Inspection on 12/03/07 for Four Seasons

This inspection was carried out on 12th March 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Four Seasons 13/03/09

Four Seasons 07/03/06

Four Seasons 30/12/04

Four Seasons 21/07/04

Four Seasons 29/03/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Four Seasons 77 The Wood Meir Stoke-on-Trent Staffordshire ST3 6HR Lead Inspector Ms Wendy Jones Key Unannounced Inspection 12 March 2007 10:20 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 Four Seasons DS0000008231.V328079.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. Four Seasons DS0000008231.V328079.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Four Seasons Address 77 The Wood Meir Stoke-on-Trent Staffordshire ST3 6HR 01782 336670 F/P 01782 343133 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) Day Care Services Limited Lynne Chetwynd Care Home 22 Category(ies) of Dementia - over 65 years of age (6), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (1), Old age, not falling within any other category (22), Physical disability over 65 years of age (6) Four Seasons DS0000008231.V328079.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To accommodate one named person with a diagnosed mental disorder admitted in June 2006. 7th March 2006 Date of last inspection Brief Description of the Service: Four Seasons is a detached property, in a semi-rural setting in Stoke on Trent (south). It was opened in 1990 for up to 8 service users and two years later extended to accommodate up to 17 people over 65 years. Six months ago a further extension was completed increasing the number of beds to 22. The new extensions provides additional bedrooms, spacious and excellent lounge facilities, conservatory and additional dining room. All but 2 bedrooms have en-suite facilities. Two bedrooms are for shared use. There are now 3 lounges, 2 separate dining areas and conservatory. The first floor is accessible by staircase and shaft lift. Nursing care is not provided. The home is a family run business, which has been built upon its reputation for providing good quality care in a homely atmosphere. The pre inspection questionnaire identifies that the fees charged by the service Four Seasons DS0000008231.V328079.R01.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 visit of Four Seasons Residential home carried out over a period of 4 day’s, which included pre inspection planning, the site visit and post visit report writing. Six relatives and 5 residents surveys, were returned prior to the site visit and the inspector spoke to one health professional. The manager was present and three staff and seven service users were spoken to during this visit. The purpose of the inspection was to inspect the key standards for older people and to review the previous requirements and recommendations of the lat unannounced inspection carried out on 27 July 2006. A range of documents including care plans staff records training information policies and procedures and servicing documents were looked at. What the service does well: What has improved since the last inspection? The service has addressed all requirements from the last inspection. There is a photograph of each resident on their care file. Efforts have been made to Four Seasons DS0000008231.V328079.R01.S.doc Version 5.2 Page 6 include residents in the monthly reviews of care plans and the manager reported that improvements had been made to the to the laundry facilities. What they could do better: 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. Four Seasons DS0000008231.V328079.R01.S.doc Version 5.2 Page 7 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 Four Seasons DS0000008231.V328079.R01.S.doc Version 5.2 Page 8 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service have access to relevant information to support any decision to move to the home and have thorough pre admission assessments of need carried out to ensure their needs can be met. EVIDENCE: The service has a Statement of Purpose and Service user Guide in place, the manager indicated that all new residents have a copy of the guide, and these are stored in either the individual’s bedroom or on the individual care file. Both documents contain the necessary information in relation to the management arrangements, facilities, staffing and terms and conditions of residency. Mrs Chetwynd was asked to ensure that any changes required since the Care Homes Regulations 2001 were amended in July 2006 were made, copies of amended documents should be provided to all residents and to the Commission for Social Care Inspection. Four Seasons DS0000008231.V328079.R01.S.doc Version 5.2 Page 9 A sample of care files showed that the service has an assessment tool that meets the guidance in the national minimum standards for older people. There was evidence on the files of privately funded residents that the manager had undertaken a thorough assessment of needs. Mrs Chetwynd was asked to ensure that where she had assessed a service user as suitable and the home could meet their needs, that this is confirmed in writing to the individual. Two residents described their experience of their introduction and admission to the home and made comments like, “ staff made me feel very welcome,” “ I was given a lot of support,” “ I was able to visit the home before I chose to move here.” Four Seasons DS0000008231.V328079.