Inspection on 06/09/06 for Fourfields

This inspection was carried out on 6th September 2006.

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 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 22/11/05

Fourfields 30/06/05

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 Hertfordshire EN7 6HR Lead Inspector June Humphreys Key Unannounced Inspection 13:00 6 September 2006 th 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 Fourfields DS0000019350.V307739.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. Fourfields DS0000019350.V307739.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fourfields Address Rosedale Way Flamstead End Cheshunt Hertfordshire EN7 6HR 01992 624 343 01992 789 807 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) www.quantumcare.co.uk Quantum Care Limited Ms Carol Withers Care Home 52 Category(ies) of Dementia - over 65 years of age (52), Old age, registration, with number not falling within any other category (52), of places Physical disability over 65 years of age (52) Fourfields DS0000019350.V307739.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd November 2005 Brief Description of the Service: Fourfields is a purpose built home comprising six linked bungalow-style units surrounding a central garden, an administration block containing offices, a central kitchen, laundry and recreational facilities. The home, which is run by Quantum Care Ltd, provides personal care and accommodation for up to 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 in Cheshunt. Local amenities are nearby and a local bus service passes the door. The home offers a safe and caring environment for its service users, some of whom suffer from dementia. Fourfields DS0000019350.V307739.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report contains the outcomes of the unannounced key inspection completed on 6th September 2006. Evidence gathered during the inspection included: • Observation of interaction between staff and service users, • Individual interviews with four service users, and four support workers • A detailed discussion with the registered manager • A look at relevant documentation maintained in the home. • Paper evidence received by the CSCI from the service since the last inspection on the 22nd November 2005. The inspection indicated that the current service was of a very good standard; Service users spoken to expressed satisfaction with the home, and the service provided. Records and documents were looked at in detail, including a sample of care plans, three staff files and supervision records, the staff rota, complaints, medication and accident records. Significant improvement was seen in the administration and recording of medication. There remains an outstanding requirement with regard to the provision of storage in the home. The manager is trying to address this with additional storage being provided in the garden. What the service does well: Care plans adequately reflect how individual needs will be met. Life story information seen was detailed. The care team are committed to supporting service users who suffer from dementia. Many staff have received training in this specialist area of work. Fourfields DS0000019350.V307739.R01.S.doc Version 5.2 Page 6 Staff clearly work hard to try to meet individual service users requests; a range of activities are offered throughout the day, and the service employs an activity co-ordinator. The home was clean and well maintained, nicely decorated and odour free on the day of inspection. What has improved since the last inspection? What they could do better: The overall environment is of a good standard. There were a few requirement made regarding the safety of the patio area in two of the units, and also the fitting of blinds in one of the corridors. Storage space remains insufficient for the needs of the home and the requirement made, has been outstanding over several inspections. Please contact the provider for advice of actions taken in response to this Fourfields DS0000019350.V307739.R01.S.doc Version 5.2 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Fourfields DS0000019350.V307739.R01.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 Fourfields DS0000019350.V307739.R01.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 The service provides a detailed guide. It is good example, which explains the type of service available. Perspective service users, and relatives are encouraged to visit prior to admission. A comprehensive assessment is carried out prior to admission. Intermediate care is not offered as part of the service. (Standard 6) The quality in this outcome group is good; this judgement has been made using all available evidence including a visit to this service. EVIDENCE: An updated Statement of Purpose and Service User Guide are available to prospective residents, copies of these documents have been provided to the CSCI. Service users and their relatives and supporters are invited to visit the unit before making a decision to move in. A new service user stated that the staff Fourfields DS0000019350.V307739.R01.S.doc Version 5.2 Page 10 made a “great deal of effort to make her feel welcome when she first moved in”. Fourfields DS0000019350.V307739.R01.