Inspection on 03/01/07 for Fountains Care Centre (The)

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 Excellent. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Fountains Care Centre (The) 17/08/09

Fountains Care Centre (The) 16/01/08

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 The Fountains Care Centre 12 Theydon Gardens Rainham Essex RM13 7TU Lead Inspector Mrs Sandra Parnell-Hopkinson Key Unannounced Inspection 3rd January 2007 09:15 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Fountains Care Centre DS0000063968.V317734.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. The Fountains Care Centre DS0000063968.V317734.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Fountains Care Centre 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 manager.fountains@lifestylecare.co.uk Lifestyle Care PLC Ms Debbie Belinda Bantick 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) The Fountains Care Centre DS0000063968.V317734.R02.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 5th August 2005 Date of last inspection Brief Description of the Service: The care home was a new build in 2005, and is called The Fountains Care Centre and is owned by Life Style Care Plc. 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 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, and all of whom require nursing care. 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 were £695 per week, with additional fees for hairdressing and chiropody. The Fountains Care Centre DS0000063968.V317734.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection undertaken by the lead inspector, Mrs. Sandra Parnell-Hopkinson together with another inspector, Mrs. Gwen Lording, on the 3rd January, 2007 from 09.15 hours until 15.00 hours. The registered manager was available throughout the time to aid the inspection process, and at the beginning and end of the inspection the deputy manager was also present. During the inspection the inspectors were able to talk with and observe service users, relatives, staff members, the registered manager, the deputy manager, 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 and a pre-inspection questionnaire which was returned by the manager. The lead inspector also attended a residents/relatives meeting at the home in 2006. 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. The garden was well maintained with seating areas for residents. All staff were observed to treat residents with kindness and respect. Residents 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. This is a real achievement in a home which has a high number of residents living with dementia. 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 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. There was very good interaction between all of the staff, and between the staff and residents. At the end of the inspection the inspectors were able to provide feedback to both the registered manager and the deputy manager. The Fountains Care Centre DS0000063968.V317734.R02.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? 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. The Fountains Care Centre DS0000063968.V317734.R02.S.doc Version 5.2 Page 7 Life histories for each resident should be further developed, but these can only be done with the involvement of the resident, their 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 used in one to one reminiscence sessions with each resident. 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. The Fountains Care Centre DS0000063968.V317734.R02.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Fountains Care Centre DS0000063968.V317734.R02.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4 and 5 (standard 6 is not applicable to this service) Quality in this outcome area is good. This judgement has been made using available 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 include detailed information about the service provided and this is 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 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. The Fountains Care Centre DS0000063968.V317734.R02.S.doc Version 5.2 Page 10 The manager is currently looking at providing information in a simpler format for the benefit of the residents living with dementia. 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. Nurses, care staff and ancillary staff at The Fountains have undertaken training in caring for people living with dementia and are fully able to understand the constantly changing needs of these residents. The Fountains Care Centre DS0000063968.V317734.R02.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this 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: First and Second Floor units The files of four residents on each unit were inspected. All had a comprehensive assessment from which had been produced a comprehensive care plan which was regularly reviewed on a monthly basis, or more frequently if necessary, and had been updated to reflect changing needs and current objectives for health and personal care. The Fountains Care Centre DS0000063968.V317734.R02.S.doc Version 5.2 Page 12 It was evident that, as far as is possible, residents are involved in the drawing up and reviewing of their care plan, and relatives are invited to attend the annual reviews, and are kept informed of any intermediate changes. Service users are encouraged to remain as independent as is possible and are therefore assisted in undertaking personal and oral hygiene on a daily basis. It was evident from talking to staff that they considered this to be an important part of the care programme, even though it could be very time consuming in getting the individual to undertake these tasks themselves. Staff were very aware of the importance of listening to what the resident was saying, and getting to know the meaning of words and phrases used by an individual resident. From observation it was apparent that staff recognised the importance of maintaining eye contact and being on the same level, not hurrying or interrupting and ensuring that the resident had any aids they needed such as hearing aids, glasses and dentures. The inspector sat a talked to several residents 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. 