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Residents’ health care needs are fully met. Residents, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Residents feel they are treated with respect and their right to privacy is upheld. Residents 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans are working documents, that are regularly reviewed and the individual resident is involved in this. Medication procedures are such that they ensure the safety and well being of residents. Residents are treated with respect. EVIDENCE: A sample of care plans showed that they reflect the assessed needs of residents at the home and there is evidence that relatives’ and some residents have been involved with care planning. Some examples showed that monthly reviews have not always been carried out, although this was the minority. There was evidence that the physical health needs of residents are well documented and met, and evidence that appropriate health professionals had been contacted to support the service and the individual. A health professional contacted prior to the inspection said that, “staff could usually be relied upon to act promptly if a residents condition had deteriorated and usually carried out instructions well.” Four Seasons DS0000008231.V328079.R01.S.doc Version 5.2 Page 11 Care files contained a photograph of the individual and the personal details section including some information on social and occupational background. There was evidence that individual residents and their families had been involved in the initial care planning and were always included in the annual reviews of care. Samples of daily records showed that staff were not always signing the record. This is important and staff should be reminded of this. In a communal handover file there were a number of entries that contained the personal information of people who use the service, this should not happen. This confidential information should only be recorded in individual care files. Medication records were appropriately maintained, with evidence that staff had signed the medication administration records (MAR) on each occasion that medication had been administered. Medication was stored in a locked cabinet. The temperature of the room in which the medication was stored should be monitored to ensure that it doesn’t exceed the recommended storage temperatures of medications. The manager agreed to monitor this and to take action to resolve the matter if necessary. Relevant staff had received training in the safe administration of medication and more training was planned. 7 residents were spoken to during this visit, they all expressed satisfaction in the service they received. Two residents discussed their experience of being admitted to the home and how they had been supported to adapt to receiving residential care. Another resident talked about the level of independence she felt she had achieved since being at the home. All residents (who were asked) knew who their key worker was and were complimentary about the manager, stating “ nothing is too much trouble, “ she puts herself out to make sure we are okay.” The visiting hairdresser stated that she visited the home regularly and felt that residents were happy and well cared for. Four Seasons DS0000008231.V328079.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 – 15 are: 12. 13. 14. 15. Residents find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Residents maintain contact with family/ friends/ representatives and the local community as they wish. Residents are helped to exercise choice and control over their lives. Residents 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported to maintain close relationships with relatives and friends. Activities are organised to ensure that those residents who wish to be involved, and those individuals who need more support receive it. EVIDENCE: Information in the pre inspection feedback indicated that residents are involved in a number of in house activities in the home, these included, bingo, quizzes, reminiscence, Hoopla, domino’s and other table top games. Shopping trips are also arranged, as are Theatre trips and meals out. One resident said she had been out of the home on a shopping trip, and others said they went out with their families. One resident confirmed that the manager took her out to do any shopping she needed to do. Staff were observed interacting with residents throughout the inspection visit, and one member of staff described how she was supporting a resident who had dementia care needs to continue playing the piano, a hobby she had enjoyed all her life. She also described how residents were involved in other activities and interests they had enjoyed prior to moving in to the home. Four Seasons DS0000008231.V328079.R01.S.doc Version 5.2 Page 13 The residents said that the manager took a real interest in ensuring that there were activities provided in the home, but also said sometime they were bored. It was also recognised that some residents made efforts to occupy themselves where others preferred to observe activities rather than interact or get involved. One resident enjoyed assisting the visiting hairdresser, and felt that this gave her a sense of purpose. Menu’s plans were available in the main kitchen and showed that a choice of meal was offered. Residents said “the food is good,” “ we have a choice and usually like what we are offered,” staff were heard to ask residents what they wanted to eat. Records showed that at meetings people who use the service are asked about meals and menu’s. Monthly food hygiene checks were carried out and recorded. Risk assessments are in place, fridge freezer temperatures are also recorded daily and food is labelled and dated when frozen. Some residents have access to the main kitchen, but this is not generally encouraged unless a risk assessment has been undertaken to ensure that the risk is acceptable. Four Seasons DS0000008231.V328079.