Inspection on 16/01/08 for Fountains Care Centre (The)

This inspection was carried out on 16th January 2008.

CSCI found this care home to be providing an Excellent service.

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

Fountains Care Centre (The) 17/08/09

Fountains Care Centre (The) 03/01/07

Fountains Care Centre (The) 05/08/05

Similar services:

Ashlong House

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

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

CARE HOMES FOR OLDER PEOPLE Fountains Care Centre (The) 12 Theydon Gardens Rainham Essex RM13 7TU Lead Inspector Mrs Sandra Parnell-Hopkinson Unannounced Inspection 16th January 2008 09:30a 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 Fountains Care Centre (The) DS0000063968.V357207.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. Fountains Care Centre (The) DS0000063968.V357207.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fountains Care Centre (The) Address 12 Theydon Gardens Rainham Essex RM13 7TU 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) 01708 554456 01708 529644 thefountains@schealthcare.co.uk www.schealthcare.co.uk Southern Cross (LSC) Ltd Veronica Joseph Care Home 62 Category(ies) of Dementia (0), Dementia - over 65 years of age registration, with number (0), Old age, not falling within any other of places category (0), Physical disability (0), Physical disability over 65 years of age (0) Fountains Care Centre (The) DS0000063968.V357207.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. To only accommodate residents with Dementia (DE) 55 years of age To only accommodate residents with Physical disability (PD) 55 years of age 3rd January 2007 Date of last inspection Brief Description of the Service: The home is situated off the Rainham Road within the London Borough of Havering. There is a garden area to the rear of the home and car parking to the front of the home. The home provides 62 single ensuite bedrooms set out over 3 floors. Each floor is independent of each other and each has its’ own dining room and lounges. The home is registered as a care home providing nursing, to care for people over the age of 55 years who may have dementia, a physical disability due to a stroke, Parkinsons or other such illness, and those people who are over the age of 65 years who are frail due to age. The statement of purpose and the last inspection report were available in the reception area of the home, and a copy of the statement of purpose will be provided on request. At the time of the inspection the fees ranged from £590 - £750 per week, with additional fees for hairdressing and chiropody. Fountains Care Centre (The) DS0000063968.V357207.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes. This was an unannounced key inspection undertaken by the lead inspector, Mrs. Sandra Parnell-Hopkinson together with another inspector, Mrs. Gwen Lording, on the 16th January, 2008 from 09.30 hours until 15.30 hours. The deputy manager was available throughout the time to aid the inspection process in the absence of the registered manager. During the inspection the inspectors were able to talk with and observe service users, relatives, staff members, the deputy manager, the administrator, the cook, the laundress, the head of domestic services and the handyman. A sample of residents’ files were case tracked, together with the viewing of staff rotas, training schedules, activity programmes, medication administration, maintenance records, accidents records, fire safety records, menus, complaints and staff recruitment processes and files. Evidence has also been gathered from the Annual Quality Assurance Assessment and from resident and staff questionnaires which had been returned to the Commission. During the inspection people using the service were asked how they wished to be referred to in this report, and the majority told the inspectors that they wanted to be called residents, and this has been reflected in this report. What the service does well: A tour of the premises, including the laundry and the kitchen, was undertaken and all of the rooms were clean with no offensive odours present anywhere within the home. During the inspection staff were observed to treat residents with kindness and respect. Residents generally appeared well dressed and groomed and happy. There was a real feeling of calm throughout the home with no resident being hurried at any time. Where possible the inspectors chatted to some residents, although this was difficult due to the varying levels of dementia, but it was evident from some of these discussions that generally residents liked the food and the care workers. Visiting relatives also spoke very highly of the care given at the home, the staff and the management team. One relative told the inspector “my wife has been here now for several months and I have no complaints. The care is very good and the staff are always kind and considerate to both my wife and myself.” Another relative told the inspector that “my father seems to be very happy and has settled well. He really enjoys the food and the staff are kind. If I had a complaint I Fountains Care Centre (The) DS0000063968.V357207.R01.S.doc Version 5.2 Page 6 would speak to the manager, but at this moment I have nothing to complain about.” All new residents receive a comprehensive needs assessment before admission. This is carried out by staff with skill and sensitivity. The manager ensures that a summary of any assessment undertaken through care management arrangements is received. For individuals who are self funding the assessment is again undertaken by qualified members of staff. Individuals are encouraged to be involved in the assessment process, and they, together with families, are invited to visit the home prior to making a decision to move in. Care plans and risk assessments are comprehensive and are being reviewed monthly, or more frequently if the need arises due to changing circumstances. Because of the change in ownership of the home, that is from Lifestyle Care to Southern Cross, the staff have worked extremely hard