CARE HOMES FOR OLDER PEOPLE
Fourseasons 33 Church Walk South Rodbourne Cheney Swindon Wiltshire SN2 2JE Lead Inspector
Bernard McDonald Unannounced Inspection 19th October 2005 09:00 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 Fourseasons DS0000057308.V256848.R01.S.doc Version 5.0 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. Fourseasons DS0000057308.V256848.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Fourseasons Address 33 Church Walk South Rodbourne Cheney Swindon Wiltshire SN2 2JE 01793 527103 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) Coate Water Care Company Limited Mr Christopher Leonard Smith Care Home 15 Category(ies) of Dementia - over 65 years of age (13), 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 (1) Fourseasons DS0000057308.V256848.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 9th June 2005 Brief Description of the Service: Four Seasons is a family owned, privately run care home. One of the homeowners assumes day-to-day management of the home. The home provides accommodation on two floors linked by a passenger lift and staircase. The home is ideally located in a quiet cul de sac with easy access to Swindon centre. The home seeks to specialise in the care of older people who experience dementia but do not require nursing care. Typically there are two staff on duty throughout the waking day plus staff who clean and cook. In addition there is one waking night staff and one member of staff who provides “sleep in “ duty. Fourseasons DS0000057308.V256848.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place over seven hours. The inspector viewed all areas of the home and met with all service users, staff and management. Since the last inspection of the home the Commission has made an additional visit to investigate concerns regarding odour in the hallway. The additional visit made two requirements that have now been complied with. The inspector examined four service user care plans and three staff recruitment records. In addition policies, risk assessments and health and safety records were examined. At the time of the inspection the inspector had received four comments cards from the relatives of service users. Comments received indicated relatives were generally satisfied with the care provided at the home. What the service does well: What has improved since the last inspection?
The home has continued with improvements to the overall environmental standards. New furniture has been purchased for bedrooms and decoration has been completed to the corridor hallways and a number of service users bedrooms.
Fourseasons DS0000057308.V256848.R01.S.doc Version 5.0 Page 6 New side tables and trays have been purchased for service users who choose to eat their meal in a comfortable chair in the lounge. This improvement means that service user can eat their meals safely and in comfort. 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.
Fourseasons DS0000057308.V256848.R01.S.doc Version 5.0 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 Fourseasons DS0000057308.V256848.R01.S.doc Version 5.0 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 the following standard(s): 3. The home has not admitted any service users since the last inspection. The previous inspection found that standards on relation to choice of home had been met. EVIDENCE: Standard relating to choice of home were not explored at this inspection having been met at the previous inspection. Fourseasons DS0000057308.V256848.R01.S.doc Version 5.0 Page 9 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, 9, 10. Service users care plans do not fully reflect their needs and do not demonstrate their needs are being safely met: however service users feel they are treated with respect and medication procedures are being safely managed. EVIDENCE: It was a requirement at the last inspection that service users care plans are reviewed each month and accurately reflect their needs. The inspector examined the care plans of four service users and found this requirement had not been met. Care plans had not been reviewed or updated since before the last inspection and service users care needs were not being accurately recorded. There was no evidence to demonstrate service users had been involved in developing their care plan or that they agreed with the contents of the document. Care plans did identify when service users were at risk, however the home had failed to complete or update risk assessments to ensure their safety. When a service had suffered a fall, risk assessments were not reviewed to reduce further risk of injury. Fourseasons DS0000057308.V256848.R01.S.doc Version 5.0 Page 10 These deficits were discussed at length with the registered manager and senior staff. The home must take action within the revised timescale to avoid the Commission taking more formal enforcement action. Service user preferred form of address is recorded in the care plan and service users were very positive about the care they receive. One service user commented that staff, “were very good” and another commented they were “really helpful”. Observations made during the inspection found staff were interacting in a relaxed and sensitive manner which service users appeared to respond to. Medication records examined demonstrated medication was being accurately recorded when administered to service users. Staff responsible for administering medication had completed safe handling of medication course through the local college. Fourseasons DS0000057308.V256848.R01.S.doc Version 5.0 Page 11 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): 13, 14, 15. The home is striving to ensure service users maintain contact with people who are important to them and are supported as far as possible to exercise control over their lives. Service users are provided with a balanced diet. EVIDENCE: Discussion with service users confirmed they were able to meet with visitors at anytime and they “just drop in”. Staff confirmed visitors are welcome and there were no restriction on visiting times. The inspector received several comments cards from the relatives of service users and these confirmed they were generally satisfied with the care provided at the home. The home does not act as agent for service users benefits as financial matters are normally dealt with by the service user, their relative or their legal representative. The home does encourage service users to bring personal items and possessions for their rooms. This arrangement is normally negotiated as part of the pre admission procedure. Since the last inspection new tables have been purchase for service users who wish to eat their meals in the lounge. This purchase reduces the problems