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. Continence programmes were in place for residents who required these, and there were no offensive odours anywhere in the home. Wound care plans were very comprehensive and where necessary, advice from a tissue viability nurse is sought. Some residents had a behavioural care plan with the necessary risk assessment being undertaken. All residents are registered with a GP, and also have the services of an optician, dentist and chiropodist. Nutritional screening is undertaken on admission, and residents are weighed on a monthly basis so that weight increases and decreases can be monitored. Appropriate action is taken if necessary with the involvement of the GP, nutritionist or dietician. Residents are never sent to hospital or to attend appointments outside of the home without being accompanied. Wherever possible family and friends are encouraged to support these appointments, but where this is not possible then a member of staff will accompany the resident. In discussions with the nurses 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 needing the toilet. Therefore, they were very The Fountains Care Centre DS0000063968.V317734.R02.S.doc Version 5.2 Page 13 well aware of the need to exclude this when trying to understand what residents are trying to express through their behaviour. Staff were observed to knock on a bedroom door before entering, and obviously had a good knowledge and understanding of the needs of residents with regards to what they preferred to be called. Staff were seen to treat residents with respect, understanding and kindness. During discussions with some staff it was very evident that they enjoyed working with people living with dementia. The accident records were also inspected and these were well documented with details of the necessary action taken recorded. Second Floor Nursing Unit Residents health, personal care and social care needs are set out in individual care plans and provide staff with the information they need to satisfactorily identify and meet residents needs. The files of five residents were case tracked and were generally found to be detailed and comprehensive. There was evidence that care plans were being reviewed at least monthly, and more frequently if necessary, and updated to reflect changing needs. As far as possible, residents’ and or their relatives are involved in the drawing up of their care plan. The documentation/health records relating to wound management; nutrition; diabetes; and the file of a recently admitted resident were detailed and being adequately maintained. Whilst some care plans had recordings of sleep patterns there were no individual ‘night’ care plans. Risk assessments are routinely undertaken for all residents around nutrition, manual handling, continence, falls and pressure sore prevention; and reviewed on a regular basis. The management of risk routinely takes into account the needs of a resident, balanced with maintaining their independence and choice. Records showed that residents are seen by other health professionals such as Tissue Viability and Parkinson’s Disease nurse specialists; optical, dental and chiropody services. Weights are monitored monthly, or more frequently were indicated and a record is maintained, including weight gain or loss. The following issues were noted and discussed with the nurse in charge of the floor and fedback to the manager at the end of the inspection: • The care plan of a resident with Parkinson’s Disease should include a care plan clearly detailing the action for staff to take when the resident suffers sudden immobilising episodes of the condition, and ensure that any distress to the resident is minimised. A specific care plan must be developed for the management of a resident with an isolated infection. However, all staff were aware of eradication protocols and Universal Precautions in effective infection control. • The Fountains Care Centre DS0000063968.V317734.R02.S.doc Version 5.2 Page 14 Several residents were asked about the care they receive in the home. Comments included: “I am well cared for, the staff are kind and understand how I like things to be done”. Another said: “I see Debbie (the manager) or Veronica (deputy) every day without fail. If I have an issue it is sorted out straight away”. The inspector also had the opportunity to speak to the relative of a resident who had recently died. She spoke very highly about the manager and the care her mother had received whilst in the home: “ I am so pleased with the quality of care my mother received in the last few months of her life. She received excellent care from Debbie and all the staff”. General to all units The principles of respect, dignity and privacy were evidenced throughout the inspection. Staff talked about and were observed to treat residents in a respectful and sensitive manner. They were seen to be very gentle when undertaking moving and handling tasks and offered explanation and reassurance throughout the activity There are clear policies and procedures for the handling and recording of medicines. An audit was undertaken of the management of medicines on each floor of the home and a random sample of Medication Administration Record (MAR) charts were examined. The following