in ensuring that all information from the individual files has been transferred into the new documentation required by Southern Cross. The routines of daily living and activities are flexible and varied to meet the individual needs and capacities of residents. The intervention of other professionals within health and social care is sought whenever circumstances require this. The inspector was able to speak with a visiting general practitioner who said “this is a really good home, advice is always sought early and acted upon.” All residents receive a contract which gives clear information about fees and extra charges. Information can be provided in other languages and formats on request to the manager. There are two activity co-ordinators employed at the home, and these people are very proactive in organising and implementing activities for all of the residents. They are responsible for the production of a newsletter on a regular basis and also are involved in the family forums to which both residents and relatives are invited. Training courses for care workers is of a high standard, and this is given a high priority within the home. What has improved since the last inspection? Residents and their families are now more involved in the reviewing of the care plans, and this has been beneficial in improving care to the residents. The service has introduced an open door policy so that relatives and residents find it easier to discuss issues and to make suggestions for improvements to the service. Fountains Care Centre (The) DS0000063968.V357207.R01.S.doc Version 5.2 Page 7 The meeting of the spiritual needs of residents has improved with various ministers visiting the home on a regular basis. What they could do better: The production of menus and other information in a pictorial format would be beneficial to some of the residents, as would more relevant pictures for display around the home so that these are meaningful for people living with dementia. Such pictures can also be used as a point of reminiscence in activities with staff and residents. Signage on the dementia care units must be improved as there were no pictorial signs which would direct people with dementia to the toilets or other locations. The inspectors were told that work was ongoing with pictorial menus, but this was highlighted as an area for improvement at the previous inspection which took place in January, 2007. Although the annual quality assurance assessment states that the home has an equality and diversity policy, and that residents’ choices are taken into consideration in all areas this was not always evident during the inspection. For example, residents are asked in the morning what they would like for breakfast, lunch and supper. However, this is not a suitable method for residents living with dementia due to their short term memory loss. The serving of lunch was observed on both of the units for dementia and there was little evidence that residents were able to make a choice. They may very well have made a choice in the morning before breakfast, or in some cases the night before, but many would not have remembered this. It was evident that care workers were giving residents what they thought they liked. The introduction of the Mental Capacity Act 2005 must affect the way in which care is delivered by staff, and choices are made by residents. There was no evidence in the observation of care practices nor in records that these areas were consistent with the Mental Capacity Act code of practice. This was discussed at length with the deputy manager. There was evidence that some staff have undertaken training in this area, and that other training has been arranged for the remainder of the staff team. It is important that training received by staff is implemented by them. Although staff receive equality and diversity training, the implementation of this was not always evidenced during the inspection. For example, although staff were very kind to residents there was very little real interaction and engagement with residents on a general basis. This may be because of cultural differences between staff and residents. All of the current residents are white British but the majority of staff members are from many other cultures and races. It is essential that staff members have an awareness of the cultural needs of the residents, as this would enable them to more closely interact and engage with residents in areas other than personal care. Although many of the residents have a life history file, which has been developed by the activities co-ordinators, these should be further developed for all residents. These can only be done with the involvement of the resident, Fountains Care Centre (The) DS0000063968.V357207.R01.S.doc Version 5.2 Page 8 other staff members, relatives and friends. It is extremely important for people living with dementia to have family photographs and other mementos with them as these play an important part in their reminiscence activities. The more that staff know about each resident the better able they are to relate to him/her as an equal in the journey through dementia. Such life histories should be readily available to care staff and activity co-ordinators as they can be used in one to one reminiscence sessions with each resident. The taking of breakfast and lunch was observed by the inspectors, and it was apparent that on all units staffing levels were not adequate to meet the needs of the residents, many of whom require either assistance or supervision. This is an area which requires review. Although the general environment was clean and well maintained, the inspectors observed that some bedroom carpets, although clean, were very heavily stained and in need of replacement. 