Fourseasons DS0000057308.V256848.R01.S.doc Version 5.0 Page 12 identified at the last inspection of service users spilling their meal on their laps or on the floor. The inspector shared the lunchtime meal with service users and found it was tasty, well presented and cooked from fresh. Service users were complimentary about the meals provided saying they were “good” and “excellent”. Discussion with the cook confirmed that the main meal of the day is provided at lunchtime. The menu is normally planned a week in advance and the actual meals served are recorded. The menu does not offer a choice at the main meal however service users likes and dislikes are known. Discussion with staff and service users confirmed that if they did not like the meal an alternative would be provided. The home was providing a separate meal for one service user from the ethnic community. Discussion with the cook demonstrated a clear understanding of the service users cultural requirements and a separate meal is provided. There was no record of these meals and it is a requirement that this is now recorded. Fourseasons DS0000057308.V256848.R01.S.doc Version 5.0 Page 13 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, 18. The home was making every effort to ensure service users views are listened to and that they are protected. EVIDENCE: Discussion with staff demonstrated an awareness and understanding of what action they would take to report any concerns affecting the welfare of service users. One member of staff confirmed their name had been put forward for the next abuse awareness training and it is planned all staff will complete the training over the next twelve months. Copies of the local adult protection procedures were in place and a whistle blowing policy has been developed to support staff in reporting any concerns or bad practice. There have been no recorded complaints since the last inspection. However the Commission has undertaken an additional visit due to concerns raised about the cleanliness of the home. Following this visit the home received two requirements, which have now been met. The inspector could not fully evidence if service users were aware of how to make a complaint, however four service users did say they would tell staff if they were unhappy about something. This would indicate that service users feel safe living at the home and would feel confident in reporting concerns to staff members.
Fourseasons DS0000057308.V256848.R01.S.doc Version 5.0 Page 14 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, 24, 26. Service users live in a clean and well-maintained environment that is suited to their needs. The home needs to ensure all areas of the home are safe and take action to ensure soiled laundry is handled in a safe and hygienic manner. EVIDENCE: Following two requirements made during an additional visit, the home has ensured all parts of the home are clean and free from odour. The inspector viewed all communal living areas and all but two of the service users bedrooms. Discussion with service users confirmed they were satisfied with the standard of accommodation provided. One service user commented, “they had everything they needed.” Service users rooms had been personalised with photographs, ornaments and pictures that reflected their individual taste and previous lifestyle. Since the last inspection new bedroom furniture has been purchased for all rooms other than rooms that have service users personal furniture.
Fourseasons DS0000057308.V256848.R01.S.doc Version 5.0 Page 15 In addition bedrooms hallways and corridors have been decorated as part of the overall planned improvements. The inspector was concerned to find the fire escape on the first floor opened to a steep staircase which in the opinion of the inspector presented a risk to service users. Discussion with the manager confirmed the area was alarmed and if service users went into this area an alarm would sound and staff would respond. However in practice when tested by the inspector the alarm was not loud enough to alert staff to the risk. It is recommended that advice be obtained from the fire safety officer regarding this matter to ensure the safety of service users. The laundry area is situated on the ground floor away from food preparation areas. Infection control guidelines are in place and the manager confirmed the trainee manager attends the local health protection agency meetings. Care staff are responsible for service users laundry. The inspector found the home did not have any red alginate bags for soiled linen. It is recommended these be purchased to reduce the spread of infection and the handling of soiled or infected laundry. Fourseasons DS0000057308.V256848.R01.S.doc Version 5.0 Page 16 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, 29. Although the home is meeting the recommended staffing guidance, staffing levels are not considered to be sufficient during the morning peak time. Service users are not being fully protected by the home’s recruitment procedures. EVIDENCE: Examination of the rota showed there were two care staff on duty at all times. This is increased at lunchtime when an additional member of staff assists with the lunchtime routine. In addition the manager and trainee manager were working at the home Monday to Friday plus covering on call duties at the weekend. There is one waking night staff and one member of staff providing sleep in cover. The inspector found care staff that are on duty in the morning had responsibility for making breakfast and assisting service users to get up. Discussion with staff confirmed this is an especially busy time. It was reported there are service users who require assistance from two staff leaving the remaining service users unsupervised and waiting for breakfast. It is the inspector’s opinion that staffing levels are insufficient at such a peak time and consideration should be given to increase staffing levels at this time. This issue was discussed at length with the manager and trainee manager who agreed to review staffing levels for this period.
