Inspection on 30/06/05 for Fourfields

This inspection was carried out on 30th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Fourfields 06/09/06

Fourfields 22/11/05

Fourfields 01/03/05

Fourfields 18/05/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Fourfields Rosedale Way Flamstead End Cheshunt EN7 6HR Lead Inspector Bijayraj Ramkhelawon Unannounced 30 June 2005 10:00 th 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 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. Fourfields I52 s19350 fourfields v236095 300605 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Fourfields Address Rosedale Way Flamstead End Cheshunt Hertforshire EN7 6HR 01992 624 343 01992 789 807 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Quantum Care Limited Carol Withers Care Home 52 Category(ies) of DE(E) Dementia - over 65 (52) registration, with number OP Old Age (52) of places PD(E) Physical Disability - over 65 (52) Fourfields I52 s19350 fourfields v236095 300605 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 01/03/2005 Brief Description of the Service: Fourfields is a purpose built home of six linked bungalow style units surrounding a central garden and including an administration block that has offices, a central kitchen and recreational facilities. The home, which is run by Quantum Care Ltd, provides personal care and accommodation for 52 older people. All bedrooms are for single occupancy, with the exception of one that is large enough to be a double room but it is only used as such when service users have made a positive choice to share. Fourfields blends in well with the other buildings on the Rosedale estate and has the benefit of a local bus service that passes the door. The home offers a safe and caring environment for its service users, some of whom suffer from dementia. Fourfields I52 s19350 fourfields v236095 300605 stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. There were 47 service users in the home of whom 2 were in hospital and one on holiday in Clacton. This was generally a positive unannounced inspection, feedback received from service users, their relatives and visitors was positive and the standard of care provided was good. The majority of time was spent talking to residents, visitors and staff. Some time was spent in the office scrutinising care plans, staff files and other records. Discussions were held with the manager who has recently been transferred from another home to whom feedback was given. However, there were areas for concerns which required to be developed. These included the management and administration of medicines, adhering to fire safety and food hygiene procedures and provision of training for staff. What the service does well: What has improved since the last inspection? What they could do better: The Statement of Purpose and Service Users’ Guide need to be updated when there have been changes in the management personnel. A robust system for administration and management of medicines must be in place including relevant training provided for staff and ensuring that a competence Fourfields I52 s19350 fourfields v236095 300605 stage 4.doc Version 1.40 Page 6 programme is carried out for staff. Staff must also be facilitated to attend training in ‘Protection of Vulnerable Adults’ as well as Fire Safety and Food and Hygiene Procedures. The redecoration programme as identified in this report must be carried out and monitored to ensure that these are attended to within a reasonable timescale. The home must ensure that adequate storage space is provided for aids and equipment. The staffing levels should be assessed and appropriately rostered to compliment the needs of service users at peak times and during the night. The care plans should be signed by the service user or their relatives/representatives to confirm agreement/acceptance. Individual service user‘s weight should be checked and monitored on a regular basis. The home should also ensure that a weekly programme of activities is displayed within the home so that service users are aware of what activities are available to them. Risk assessments should be reviewed on a regular basis so that up to date guidance is available to staff. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Fourfields I52 s19350 fourfields v236095 300605 stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Fourfields I52 s19350 fourfields v236095 300605 stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1-5 Adequate information was available to prospective service users and their relatives to assist them in their decision making process when chosing the home. Each service user has a detailed assessment of needs carried out by the home prior to an offer of placement is made. However, the Statement of Purpose and Service User Guide must be updated to reflected the recent management changes. EVIDENCE: There is a Statement of Purpose and a Service Users Guide. However, both these documents were not updated to reflect the recent management staff changes. Service users were given a statement of Terms and Conditions and a contract. These documents gave details of their rooms, the care and other services that they will receive, including the fees payable and the terms and conditions of occupancy and the liabilities if there is any breech of contract. Service users’ have had their assessment of needs carried by the home’s staff prior to an offer of placement being made. Fourfields I52 s19350 fourfields v236095 300605 stage 4.doc Version 1.40 Page 9 There is a stable group of experienced staff who have developed a good understanding of the service users needs and of how these should best be met. Relevant training was also provided to care staff. Service users spoken to confirmed that they and their relatives had the opportunity to visit and view the home before they agreed to reside at the home. Fourfields I52 s19350 fourfields v236095 300605 stage 4.doc Version 1.40 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. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7-11 Service users observed during the course of this inspection appeared to be well cared for, were comfortable and received care and attention in a timely manner. Good care practices and interactions were observed. Care plans were comprehensive but had not been signed by individual service user and or their relatives or representatives (if any) to confirm agreement with the plan. Service users’ weights was not monitored and recorded on a regular basis. Records of medicines including the receipt, storage and disposal were kept in good order. However, the practice observed during administration of medicines by staff was unsafe, unhygienic and against the guidelines set by the Royal Pharmaceutical Society. There is a need to provide additional training and a competence audit to be carried out for those who administer medication to service users. EVIDENCE: Care plans examined were found to be well documented. These were reviewed and updated on a regular basis to reflect the changing needs of service users. However, the care plans were not signed by the service users, nor their relatives or representatives. It was noted that service users weights were not checked and monitored on a regular basis. Weight is a good indication of a Fourfields I52 s19350 fourfields v236095 300605 stage 4.doc Version 1.40 Page 11 persons general well being and helps to ensure that nutritional needs are being monitered and met. All service users were registered with a GP, the District Nurses visit the home to provide treatment to service users who required nursing care and offered assistance with specialist equipment and advice to staff. A ‘knock and wait’ policy is in place and staff were interacting with service users in a professional manner so as not to override their dignity or privacy. The Monitoring Dosage System was in use. During the inspection the administration of medicines was observed in the presence of the manager. The practice was very unsafe, unhygienic and the guidelines set by the Royal Pharmaceutical Society were not followed. Tablets were placed on the palm of the hand and then in measuring cups which were left on the dining tables in front of the service users. The staff did not check to ensure that the medicines were taken by the service users but the MAR sheets were signed as given. There were gaps in the MAR sheets with no reasons entered for these omissions. There was one service user who was on Warfarin but no risk assessment had been carried out, nor any instructions for staff what they should do if the service user had a fall or bruising etc. The policy and procedure for the administration of medicines did not indicate that all medicines must be kept for 7 days in an event of a death. It was also noted that medicines dispensed in ordinary containers were not dated when first opened. Fourfields I52 s19350 fourfields v236095 300605 stage 4.doc Version 1.40 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12-15 The staff promote service user autonomy and choice. Integration within the local community is also encouraged in accordance with service users preferences and regular outings in small groups or on one to one was provided as often as possible. However, a weekly programme of planned activities should be displayed as information to all service users, relatives and visitors. EVIDENCE: The continued benefits being derived from the recent increase in activity organiser hours was mentioned by several staff and by some of the visitors. Staff reported that they had planned a programme of outings and visits using the homes bus. Relatives and visitors spoken to were complimentary of the service provision. The home continues to benefit from the involvement of local community groups who raise funds and assist with development projects. The creation of a sensory garden in one of the enclosed forecourts was a particularly notable achievement, which added considerably to the ambiance of that area of the home. However, there was no programme of planned activities displayed as information to service users, relatives, visitors and staff. The service users were encouraged to retain personal autonomy and choice wherever possible and this was seen to be demonstrated in the personalisation of their rooms with small items of furniture, ornaments and pictures etc. Fourfields I52 s19350 fourfields v236095 300605 stage 4.doc Version 1.40 Page 13 Most of the existing service users have family or friends who assist them with their