issues were discussed with the manager and the nurse’s in charge of the particular floors: • • Where oxygen is in use in bedrooms a warning sign must be displayed on the door to indicate as such. Hand written entries on MAR charts must be signed and dated by the person making the entry. The entry must also include the source of the information. i.e. GP, registered nurse. It was noted that insulin in current use was being stored in the medicine fridge. In accordance with directions and the product license, some insulin products in current use must be stored at room temperature. This was confirmed by the inspector and the nurse reading the ‘pharmaceutical information’ regarding storage as included with the product. One resident in the home currently takes responsibility for his own medication. A current record is maintained of medication and a lockable facility is provided in which to store the medication in his room. There was a completed risk assessment on file however, it is recommended that such risk assessments be regularly reviewed to ensure that any changing needs are identified and addressed. DS0000063968.V317734.R02.S.doc Version 5.2 Page 15 • • The Fountains Care Centre The registered manager was given a copy of the Medical Advice Alert (MDA/2006/066) issued by the Medicines and Healthcare Products Agency (MHRA) on Lancing devices used in nursing homes and care homes for blood glucose monitoring. She confirmed that she had already received a copy of this alert and had taken the appropriate action. Monitoring charts were examined including fluid intake/output, turning charts and blood sugar monitoring charts. All charts were up to date but staff must record the amount of food intake as well as the type of food. On one chart staff entries included “porridge, soup, sandwich”. The amount of food taken by the resident must be clearly recorded for example, two tablespoons; large bowl; size and number of sandwiches. This detail of recording will ensure that an accurate record is being maintained of nutrition. The development of the night care plans was discussed with the manager and deputy. All residents should have individual night care plans which identify specific preferences, for example, times for getting up/ going to bed; night light to be left on; number of pillows; curtains not to be drawn at night; and night time drink before retiring. From viewing the care plans and talking to the manager and some staff, the inspectors were satisfied that residents who may be dying, are treated with care and dignity, and the necessary religious rites observed where appropriate. However, more detailed end of life care needs, in line with the Department of Health guidance, were discussed with the manager and she will now be developing more detailed care plans in 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. Staff may benefit from some additional training in this area and the registered manager is directed to the guidance currently given by the Department of Health and the Commission for Social Care Inspection, both of which can be found on the respective web sites. In discussions with the registered manager it was evident that any resident wishing to remain at The Fountains rather than being transferred to hospital would be enabled to do so with the appropriate services being provided. Support is also given to the families and friends of residents who may be dying as was evidenced by a conversation between an inspector and relatives of a resident who had recently died. Some cut backs in the services being provided by the local PCT are having an impact on the care homes. For example the manager has received a letter from the Havering PCT Chief Community Dietician saying that due to current shortages only emergency referrals will be dealt with and other referrals will be sent written information in the form of leaflets. The Fountains Care Centre DS0000063968.V317734.R02.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 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users 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. All service users are helped to exercise choice and control over their lives and to maintain contact with family and friends and the local community as they wish. They can be assured that they will receive a wholesome appealing balanced diet in congenial surroundings, and at times convenient to them. EVIDENCE: All Units There is a general programme of activities available for residents on both units, and these include singalongs, board games, bingo, drawing, quizzes and visiting entertainers. Day trips are also organised but these are less frequent because of the need to have 1 carer to 1 resident in view of the dementia suffered by the residents on these units. Some relatives volunteer to help on these outings. However, the manager may wish to give consideration to organising days out for much smaller groups on occasions. The Fountains Care Centre DS0000063968.V317734.R02.S.doc Version 5.2 Page 17 All of the residents on these two units have a diagnosis of dementia, and therefore, their concentration span is very short and this does make the organising of activities very difficult. All residents have had an activity assessment completed and this is providing guidance on the appropriate level of activity for each individual. There is currently one part-time activities co-ordinator but another has just been appointed. There is a sensory room and this is used from time to time for those residents living with dementia who would benefit from the use of the equipment in this room. This form of activity is always undertaken with a member of staff who has been trained in the use of such equipment. Staff do give great consideration and time to the retention of an individual’s daily living skills, and the task of assisting a resident living with dementia in washing and dressing can be very time consuming. The manager ensures that staff are given the time to sit and talk to residents on a small group or individual basis, and the further development of the life histories will help in this area. During the inspection it was observed that staff did spend time sitting and talking to either individual residents or a small group of residents. Activity resources are available on both units, and it is was noted that these are left out during the day so that residents can “dip in and dip out” as they wish, as the organising of a designated time can prove to be very difficult for those residents 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. 