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. Fountains Care Centre (The) DS0000063968.V357207.R01.S.doc Version 5.2 Page 9 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 Fountains Care Centre (The) DS0000063968.V357207.R01.S.doc Version 5.2 Page 10 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): 2 and 3 (standard 6 is not applicable to this service) People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective service users and their relatives have the information required to enable them to make an informed choice about where to live, and do not move into the home without having had a comprehensive assessment of need undertaken, and been assured that these will be met. Both service users and their relatives have an opportunity to visit and assess the quality, facilities and suitability of the home before making a decision to move in. EVIDENCE: The statement of purpose and service users’ guide was available in the entrance hall, and these documents include detailed information about the service provided. They are also made available to all prospective residents and relatives. Before a decision is taken to accept a new resident, that person is invited to spend a day at the home, and a comprehensive assessment is Fountains Care Centre (The) DS0000063968.V357207.R01.S.doc Version 5.2 Page 11 undertaken to ensure that the person’s needs can be met. A member of staff helps them to feel comfortable in their surroundings, and endeavours to ensure that they are not unduly confused with too much information on admission to the home. On request, information can be provided in other formats and languages. Relatives and friends are told that their support and involvement in the continued care of the person living with dementia is important, and that they can bring in familiar objects that have real meaning to the person with dementia. Family forums are held at the home on a regular basis, and these are open to residents and relatives and friends. Residents and relatives are also encouraged to participate in monthly reviews of care. All residents are given a contract or terms and conditions of residency at the home. Such contracts are reviewed from time to time if circumstances change. Fountains Care Centre (The) DS0000063968.V357207.R01.S.doc Version 5.2 Page 12 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 and 11 People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The health, personal and social care needs of each service user are set out in an individual care plan. They can be assured that their health care needs are fully met, that they are protected by the home’s policies and procedures for the administration of medication, and that they will be treated with respect and their right to privacy upheld. Service users are also assured that at the end of life they and their family will be treated with care, sensitivity and respect. EVIDENCE: The home has recently implemented new care planning documentation due to the change in ownership of the service. Individual care plans were available for each resident and a total of 15 residents were case tracked, and their care plans and related documentation inspected. Care plans were generally comprehensive and covered health and personal care needs, and the social care needs of the individual to a lesser degree. The care planning documentation contains a ‘social’ care plan and where these had been completed, with the involvement of the resident and their families, they were Fountains Care Centre (The) DS0000063968.V357207.R01.S.doc Version 5.2 Page 13 very helpful in informing the care plan. Some social care needs had been identified in the life history profiles which had been completed for some residents by the activity co-ordinators. However, these records were kept in the activity co-ordinators’ office and were not generally accessed by the care staff. There was evidence that care plans were being reviewed on a monthly basis, or more frequently if necessary, and updated to reflect changing needs. There was also evidence that as far as possible, residents and or their relatives are involved in the drawing up of their care plan, and residents and relatives are routinely invited to attend six monthly reviews. Some residents had specific ‘night’ care plans, and this practice should be extended to all residents. The documentation/health records relating to wound management; management of insulin dependent diabetes; residents with behaviours that may challenge, a resident with communication difficulties, and three recently admitted residents were examined. The records for these residents were found to be very detailed and maintained up to date with regular reviews being undertaken which involved the resident, and or relatives. Continence programmes were in place for those residents who required them. The inspector sat and talked to several residents living with dementia, as far as their verbal and mental skills allowed, and these residents appeared relaxed and happy. One resident had become very attached to a doll that she saw as her baby and this certainly appeared to enable the person to maintain engagement with the world around her. In discussions with the nurses in charge of the two units caring for people living with dementia, they demonstrated an awareness that some behaviours in residents living with dementia, such as refusing food, quiet rocking, or really challenging behaviour, could be due to an individual experiencing discomfort such as pain or needing the toilet. Therefore, they were very well aware of the need to exclude this when trying to understand what residents are trying to express through their behaviour. As with the production of menus in pictorial format, so the manager may wish to give consideration to producing daily living tasks in a pictorial format, as this may assist in the continued independence of the person living with dementia. Risk assessments are being routinely undertaken on admission around nutrition, manual handling, continence, risk of falls and pressure sore prevention, and are being reviewed on a regular basis. Records are maintained of nutrition, including weight loss or gain with appropriate action being taken where necessary. Monitoring charts such as fluid intake/output; turning regimes and blood sugar monitoring, were up to date and being adequately maintained on all of the units. Files evidenced involvement from GP’s; tissue viability