finance. Thre are links with the Advocacy service provided by Age Concern but no service users were using this service. Service users spoken to commented favourably on the meals, also that there was always plenty of food and it was very tasty. Fourfields I52 s19350 fourfields v236095 300605 stage 4.doc Version 1.40 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16-18 A robust complaints procedure is in place of which all service users and visitors spoken to were aware of. The manager has been recently appointed and has a presence within the home, thus safeguarding service users. However, all staff must be facilitated to attend the training in Protection of Vulnerable Adults. EVIDENCE: A copy of the complaints procedure was available to prospective and current service users. Those spoken to said that they were aware of the complaints procedure but would prefer to speak to a member of staff or the manager if they had any concerns. There were two complaints received since the last inspection which were fully investigated and both complainants informed of the outcome. Staff spoken to said that they had not received training on ‘adult abuse’. This must be addressed so that service users are fully protected and safeguarded. Fourfields I52 s19350 fourfields v236095 300605 stage 4.doc Version 1.40 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19-26 The home and its surroundings offer a pleasant, comfortable and safe environment to its service users. The home was kept reasonably clean and bedrooms were personalised offering a homely, lived in feel. However, the paintwork in the communal areas (e.g. skirting boards, doors and doorframes) required attention. Adequate storage space for aids and equipment including wheelchairs is not availble so this often impacts on living ‘space’ reducing the amount of room available. EVIDENCE: During the inspection, it was noted that there had been a leak in the back corridor and all electrical equipment was being made safe. The home provided adequate communal space to meet the requirements of this Standard although some units where the service users have a number of items of mobility equipment were very crowded. One service user commented that ‘I can hardly move around my chair. There is no space around me’. Fourfields I52 s19350 fourfields v236095 300605 stage 4.doc Version 1.40 Page 16 Equipment was stored along the corridors and on one unit the fire exit door was completely blocked (see Standard 38). Adequate numbers of toilets, washing and bathroom facilities to meet the requirements of this Standard are provided and these meet the needs of the service users. The size of some of the toilets was insufficient to enable a carer to be present in the room to assist the service user without the door being left open. Staff were aware of the privacy implications that this created and wherever possible avoided using the toilets where service users required assistance. As all accommodation are provided on the ground floor, no passenger lift is required. The bedrooms were for single occupation and these met or exceeded the minimum space requirement. Grab rails and other aids are provided in corridors, bathrooms, toilets, communal rooms and in bedrooms according to the assessed needs of the service users. Assessment of these needs were carried out by occupational therapists. Despite the routine maintenance programme of the home, many areas of the paintwork on the doors, doorframes and skirting boards along all the corridors have a very scuffed and chipped appearance and were in need of repainting. Fourfields I52 s19350 fourfields v236095 300605 stage 4.doc Version 1.40 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27-30 The skills and experience of staff was varied. There was an enthusiastic management team and the care staff were dedicated and caring. However, staffing levels should be reviewed to ensure that the increased care needs of service users can be adequately met. EVIDENCE: Staff spoken to commented that the level of care needs of the service users had increased and it was noted that there were times when service users were left without supervision. However, the manager was able to provide additional cover when required but it was noted that there are only 4 staff on duty during the night to cover 6 units. The comments from many of the relatives gathered during the quality assurance forum also confirmed this. Staff seem to have too much work“ and “they are rushed off their feet and this makes their care tasks very difficult as older people cannot be hurried.” The home was carrying a number of care staff vacancies, which the manager said was endeavouring to fill. All staff have a training needs profile that was reviewed annually. Staff confirmed that they expected to attend training and that they did so for more than the required three days per year. Several staff commented that the training opportunities offered to them were very good. As previously stated training in the protection of vulnerable adults has yet to be provided to all staff. Fourfields I52 s19350 fourfields v236095 300605 stage 4.doc Version 1.40 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31-38 The manager is new to the home although she has many years of experience