The registered person should ensure that service users psychological health is monitored and recorded in the care plan. The registered person should ensure staff receive appropriate training to carry out person centred care. The registered person should ensure through monitoring DS0000067689.V314907.R02.S.doc Version 5.2 Page 38 3 3 4 5 OP7 OP8 OP8 OP8 Fosse House Nursing Home 6 7 8 9 10 11 12 13 14 OP8 OP8 OP9 OP12 OP15 OP16 OP26 OP29 OP30 processes that service users receive high calorie drinks as prescribed. The registered person should ensure all registered nurses are working cohesively to promote good wound care. The registered person should seek the advise of the tissue viability nurse specialist to determine appropriate wound care for service users. The registered person should ensure all hand written prescriptions on the medicine administration record are initialled and witnessed. The registered person should ensure service users receive social care that is planned and suited to meet their individual abilities. The registered provider should ensure there is a choice of meals and snacks available at meal times that is appropriate to service users likes. The registered person should ensure all complaints or concerns are investigated thoroughly and appropriately responded to in correspondence. The registered person should have metal bins in clinical and communal toilets / bathrooms to promote good infection control practices. The registered person should ensure prospective employees provide last employer referees. The registered person should develop a staff training matrix to identify statutory training attendance. Fosse House Nursing Home DS0000067689.V314907.R02.S.doc Version 5.2 Page 39 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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