nurse; speech and language therapist, dietician; optical, dental/hygienist and chiropody services. One inspector took the opportunity to Fountains Care Centre (The) DS0000063968.V357207.R01.S.doc Version 5.2 Page 14 speak with a visiting GP who spoke positively about the quality of care being provided in the home and expressed no concerns. He told the inspector “Residents were referred to the surgery in a timely manner; any advice given was well received by staff and actioned accordingly to the benefit of the residents.” Good care was evidenced when observing staff carrying out their duties and residents physical care needs were being well met. All staff were seen to treat residents with kindness and respect, and residents appeared clean and well groomed. Staff ensure that care is person led, personal support is flexible, and is able to meet the changing needs of the residents. During the inspection it was observed that residents could choose when to get up in the morning. Staff respect people’s preferences and have knowledge about individual personal needs when providing support, including intimate care. The staff group was balanced to enable choice of male or female related preferences when delivering personal care. Necessary aids and equipment are provided to encourage maximum independence for all of the residents. Where necessary the use of assistive technology is used, such as the use of alarm mats where residents may be at risk of falling in their bedrooms. The inspectors spoke to a number of residents and asked about the care they receive in the home. Those residents not living with dementia spoke positively about the care and support they received. Comments included: “I am well looked after here”; “I want to stay as independent as I can, for as long as I am able but the staff help me when I need help”. One inspector was able to speak to several relatives who were visiting residents living with dementia, and all spoke very highly of the care delivered and the friendly, caring attitude of the staff. One relative told the inspector “my wife has been here now for several months and I have no complaints. The care is very good and the staff are always kind and considerate to both my wife and myself.” Another relative told the inspector that “my father seems to be very happy and has settled well. He really enjoys the food and the staff are kind. If I had a complaint I would speak to the manager, but at this moment I have nothing to complain about.” An audit was undertaken for the handling and recording of medicines within the home, and a sample of Medication Administration Record (MAR) charts were examined on each floor. Discussions with the deputy manager and the review of medication records showed that nursing staff are following policies and procedures, so as to ensure that residents are safeguarded with regard to medication. Medication audits are undertaken on a regular basis by the manager and deputy manager. The organisation has recently changed the supplier of the monitored dosage system used in the home and all nursing staff have received training in its use. Fountains Care Centre (The) DS0000063968.V357207.R01.S.doc Version 5.2 Page 15 From discussions with staff the inspectors are satisfied that residents are assured that at the time of their death they will be treated with sensitivity and respect, as would their families. It was also evident from discussions with the deputy manager that any person wishing to remain at the home rather than being transferred to hospital would be enabled to do so with the appropriate care being given and support for family, friends and staff. However, there was little other evidence in care plans that end of life had been discussed with either residents or their relatives. It is acknowledged that this can be a difficult and sensitive area but it is an important part of a person’s care plan and more consideration must be given to this area. End of life care planning is not just about the actual wishes after death, but the desired plan of care leading up to the process of dying and death. There was evidence that some staff have received training in palliative care. The manager is also directed to the guidance currently given by the Department of Health and the Commission for Social Care Inspection, which can be found on the respective web sites. Finally, the introducion of the Mental Capacity Act 2005 in October 2007 will impact on the delivery of care and the method of recording choices made by individual residents. This was discussed at length with the deputy manager and the inspectors are assured that this area will be addressed in accordance with the Commission’s guidance and the Mental Capacity Act 2005 code of conduct. Fountains Care Centre (The) DS0000063968.V357207.R01.S.doc Version 5.2 Page 16 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 and 15 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be assured that the lifestyle experienced in the home generally matches their expectations and preferences with regard to social, cultural, religious and recreational interests and needs. Generally residents are helped to exercise choice and control over their lives but this could be improved with a review of staff resources especially at peak times. Contact with family and friends and the local community is encouraged, and visitors to the home are made very welcome. Residents can be assured that they will receive a wholesome balanced diet in congenial surroundings, and at times convenient to them. EVIDENCE: There is a general programme of activities available for residents on all of the units, and these include singalongs, board games, bingo, drawing, quizzes and visiting entertainers. On the day of the inspection some residents were participating in a sing-a-long and playing musical instruments. However, with this exception there was little evidence of any other meaningful activities Fountains Care Centre (The) DS0000063968.V357207.R01.S.doc Version 5.2 Page 17 taking place in the home. Resources are available on each of the units but it was evident that unless