in managing similar care homes. She has identified a number of areas for development and she said that she is very enthusiastic about her new post. She stated that she was in the process of making changes to ensure that the home meets the National Minimum standards and would continuously seek improvement in the quality of service delivery. However, there were areas of concerns which included that fire exits must not be obstructed but kept clear at all times and that the bolt on the bedroom door must be removed. Fridges and freezers temperature must be checked on a daily basis with records kept to ensure compliance with food hygiene procedures. It was recommended that risk assessments should be reviewed on a regular basis. Fourfields I52 s19350 fourfields v236095 300605 stage 4.doc Version 1.40 Page 19 EVIDENCE: Staff spoken to displayed a positive attitude to their work and seemed more than willing to work cohesively together to ensure the good quality of care is provided. The records showed that staff meetings were being held and that these were well attended and that a variety of staff made a good contribution to them. The manager has an open-door policy where staff could see her at any time with any issues or concerns they may have. Service users and their relatives have commented positively on the good practices and quality of service provision. The company operates a quality monitoring audit, which includes seeking the views of the service users and their relatives on a regular basis. The views of new service users and their relatives were particularly sought. The home also hosts an annual Forum meeting led by a company Director to which relatives and stake holders in the home were invited. It was noted that the fire exit in one area of the building was blocked and obstructed by equipment and wheelchairs. It was also noted that one of the bedroom doors was bolted from outside, this is unsafe practice and if the service user wishes to lock their door they should be provided with a key. The temperature of the fridges and frezeers in the units were not checked, monitored nor recorded. Risk assessments were not reviewed on a regular basis. Fourfields I52 s19350 fourfields v236095 300605 stage 4.doc Version 1.40 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 3 3 2 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 2 3 3 3 3 3 3 3 1 Fourfields I52 s19350 fourfields v236095 300605 stage 4.doc Version 1.40 Page 21 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP 1 Regulation 6(a) Requirement The Statement of Purpose and Service User Guide must be updated to reflect the recent management changes (outstanding from last inspection of 01/03/2005). Medicines must be administered as prescribed and the reasons for any omissions must be recorded. Risk assessments must be carried out for service users who are on anticoagulant (Warfarin) medicine. Policy and procedures in medicines must include that all medicines must be kept for 7 days in an event of a death. Medicines dispensed in ordinary containers must be dated when first opened for ease of reconciliation and auditing. An audit of competence in the administration of medicines must be carried out and further training provided where necessary. All staff must be facilitated to attend the training in Protection of Vulnerable Adults. Paintwork in communal areas Timescale for action 30/09/05 2. OP 9 13 (2) 30/06/05 and Henceforth 30/06/05 and Henceforth 30/09/05 3. OP 9 13 (2) 4. OP 9 13 (2) 5. OP 9 13 (2) 30/06/05 and Henceforth 30/09/05 6. OP 9 13 (2) 7. 8. OP 18 OP 19 13 (6) 23 (2) (d) 30/09/05 30/09/05 Page 22 Fourfields I52 s19350 fourfields v236095 300605 stage 4.doc Version 1.40 9. 10. 11. 12. 13. OP 22 OP 38 OP 38 OP 38 23 (2) (l) 23 (4) (b) (e.g. skirting boards, doors and doorframes) must be repainted (outstanding from last inspection of 1st March 2005). Suitable provision must be made for storage. Fire Exits must not be obstructed but kept clear at all times. 25/11/05 30/06/05 and Henceforth 30/06/05 and Henceforth 30/06/05 and Henceforth 13 (4) (c ) Bolt on bedroom door must be removed. 13 (4) (c) Fridge and freezers temperatuire must be checked on a daily basis with records kept. 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. 3. 4. 5. 6. Refer to Standard OP 7 OP 8 OP 12 OP 27 OP 38 OP 38 Good Practice Recommendations Care plans should be signed by the service user and or their relatives or representatives. Service users weights should be checked and monitored on a regular basis. A weekly programme of activities should be displayed within the home. Staffing levels should be reviewed to ensure that the increased care needs of service users can be adequately met (outstanding from last inspection). Fire Safety training should be reinforced to all staff working at the care home. Risk Assessments should be reviewed on a regular basis. Fourfields I52 s19350 fourfields v236095 300605 stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection Mercury House 1 Broadwater Road Welwyn Garden City AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Fourfields I52 s19350 fourfields v236095 300605 stage 4.doc Version 1.40 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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