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 – 18 are: 16. 17. 18. Residents and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Residents’ legal rights are protected. Residents 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints and Vulnerable adults procedures are in place to inform staff and to ensure that they are able to safeguard service users from the risk of abuse. EVIDENCE: A complaints procedure is displayed in the home and is included in the Statement of Purpose and Service User guide. Residents said that if they had any concerns they felt happy to go to speak to the manager about them. The complaints procedure in the home should be changed to show the Commission for Social Care Inspection not the National Care Standards Commission and should also be amended to show that the Commission for Social Care Inspection can be contacted at any time. No complaints have been received by the Commission for Social Care inspection in respect of this service, and the homes records showed that no complaints had bee made to the home. The manager was familiar with the Procedures for the Protection of Vulnerable adults agreed locally and said that staff had received training. No vulnerable adults investigations have been reported in this home. Four Seasons DS0000008231.V328079.R01.S.doc Version 5.2 Page 15 Four Seasons DS0000008231.V328079.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Residents live in a safe, well-maintained environment. Residents have access to safe and comfortable indoor and outdoor communal facilities. Residents have sufficient and suitable lavatories and washing facilities. Residents have the specialist equipment they require to maximise their independence. Residents’ own rooms suit their needs. Residents live in safe, comfortable bedrooms with their own possessions around them. Residents 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment was maintained to a good standard ensuring that people who use the service have a safe and comfortable place to live. EVIDENCE: Information in the pre inspection questionnaire and in discussion with the care manager during the site visit, indicates that since the last inspection some areas of the home have been redecorated and the laundry has been fitted with a washing machine with sluice facility. The home is in a good state of repair generally, clean and tidy and no major environmental changes have been made to the home since the last key inspection. Four Seasons DS0000008231.V328079.R01.S.doc Version 5.2 Page 17 The home has been extended over recent years and most bedrooms now have an en-suite facility. Two bedrooms are shared. All bedrooms have door locks and residents are offered keys. Bathing areas include a walk in shower facility on the first floor and an assisted bathroom on the ground floor. A third bathroom is not in use, because it has been deemed to be unsuitable. The provider has previously discussed his plans for this facility with the Commission for Social Care Inspection. But action has not been taken to make any changes. The provider should undertake the necessary work to make improve this facility for the benefit of residents. All communal areas, and a sample of the bedrooms on both floors were seen during this visit. A fire door by the hairdresser’s salon was not closing too properly, the manager was aware of this and discussed it with the provider for immediate action. This was addressed during this visit. A nurse call point in one bedroom had broken, this had also been reported to the provider, he attended to it during this site inspection. It was also established that the home’s fax machine had also broken and should be replaced. Bedrooms were well-personalised reflecting interests of residents. All were comfortable and well-furnished, the standards of hygiene and cleanliness throughout the home were high. At previous inspections there have been discussions regarding the use of the conservatory, residents do not often use this pleasant facility. The manager and staff stated that they had made efforts to encourage better use but had only been successful during the summer months. The main kitchen was showing signs of wear and looked a little tired, the manager stated that she understood the provider has plans to refurbish this area. This would be of benefit and ensure that good food hygiene standards are maintained. Residents said, “I like the home,” “ I have my bedroom how I like it,” “if I want a key to my room, I’ve been told I can have one.” Four Seasons DS0000008231.V328079.