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Care plans adequately reflect how individual needs will be met. Dignity of service users is seen has a priority, and was consistently observed. Service users spoken to appeared satisfied, and pleased with the service they received. Information in daily recoding notes could be improved. The system for administering and recording of medication has significantly improved. The quality in this outcome group is good; this judgement has been made using all available evidence including a visit to this service. EVIDENCE: Six care plans were looked at as part of the inspection process. Two care plans were in the old format, and four were in the newly introduced style. Two care plans were of two service users suffering from dementia. It was evident that the new format provided greater detail, and was much easier to read. The care plans were clear and information could be easily Fourfields DS0000019350.V307739.R01.S.doc Version 5.2 Page 12 tracked from care plan, risk assessment and case notes. Care plans seen had been signed either by the service user or relative. Staff monitor and record the progress of service users and action had been taken where necessary, however daily recordings by staff were basic, and did not relate to the goals set in the care plans. The manager agreed to discuss daily recording with the staff team to try to improve this area of work, which will simplify work required prior to review. The care plans included full family and social histories that help care staff to work with service users with greater understanding and sensitivity. Staff raised this when interviewed has being important for the service users suffering from dementia which showed an example of increased understanding. Observation of the care staff at work showed that interaction with service users was caring and respectful. Personal care was delivered discreetly and appropriately in keeping with peoples needs. Feedback from service users spoken to was positive. The previous requirement with regard to the administration and recording of medication has now been met. The manager has invested considerable effort to improve standards in the home in relation to medication. This was evident in the new audit, which is now in place, and also the individual medication files for each service user. Fourfields DS0000019350.V307739.R01.S.doc Version 5.2 Page 13 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 the following standard(s): 12,13,14 and 15 Service users are able to make choices about their lifestyles in the home and are encouraged to do so by the care staff. Service users can maintain contact with family and friends outside the home and involvement with the local community is encouraged. Service users dietary needs are met. The menu has been reviewed, and provides greater variety. The quality in this outcome group is good; this judgement has been made using all available evidence including a visit to this service. EVIDENCE: The inspectors observed a range of activities being offered on all six units on the day of the inspection. Quantum Care Ltd employs two activity cocoordinators. A weekly programme of activities was on display, as well as adhoc activities that had been organised involving outside speakers and guests. A regular newsletter is produced to inform service users and relatives about what is happening in the home. Fourfields DS0000019350.V307739.R01.S.doc Version 5.2 Page 14 Staff clearly work hard to try to meet individual service users requests; and activities were changed after consultation at service user meetings. One service user said that all her needs were well met “there’s entertainment daily but I do prefer to read”. Mealtimes are flexible to suit personal choice; breakfast is prepared in the unit kitchen when people are ready to eat, and Service users get up when they chose. The manager advised that unit kitchens were being refurbished to allow staff to assist service users allowing greater variety and choice. One service user said the “staff are very nice, and the food is good”. This is an area of improvement since the last inspection. Fourfields DS0000019350.V307739.R01.S.doc Version 5.2 Page 15 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 the following standard(s): 16 and 18 Service users, their families and friends can be confident that they will be protected from abuse and that staff will listen to complaints, and that they will be dealt with. The quality in this outcome group is good; this judgement has been made by using all avaliable evidence including a visit to the service. EVIDENCE: The manager stated that she fully investigates all complaints, and is keen to resolve any concerns. The company has a robust procedure in place to ensure all complaints are fully investigated. Three complaints had been received since the last inspection and the recording associated with the complaints was looked at on the day of inspection. One complaint had not been referred to the vulnerable adults procedure and an e -mail had been sent reminding the service of their duty to do this. There is an adult protection policy and procedure in place and staff spoken with at the inspection showed a clear understanding of their responsibility in respect of abuse recognition and prevention. They also confirmed that they receive training in handling POVA issues and staff interviewed had a good understanding of the process to follow. Fourfields DS0000019350.V307739.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. 