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 brother-in-law has settled very well”, another said “staff are very good and the food is very nice and well presented”, another said that “if I have any complaints I would know who to speak to, as the manager’s door is always open.” 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: The Fountains Care Centre DS0000063968.V317734.R02.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. Lunch was observed being served, and the meals were nicely presented and served and residents were not being hurried. Sufficient staff were on hand to give assistance where required. However, it would have been nicer for the residents if the tables had been appropriately laid prior to lunch. It is acknowledged that this may cause extra work for staff as some residents would be prone to removing the cutlery, but for some of the residents it would be an indicator that a meal was going to be served. Menus were viewed and these give a choice for residents, but there are also other choices available if neither of the main dishes are liked. 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 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. The cook is well aware of the recorded dietary and cultural needs of each resident and does listen to their comments about the meals, and makes adjustments and changes where necessary. The cook and care staff are also very aware of the importance of providing “finger” foods where residents are experiencing difficulty in using cutlery. Some residents have chosen to have some of their meals in their bedrooms. A visit was made to the main kitchen and the inspector was able to discuss the storage and preparation of food and menus with the head chef. She was fully aware of those residents requiring special diets for example; diabetic and coeliac diets and a list of such are prominently displayed in the main kitchen and servery kitchens. She demonstrated a good knowledge and understanding of the importance of well balanced, nutritious and well presented meals for older people. A recent development by the manager has been to provide the chef with a list of those residents who are losing weight or have a diminished appetite. In conjunction with advise from the PCT’s Dietetics Service, the kitchen staff are involved in drawing up care plans with nursing staff to address the nutritional needs of these residents. This includes preparing soups and desserts using nutritional supplements, the addition of milk powder and the use of full fat milk. The chef receives regular information regarding these residents and can evaluate the use of these supplements with nursing staff. There is little reliance on tinned, processed or frozen foods and fresh fruit is available each day. The Fountains Care Centre DS0000063968.V317734.R02.S.doc Version 5.2 Page 19 Some prepared food items being stored in the refrigerators were not labelled and the chef must ensure that all kitchen staff are made aware that this is a requirement. The report of a visit to the kitchen on the 24/10/06, undertaken by the London Borough of Havering’s Environmental Health Department stated, ‘Excellent standards found’. 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. The inspector was able to attend one of these meetings during 2006. It was a very active and lively meeting and relatives said how pleased they were with the home. It was obvious during the inspection that the preferences of residents are catered for, and staff are very aware that The Fountains is the home of the residents and try to make this as appealing as is possible. 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 in place that balances safety with the individual’s right to be as free and in charge of their actions as possible. The manager also ensures that the rights of all residents are recognised and addressed and balances the needs of all with the needs of individuals. Appropriate signage and décor is in place to aid the orientation of residents living with dementia, and the manager is constantly looking at ways to make improvements in this area. The Fountains Care Centre DS0000063968.V317734.R02.S.doc Version 5.2 Page 20 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 and 18 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users and 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. EVIDENCE: As part of the inspection process the complaints log was viewed and this was found to be comprehensive in that complaints are recorded together with the action taken to resolve them. There have been very few formal complaints, but where these have been received they have been responded to in writing. The complaints policy and procedures are available within the home to residents and relatives. Because of the difficulty of residents living with dementia to express verbally concerns or complaints, staff are very observant to the changing behaviours of residents in case they are unhappy, and also to comments being made by residents. For instance a resident living with dementia had repeatedly mentioned the name of a carer. Another carer had picked up on this and reported it to the manager. There was an investigation, which included the GP, in case any abuse had taken place, but this proved not to be the case only that the resident had had an infection and was sore when being washed. The Fountains Care Centre DS0000063968.V317734.R02.S.doc Version 5.2 Page 21 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. There is currently an adult abuse investigation being undertaken but it has not yet been finalised. The manager and her staff are to be commended on the way in which this has been dealt with as it has been a very difficult time for all at the home. 