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Residents’ needs are met by the numbers and skill mix of staff. Residents are in safe hands at all times. Residents 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels are adequate and staff have received sufficient training to ensure the safety and well being of people who use the service. EVIDENCE: Staffing for the day of the site visit included the manager 9am-5pm, 2 x care staff from 8am until 10pm, the service provides 2 waking night staff. Staffing vacancies include 1x 18 hour cook vacancy and 30 hours care. During the site visit the manager was taking responsibility for the catering as her hours were supernumerary for that day. The manager reported that 8 out of 11 staff have trained to National Vocational Qualification (NVQ) level 2, exceeding the minimum of 50 of the workforce. The manager reported that 2 wanted to enrol on NVQ level 3. A sample of staff recruitment records showed that application forms had been completed, two written references had been sought, and a Criminal Records Bureau check had been applied for or received. Induction had been started and completed where appropriate this included health and safety and fire safety. A code of practice for social care workers had been given to each member of staff and there was evidence that proof of identity had been provided. Four Seasons DS0000008231.V328079.R01.S.doc Version 5.2 Page 19 The manager confirmed in the pre inspection information that most staff had a basic first aid certificate, but the majority needed to update the training in March or April 07. Other staff training undertaken since the last key inspection has included, risk assessment, dementia care, infection control, abuse and Vulnerable adults, mental health awareness and safe handling of medication. Four Seasons DS0000008231.V328079.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Residents 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. Residents benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of residents. Residents are safeguarded by the accounting and financial procedures of the home. Residents’ financial interests are safeguarded. Staff are appropriately supervised. Residents’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of residents 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management arrangements at this home are sufficient to ensure that people who use the service can be confident that their health and safety is assured. EVIDENCE: The manager of the service has been approved as a fit person and has undertaken the appropriate qualifications in care and management. Staff, residents and relatives hold her in high regard and confirmed that she actively addresses any issues bought to her attention. The health and safety policies and procedures in place are satisfactory, there is evidence that staff had been asked to read them and sign when they had done Four Seasons DS0000008231.V328079.R01.S.doc Version 5.2 Page 21 so. Insurance documentation for employer liability and public liability is up to date. Risk assessments are reviewed annually, and there is evidence that the service has complied with the requirements and recommendations of the last inspection and the Environmental Health Officer visit. Records showed that the hoists, bath and shaft lift were serviced regularly and Portable appliances had been tested in February 2007. The nurse call system had been due for a service in November 2006; this had not been carried out. In addition there were reported problems with the system that one of the providers was dealing with during this visit. The manager was asked that the servicing contractor is contacted to make arrangements for the routine service of the system to be undertaken. Monthly visits from the directors of the company are undertaken, copies of the reports of these visits are available in the home and are provided to the Commission for Social Care Inspection. The quality assurance system for this home was not checked during this visit, but the provider is remeinded that quality audits should be carried out and the outcomes of any audits should inform an action or annual development plan. Four Seasons DS0000008231.V328079.R01.S.doc Version 5.2 Page 22 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 3 3 2 X x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 2 X X 3 3 3 STAFFING Standard No Score 27 2 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 3 X X 3 X 3 3 Four Seasons DS0000008231.V328079.R01.S.doc Version 5.2 Page 23 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. Refer to Standard OP1 Good Practice Recommendations A review of the Statement of Purpose and Service user Guide should be undertaken to ensure that they provide up to date information. Provide in writing to the individual confirmation that the service can meet their assessed needs. People who use the service and or their representatives should be included in any review of their care plan. All entries made in the care records of people who use the service, should be signed by the person responsible for writing in them. People who use the service must be confident that their personal details are only recorded on their individual file and not in a communal record. Medication should be stored at recommended temperatures. Any plans to make environmental changes in the home to DS0000008231.V328079.R01.S.doc Version 5.2 Page 24 2. 3. 4. 5. 6 7 OP4 OP7 OP7 OP10 OP9 OP21 Four Seasons 8 9 OP30 OP20 improve the facilities for people who use the service should be discussed with the Commission for Social Care Inspection. Staff should receive up training up dates regularly. The fax machine should be replaced Four Seasons DS0000008231.V328079.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES 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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