the activity co-ordinators instigate an activity with the residents, then this does not generally happen. Resources such as magazines, puzzles, board games, cards and dominoes should be visible in lounges on all of the units. This may then encourage residents to use them with or without the help of care staff. It is also important for care to recognise the important part that they can play in the motivation of residents in daily living, and not feel that this is the sole domain of the activity co-ordinators. Some of the lack of interaction and engagement may be due to cultural differences, and these areas must be addressed during equality and diversity training so that care workers can gain a working knowledge of the cultural needs of the residents. The majority of the residents have had an activity assessment completed which is providing guidance on the appropriate level of activity for each individual. However, as previously stated these need to be more accessible to all staff, especially care staff, so that the information can be used in 1:1 reminiscence sessions taking place with people living with dementia. The purchase of items for a “memory box” such as various types of material, items of home equipment which may have been used by the residents in their younger days and old photographs of the 1920’s onwards could also be used as discussions points in reminiscence sessions with individual residents or small groups. These could be located in lounges so that residents themselves can ‘dip in and dip out’. Care plans included risk assessments around maintaining individual’s independence and choice. They detailed a good balance between managing such risks and respecting the individual’s choices around the life they wish to lead. However, records were not able to demonstrate the ability of all residents to make choices and how these were enabled. Again reference is made to the Commission’s guidance on the Mental Capacity Act 2005 and the Mental Capacity Act 2005 code of conduct. There are regular visits by local clergy and if any resident wishes to attend a religious service outside of the home then this would be arranged. Other annual festivals are celebrated and these include the birthdays of residents. The inspector was able to speak to several relatives and one said “I find the home very good and my father has settled very well, but activities could be improved. I have seen carers sitting in the lounge watching television with the residents, but not talking to them, or they may just sit and read a newspaper without involving any of the residents”, another said “staff are very good and the food is very nice and well presented”. Although there are set mealtimes, residents can exercise choice in relation to these as these are made flexible and varied to suit an individual’s preferences and capacities. Four meals per day are served and these are: Fountains Care Centre (The) DS0000063968.V357207.R01.S.doc Version 5.2 Page 18 • • • • Breakfast – between 8.30 a.m. and 9.30 a.m. (or later if desired) Lunch – between 12 noon and 1p.m. (or later if desired) Tea – between 5p.m. and 6p.m. (or later if desired) Supper – from about 8p.m. Drinks and snacks are freely available between these times, and during the night. The inspectors were able to observe both breakfast and the lunchtime meal being served on all units. The dining tables on the ground floor were laid prior to lunch, with cloths, napkins, condiments, cutlery and glasses. Some residents chose to eat in their rooms and meals were served to them on attractively laid trays. However, this was not the case on the two units caring for people living with dementia where the dining tables were not always appropriately laid, certainly not for breakfast. During the observation of breakfast on the 1st floor, at one point there were no carers in the dining room or the servery. Residents living with dementia were left unsupervised and without assistance. Drinks were not freely available, and some residents were having great difficulty in eating porridge which was very thick. In discussions with the deputy manager, the inspectors were informed that the home operates a policy of ‘protected mealtimes’ which means that staff should be fully engaged in serving and assisting residents. However, it was apparent that on all units many of the residents currently require either supervision or assistance with eating and the staff resources were not adequate to meet these needs, especially as staff also need to give assistance to residents who remain in their bedrooms either through choice or health reasons. Staffing levels must be reviewed to ensure that there are sufficient staff at peak times, such as mealtimes for those residents who need support. The same thought must be given to ensuring that dining tables are appropriately laid in the units caring for people living with dementia, as that given on the ground floor. It is acknowledged that this may cause extra work for staff as some residents would be prone to removing the cutlery and condiments, but for some of the residents it would be an indicator that a meal was going to be served. Menus were viewed and these did give a choice for residents. There is a fourweek menu cycle and a choice is offered at each meal. However, on the day of the visit the meal option for the lunchtime meal was either braised steak or lamb stew. There was no vegetarian or fish option for those residents who wanted an alternative to red meat. The inspectors were told that other choices were available if neither of the main dishes are liked, but again this would not have been apparent to residents living with dementia. As indicated at the previous inspection menus should be produced in pictorial format to aid choice, and another method of enabling choice is by the use of other senses such as Fountains Care Centre (The) DS0000063968.V357207.R01.S.doc Version 5.2 Page 19 smell, sight and touch of the actual meal. A choice of the two meals on offer could be put onto small plates which are then shown to the resident, so that he/she can make a choice at that