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 manager and some staff, it was also apparent that they are vigilant to the possible abuse between resident and resident/s. The manager does not act as appointee for any resident, but some personal expense monies is held for residents. The records for financial transactions were inspected and found to be in good order. The manager is very proactive on acquiring information and knowledge on new legislation, and was very informed on the new Mental Capacity Act which comes into effect in 2007. The promotion of the rights of the individual are paramount to the manager and staff at The Fountains and this was evidenced during the inspection process through observation and discussions with residents who were able, staff and relatives. The Fountains Care Centre DS0000063968.V317734.R02.S.doc Version 5.2 Page 22 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, 22, 24, 25 and 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users live in a safe, 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. EVIDENCE: A tour of the premises was undertaken and the home was found to be well-lit, clean, pleasant and hygienic with no offensive odours anywhere in the home. Specialist equipment such as hoists, handrails, signage and décor suitable for people living with dementia were evident, and any other equipment would be provided to enable a resident to maintain independence. The Fountains Care Centre DS0000063968.V317734.R02.S.doc Version 5.2 Page 23 There are 62 single bedrooms each with its’ own ensuite toilet and handbasin. All of the bedrooms are fitted with a call alarm system which is located within easy reach of each resident’s bed. There is a mixture of suitable baths and showers which gives a resident choice. The toilet door-frames have been painted in a different colour with appropriate signage to aid orientation for people living with dementia. All of the toilets were equipped with toilet paper, towels and soap, and hot water was plentiful. The manager and staff are proactive around infection control and staff have undertaken training in this important area. The manager is now looking at replacing pictures around the home to ensure that these are meaningful to residents living with dementia, and also will provide points of interest to them when moving around the home. Bedrooms have been personalised by the individual, and fixtures and fittings are of a good standard. Residents are encouraged to bring in some of their own furniture, and many rooms have photographs of family members. The lounge/dining areas are well furnished and carpets are not highly patterned which prevents visual disturbance. On each unit one lounge is kept as a quiet lounge for those residents who do not want to watch television, and it was nice to see that all of the communal areas were being put to good use. Residents were able to walk around the home freely without being told to “sit down” by care staff. The rear garden area is laid to paving and lawn and has sitting areas for residents. The front of the home is given over to car parking spaces. The laundry area was visited and this was found to be clean, with soiled articles, clothing and infected linen being appropriately stored, pending washing. Laundry personnel were aware of health and safety regulations with regard to handling and storage of chemicals. Personal Protective Equipment (PPE) such as gloves, masks and goggles were available and in use. During this visit, it was clear that the laundry personnel are doing a good job and clothes are obviously being well cared for. However, because of the lack of “marking” clothes with the name of the resident some clothes are not being returned to the correct owner. The manager is attempting to address this by informing relatives of the need to mark all clothing brought into the home; inviting relatives to identify any unmarked items of clothing, and is also considering the possibility of purchasing a labelling machine for use by laundry staff. Hand washing facilities are prominently sited and nursing and care staff were observed to be practising an adequate standard of hand hygiene. The Fountains Care Centre DS0000063968.V317734.R02.S.doc Version 5.2 Page 24 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this 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: The recruitment processes are very robust with the necessary application forms being completed, interviews undertaken and the required references and criminal records bureau disclosures obtained. All new staff undertake an intensive induction training in line with the Skills Council requirements, and shadow experienced care staff for the first few weeks of employment. A random sample of three personnel files of the most recently recruited staff were inspected. These were generally found to be in good order with necessary references and criminal records bureau disclosures. Application forms were duly completed but the manager must ensure that a full employment history is obtained, together