Fourseasons DS0000057308.V256848.R01.S.doc Version 5.0 Page 17 Three staff recruitment records were examined. The records contained all information required of the standard including terms and conditions of employment and a satisfactory criminal records bureau enhanced disclosure. The inspector found that gaps in staff member employment history were not being explored. It is a requirement that the home undertakes these checks as part of the application or interview process. Fourseasons DS0000057308.V256848.R01.S.doc Version 5.0 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 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): 33, 35, 38. The home is moving towards a quality monitoring system and is safely managing service users financial interests. Policies and safety certificates are in place to promote the health, safety and welfare of service users. EVIDENCE: Discussion with the trainee manager confirmed views of service users and their families are obtained every six months. The inspector has received four comments cards from relatives that identified they were not aware of the inspection reports. It is recommended that this be addressed as part of the homes quality review. The records to demonstrate the outcome of the quality review were held at the main office. It is a requirement that the outcome of the last quality review is sent to the Commission to demonstrate that the views of service users and their supporters are being listened to.
Fourseasons DS0000057308.V256848.R01.S.doc Version 5.0 Page 19 The home was holding money on behalf of service users. Records examined demonstrated money was being safely managed. Records were being signed by two members of staff when money is withdrawn or received on behalf of service users and records reflected the money being held at the home. Health and safety policies and procedures were in place at the home. Fire safety records showed safety tests were being held at the required intervals. Water temperatures are being regulated at the main boiler and again on the hot water outlets in the bathroom. A record of water temperatures is being kept of all baths and showers. It is recommended that similar checks be made on all hot water outlets to ensure the temperature is being regulated close to 43c to reduce the risk of scalding to service users. Fourseasons DS0000057308.V256848.R01.S.doc Version 5.0 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 X 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X 3 X 2 STAFFING Standard No Score 27 2 28 X 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 3 X X 2 Fourseasons DS0000057308.V256848.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? YES Fourseasons DS0000057308.V256848.R01.S.doc Version 5.0 Page 22 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(1)(2) (b) Requirement The registered person must ensure service users care plan are reviewed each month, or earlier if the needs of service users change, these plans and reviews must accurately reflect the service users needs. This was requirement was outstanding from the previous inspection. The timescale for action was 01/07/05. The registered person must ensure that risk assessments are completed where a risk has been identified. The registered person must review risk assessments following a fall to a service user. The registered person must ensure all meals served at the home are recorded. The registered person must review the safety precautions regarding the fire escape on the first floor and take advice from the fire safety officer regarding any action that needs to be taken. The registered person must explore any gaps in applicants’ employment history. The registered person must supply the Commission with a copy of the most recent quality review report
DS0000057308.V256848.R01.S.doc Timescale for action 01/12/05 2 OP7 13(4)(b) (c) 13(4)(a) (b)(c) 17(2) 23(4)(b) 01/12/05 3 4 5 OP7 OP15 OP38OP19 01/12/05 19/10/05 01/12/05 6 7 OP29 OP33 19(1) 24(2) 20/10/05 01/12/05 Fourseasons Version 5.0 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 2 3 4 Refer to Standard OP26 OP27 OP33 OP38 Good Practice Recommendations The registered person should purchase red alginate bags for infected and soiled laundry. The registered person should review the staffing levels in the morning. The registered person should ensure the CSCI inspection report is made available to service users their family and stakeholders. The registered person should maintain a record of all hot water temperatures. Fourseasons DS0000057308.V256848.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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