moment by using the senses of smell, sight and touch. This was again discussed with the deputy manager who did inform the inspectors that work was currently in progress to produce pictorial menus. A visit was made to the main kitchen and the inspector was able to meet with the head cook and discuss the storage and preparation of food. She was fully aware of those residents requiring special therapeutic diets such as diabetic and gluten free. A cooked breakfast is available on Sundays and the take up request from all floors is relatively high. There are plans to extend this to another day in the week. However, with regard to the number of residents who choose to have a cooked breakfast on Sundays it would suggest that some residents might wish to have a cooked breakfast more often than twice a week. The use of full cream milk, butter and cream is used wherever possible to supplement the diets of those residents with reduced food intake/ diminished appetites. The cook has requested the purchase of a food blender so that she can prepare nutritional milkshakes/ fruit smoothies for those residents who are experiencing weight loss. There is little reliance on tinned, processed or frozen foods. Fresh fruit is provided daily and is also available on request. ‘Grazing’ boxes are delivered to each floor with the evening meal and include instant soups, crackers, cheese portions, and small packets of biscuits, raisins and savoury snacks. It was apparent from talking to some residents, relatives and staff that residents can choose when to get up and go to bed. Contact with family and friends, and the local community, is encouraged and periodic residents/relatives meetings are held and minutes are available to all relatives. A regular newsletter is produced and again this is available to residents and relatives. Currently children from several local primary schools visit the home and this appears to be welcomed by both the residents and the children. A visiting relative told the inspector “I am always made welcome and offered a cup of tea, or if the staff are busy, I know that I can go and make one for myself.” The annual quality assurance assessment also supports this, and also the fact that relatives, for a small charge, can choose to have a meal with their loved one. This has proved useful for one relative who visits the home every other day. The manager and staff were also very aware of the need to minimise any reduction in the freedom of residents to walk about the home, and realistic risk assessments are included in the care plans that balances safety with the individual’s right to be as free and in charge of their actions as possible. In order to improve the signage and décor in the home, especially on the units caring for people with dementia, the activity co-ordinators are endeavouring to Fountains Care Centre (The) DS0000063968.V357207.R01.S.doc Version 5.2 Page 20 locate art students who would be able to help with painting murals on some of the corridor walls. Fountains Care Centre (The) DS0000063968.V357207.R01.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, 17 and 18 People who use this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residentsand their relatives can be confident that their complaints will be listened to, taken seriously and acted upon and that they will be protected from abuse. Also that their legal rights are protected by enabling them to participate in the civic process if they wish, and that their rights to participate in the political process are upheld. EVIDENCE: Complaints and concerns made to the manager are always taken seriously, acted upon and viewed in a positive way. Where an incident needs external input from other agencies such as the Commission, local adult protection, then advice is sought in order to clarify difficult judgements. During the inspection the complaints log was viewed and it was evident that where a complaint had been received, this had been dealt with in accordance with the home’s policy and procedure. A review of the number and nature of complaints made is used as part of the quality assurance procedures and the home uses the complaints to improve its service. There is an open culture within the home where individuals feel safe and supported to share any concerns in relation to their protection and safety. This was supported through discussions with some staff and relatives. One relative Fountains Care Centre (The) DS0000063968.V357207.R01.S.doc Version 5.2 Page 22 told the inspector that “if I needed to complain I would not worry about repercussions for my relative, as I know that the manager would act appropriately.” Since the previous inspection in January, 2007, there have been adult protection referrals to the local authority. However, all of these were dealt with appropriately by the manager and the organisation. In discussions with the local authority adult protection co-ordinator, it was evident that the manager works co-operatively and openly with regard to adult protection concerns. Training records viewed and staff spoken to confirmed that all staff had received training in adult protection and recognising and reporting any adult abuse. This is especially important in the care of people living with dementia, since abuse is more likely to go unrecognised because of the inability of such residents to verbally express themselves. In discussions with the deputy manager and some staff, it was also apparent that they are vigilant to the possible abuse between resident and resident/s. Staff spoken to were able to demonstrate an understanding of what restraint is and alternatives to its use in any form are always looked for. The home fully respects the human rights of people using the service. Fountains Care Centre (The) DS0000063968.V357207.R01.