with a satisfactory written explanation of any gaps in employment. From talking to staff, inspecting the training records and observation, it was apparent that staff have the opportunities to undertake various training courses, and that such training is then put into practice within the home. The Fountains Care Centre DS0000063968.V317734.R02.S.doc Version 5.2 Page 25 Some staff have undertaken intensive training in dementia care. Other staff have undertaken training in supervisory development, infection control, fire safety, manual handling, care planning, nutrition, adult protection, health and safety, food hygiene and reduced incontinence. Ancillary workers also participate in various training courses such as dementia care, moving and handling, COSSH requirements, infection control and adult protection. The handyman has recently completed a fire safety course and now has a certificate for Fire Marshall. At the time of the inspection there were sufficient staff on duty to meet the needs of the residents, and in discussions with the manager it was apparent that if additional staff are required at any time then such staff would be rostered. 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 people living with dementia. Approximately 50 of the care staff have been trained to NVQ level 2 and some to NVQ level 3, and the remainder of the staff are currently undertaking the NVQ level 2 qualification. All staff are given a copy of the General Social Care Council’s code of conduct and practice and are employed in accordance with this. The Fountains Care Centre DS0000063968.V317734.R02.S.doc Version 5.2 Page 26 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, 34, 35, 36, 37 and 38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this 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 service users. Service users 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: It was evident during the inspection that the home is being very well managed and both the manager, the deputy manager and the organisation are keen to work in collaboration with external agencies and the Commission. The Fountains Care Centre DS0000063968.V317734.R02.S.doc Version 5.2 Page 27 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. 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. The financial records for the maintenance of residents’ monies were inspected and these were found to be in good order with receipts being kept around expenditure. Maintenance records including fire safety, fire alarm testing, insurance, lift maintenance, electrical and gas checks, boiler, central heating systems and water temperatures were viewed and found to be up to date and in good order. PAT testing is also carried out annually. 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 by both the manager and the deputy manager 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. The manager undertakes quality assurance questionnaires with staff, health professionals, relatives and residents, where possible, 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 any necessary equipment, together with appropriate risk assessments which are regularly reviewed. Currently the manager does not act as an appointed agent for any resident. Residents’ financial affairs are managed by their relatives/ representatives. The home has responsibility for the personal allowance of several residents, which is usually managed by the home’s administrator. Through discussion with the manager and records inspected, there was evidence to show that residents’ financial interests are safeguarded in line with the organisations policies/ The Fountains Care Centre DS0000063968.V317734.R02.S.doc Version 5.2 Page 28 procedures. Secure facilities are provided for the safekeeping of money and valuables held on behalf of residents. There are small serveries on each unit but some of the food being stored in the fridges was not labelled or had exceeded their best by dates. Before the inspectors had left the home the manager had addressed this matter and had reviewed the procedures around the responsibility to monitor the cleanliness and appropriate storage of foods in these fridges. The Fountains Care Centre DS0000063968.V317734.R02.S.doc Version 5.2 Page 29 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 3 X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 4 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 3 4 X X 3 X 3 4 4 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 3 3 3 3 3 The Fountains Care Centre DS0000063968.V317734.R02.S.doc Version 5.2 Page 30 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. 1 Standard OP7 Regulation 15 Requirement The manager must ensure that the care plan of a resident with Parkinson’s disease should include details of action to be taken by staff when the resident suffers sudden immobilising episodes of the condition. Also to develop specific care plans for the management of a resident with an isolated infection. The manager must ensure that hand written entries on MAR charts are signed and dated by the person making the entry and that this must also include the source of the information, i.e. GP. Also that insulin in current use is stored in accordance with directions and the product licence. Also that risk assessments on residents who are self medicating are reviewed on a regular basis to take account of changing needs. Timescale for action 12/01/07 1 OP9 13(2) 12/01/07 The Fountains Care Centre DS0000063968.V317734.R02.S.doc Version 5.2 Page 31 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Fountains Care Centre DS0000063968.V317734.R02.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 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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