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 the following standard(s): 19 and 26 The home was clean and well maintained, nicely decorated and odour free. Blinds/shading is to be provided in one of the communal areas that link the units together. A requirement has been made in relation to this. The quality in this outcome group is adequate; this judgement has been made using all available evidence including a visit to this service. EVIDENCE: On the day of the inspection the home was clean, fresh and well maintained. The grounds are well maintained with service users having level access to an outside garden area in each unit, and the staff has developed a sensory garden. Fourfields DS0000019350.V307739.R01.S.doc Version 5.2 Page 17 The environment is well designed for the needs of older people who may have restricted mobility and confusion and service users are able (should they chose) to walk through from one unit to another by linking corridors. One of these communal areas needs blinds/shading to ensure it can be used safely during the summer months. The unit is decorated and equipped to a high standard and has a comfortable and homely atmosphere, with a range of equipment available to assist staff when working with people with a physical disability. Service users bedrooms seen were personalised and individualised in their décor. Two service users interviewed were clearly very pleased with their recent re-decoration. A maintenance programme is in place and refurbishment is therefore on going. A requirement was made at the last inspection with regard to the shortage of storage space in the home. This has yet to be addressed and a repeat requirement has been made. Patio doors have been put into the dining areas in units one and four. (Aragon and Boleyn) This is very nice for service users, as they now can eat with the doors open. It also makes easy access to the garden. However the patio area had not been made safe on the day of inspection and until this work has been finished access to the garden is unsafe. Fourfields DS0000019350.V307739.R01.S.doc Version 5.2 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 The policies and procedures relating to recruitment meet the requirements of the national minimum standards, and care homes regulations. Staffing levels within the unit are sufficient to meet service users’ needs. Staff have appropriate skills and experience to respond to individual needs. The quality in this outcome group is good; this judgement has been made using all available evidence including a visit to this service. EVIDENCE: Ratios of staff have improved in the home and this means that staff now have more time to spend with service users doing the things they may wish to do. There is a range of training being offered to increase and develop knowledge within the staff team with a view to the continued improvement of the service provided. There is a stable staff team in place with few vacancies. Supervision is offered regularly, as well as on the job coaching. New staff are fully inducted and do not work unsupervised until confident. Two members of staff spoken with said they were very well supported both by senior staff and the registered manager. A relatively new member of staff discussed the induction process in the home has informative, and felt that the overall support provided was very good. Fourfields DS0000019350.V307739.R01.S.doc Version 5.2 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 The manager communicates a clear sense of direction and has identified a number of areas for improvement in the home that should benefit service users. Service users, relatives and representatives are invited to give their views, and to influence how the home is run. The quality in this outcome group is good; this judgement has been made using all available evidence including a visit to this service. EVIDENCE: The current manager has a strong commitment to raise and sustain standards. There have been a number of improvements noted in the operation of the Fourfields DS0000019350.V307739.R01.S.doc Version 5.2 Page 20 home since the last inspection, providing evidence of her effectiveness. This has included improved administration and recording of medication. The financial interests of service users are safeguarded, paperwork of two service users was viewed and seen to be accurate. Fourfields DS0000019350.V307739.R01.S.doc Version 5.2 Page 21 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 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Fourfields DS0000019350.V307739.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP19 Regulation 16(2)(c) Requirement In the interests of health and safety, and the comfort of the service users, blinds or another form of shading must be provided in the corridor that links the two units. This will protect service users from the heat of the sun projected through the glass. The outside patio areas (units, Boleyn and Aragon) need to be made safe. Suitable provision must be made for storage in the home to ensure the premises remain safe and free from clutter. Timescale for action 28/11/06 2. 3. OP19 OP22 13(4)(a) 23(2)(1) 31/10/06 31/12/06 Fourfields DS0000019350.V307739.R01.S.doc Version 5.2 Page 23 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 OP7 Good Practice Recommendations The manager must ensure that service users daily notes reflect the care that is provided, and that care plans are reviewed and updated to reflect changing needs. Fourfields DS0000019350.V307739.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire 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. 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