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 and 26 People using this service experience good quality outcomes in this area. We have made this judgement using available evidence including a visit to the service. Service users live in a safe, generally well-maintained environment with sufficient and suitable lavatories and washing facilities. Any specialist equipment required by a resident is provided, and their bedrooms reflect their own choices with their own possessions around them. The home is clean, pleasant and hygienic. However, some of the bedroom carpets require replacement as these are heavily stained, although clean. EVIDENCE: The building was toured by the inspectors at the start of the visit, and all areas were visited again later during the day. There were no offensive odours and all parts of the home were clean and tidy. All of the bedrooms seen were very personalised and were reflective of the occupant’s interests, culture and religion. Although the housekeeping staff are constantly deep cleaning Fountains Care Centre (The) DS0000063968.V357207.R01.S.doc Version 5.2 Page 24 carpets, some bedroom carpets were badly stained and showing signs of wear. This was addressed with the deputy manager during the inspection, and she has undertaken to pursue this with the registered manager. The laundry area was visited and this was found to be clean, with soiled articles, clothing and infected linen being appropriately stored, pending washing. The laundry manager was aware of health and safety regulations with regard to the handling and storage of chemicals. Personal Protective Equipment (PPE) such as clothing, gloves, masks and goggles were available and in use. Hand washing facilities and alcohol sanitisers are prominently sited throughout the home, although several of these were found to be in need of replenishing. Staff were observed to be practising an adequate standard of hand hygiene. There were adequate supplies of disposable gloves, wipes and aprons and available at prominent sites throughout the home. A full time maintenance person is employed and there is an effective system in place for staff to report items requiring attention or repair. During the inspection work was progressing to provide a sensory garden for the added enjoyment of residents. However, more work is required around appropriate signage and décor on the two units caring for people living with dementia. Fountains Care Centre (The) DS0000063968.V357207.R01.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 and 30 People using this service experience good quality outcomes in this area. We have made this judgement using available evidence including a visit to the service. The procedures for staff recruitment are robust and provide safeguards for the protection of service users, and due to the training, numbers and skill mix of staff service users can feel that they are in safe hands. EVIDENCE: A record is maintained of staff training, and these showed that staff have undertaken training in essential areas such as manual handling, infection control, fire safety, health and safety, food hygiene and safeguarding adults. Six key members of nursing staff have undertaken training in vene-puncture; four members of nursing staff have attended a two-day training course at St. Francis Hospice around End of Life Care, and other care staff will attend a oneday course. The deputy manager has completed training in Understanding Dementia and this will be cascaded to all staff working in the home. All qualified nurses have received one day’s training from an Independent Mental Capacity Advocate (IMCA) around the recently introduced Mental Capacity Act 2005, and the impact it will have upon the delivery of care to vulnerable people. It is essential that all staff working in the home receive adequate and appropriate training in this important area, and that such training is implemented in the delivery of care and the daily recordings. Future planned training in Palliative Care, Dementia Awareness, Equality and Diversity and Fountains Care Centre (The) DS0000063968.V357207.R01.S.doc Version 5.2 Page 26 Understanding MRSA, has been sourced through the National College of Further Education. The AQAA completed by the manager stated that approximately 70 of care staff are qualified to National Vocational Qualification (NVQ) level 2 or above. The remaining care staff are currently working towards this qualification. Ancillary workers also participate in various training courses such as dementia care, moving and handling, COSSH requirements, infection control and adult protection. During the inspection there were times when there did not appear to be sufficient care staff on duty to meet the assessed needs of all of the residents. This was particularly around mealtimes when staff were not always on hand to give the required assistance to residents. In discussions with the deputy manager it was apparent that the home operates on a ratio of staff to residents, but staffing levels should be based on meeting the assessed needs of all of the residents. This should not just be the health and personal care needs, but also the daily life and activity needs of the residents. There is little use of agency staff and any gaps in the rota are generally covered by permanent staff. This has certainly been to the benefit of residents since it does provide consistency of care which is extremely important for all of the residents, but certainly for those people living with dementia. A random sample of the files of four staff recruited since the last inspection were examined. These were found to be in good order with necessary references, Criminal Records Bureau (CRB) disclosures, and application forms duly completed. Qualified nurses’ files included checks on their Nursing and Midwifery Council (NMC) PIN and Statement of Entry. Southern Cross Limited, as an organisation, employs a workforce from diverse cultures and backgrounds. However, it was apparent at the time of the inspection that the ethnicity of the nursing and care staff was different to that of the people living in the home. It is important that staff are able to understand and appropriately meet the needs of all residents, wherever possible around equality and diversity issues. This must be reinforced through staff training and supervision. This will ensure that the spiritual, cultural, sexual and any other diverse needs of residents at the Fountains is met through meaningful ‘person centred’ care. Staff skills around communication with residents could be improved as there was a lack of interaction and engagement observed during the inspection process. The manager has identified in the annual quality assurance assessment future plans for the continued staff development in areas such as equality and diversity, and self-motivation. Fountains Care Centre (The) DS0000063968.V357207.R01.S.doc Version 5.2 Page 27 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, 35, 36 and 38 People who use this service experience excellent quality outcomes. We have made this judgement using available evidence including a visit to the service. The home is run and managed by people who are fit to be in charge and able to discharge their responsibilities fully to the benefit of residents. Residents are safeguarded by the accounting and financial procedures of the home, including the management of their finances where necessary. Staff are appropriately supervised and the health, safety and welfare of service users and staff are promoted and protected. EVIDENCE: Since the last inspection there has been a change in both the ownership and management of the care home. However, it was still evident that the home continues to be very well managed and both the manager, the deputy manager Fountains Care Centre (The) DS0000063968.V357207.R01.S.doc Version 5.2 Page 28 and the organisation are keen to work in collaboration with external agencies and the Commission. Through staff training, supervision and good management staff are ensuring that residents receive a high standard of care and that the home is run in their best interests. The inspectors are confident that areas for improvement which have been identified in this report, will be positively received by the management and steps taken to address the issues. In discussions with the staff they said that the management style is open and inclusive and that they receive regular supervision. Supervision is undertaken by 1:1 sessions, direct observation of care practices, annual appraisals and group team meetings, and this was evidenced from viewing the staff files and records. Currently the manager does not act as an appointed agent for any resident. Resident’s financial affairs are managed by their relatives/ representatives. The home has responsibility for the management of personal allowances for several residents. Through discussion with the administrator and records inspected, there was evidence to show that residents’ financial interests are safeguarded, and that person allowances are well managed with invoices and records being accurately maintained. Secure facilities are provided for the safekeeping of money and valuables held on behalf of residents. A wide range of records were looked at including, fire safety; emergency lighting; recording of water safety temperatures; accident/incident reports; and lift/hoist servicing and maintenance. These records were found to be in good order and maintained up to date. The manager ensures that policies and procedures are reviewed on a regular basis and that she keeps up to date with new and changing legislation. Spot checks and quality monitoring systems provide management evidence that practice reflects the homes policies and procedures. Unannounced night visits are made to ensure that the care being delivered at night is also consistent with the ethos, policies and procedures of the home. The responsible individual regularly undertakes the regulation 26 monthly monitoring visits which are unannounced and are very comprehensive covering both the good areas and areas for improvement. Quality assurance questionnaires with staff, health professionals, relatives and residents, where possible, are undertaken and arranges relatives/residents meetings and uses the information gained to make any improvements or changes in the service delivery. Information gained from complaints, concerns and compliments are also used to influence service delivery. The health and safety of both residents and staff is a high priority and the manager ensures safe working practices by way of training and the provision of Fountains Care Centre (The) DS0000063968.V357207.R01.S.doc Version 5.2 Page 29 any necessary equipment, together with appropriate risk assessments which are regularly reviewed. From observation, records and discussions with staff, residents and relatives, it was apparent that staff at all levels have a good understanding of risk assessment processes which is underpinned by promoting independence, choice and autonomy. The annual quality assurance assessment has been comprehensively completed, and the management demonstrates a high level of self-awareness and recognises the areas that still need to improve. Fountains Care Centre (The) DS0000063968.V357207.R01.S.doc Version 5.2 Page 30 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 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 4 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 3 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 4 X 3 3 X 3 Fountains Care Centre (The) DS0000063968.V357207.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP19 OP27 Good Practice Recommendations That the organisation, together with the registered manager addresses the issue of heavily stained carpets in some of the bedrooms. That the registered manager addresses the issue of staff resources at peak times, especially around mealtimes, to ensure that all residents receive the level of assistance appropriate to their need. That the registered manager ensures that the requirements of the Mental Capacity Act 2005 are fully implement with all staff and residents, and that staff ensure that training is implemented, in fact, such as more meaningful interaction and engagement with residents. 3 OP30 Fountains Care Centre (The) DS0000063968.V357207.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU 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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