Inspection on 09/06/05 for Fourseasons

This inspection was carried out on 9th 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 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

Fourseasons 14/01/09

Fourseasons 16/08/06

Fourseasons 19/10/05

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Stallcombe House

Belma

Hunters Care Centre

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

CARE HOMES FOR OLDER PEOPLE Fourseasons 33 Church Walk South Rodbourne Cheney Swindon Wiltshire SN2 2JE Lead Inspector John Hurley Unannounced 9 June 2005 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. Fourseasons DD51_D01_S57308_FOURSEASONS_V231099_030605_STAGE4.doc Version 1.30 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 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 DE(E) Dementia - over 65 13 registration, with number MD(E) Mental Disorder - over 65 of places OP Old age 1 1 Fourseasons DD51_D01_S57308_FOURSEASONS_V231099_030605_STAGE4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 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 a good overall standard of accommodation on two floors. Each floor is linked by a vertical passenger lift. The home is ideally located in a quiet cul de sac with easy access to Swindon town centre. The home seeks to specialise in the care of older people who experience dementia but who do not need nursing care. Typically there are 2 staff on duty throughout the period 8-00 a.m. to 930 p.m. plus staff who clean and cook. At night time there is one person who works an awake duty and one staff member who undertakes a “sleep-in duty”. This person can be called upon to assist in an emergency or meet night time needs. Fourseasons DD51_D01_S57308_FOURSEASONS_V231099_030605_STAGE4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place over four hours, the inspector returning to ensure that the requirements set at the previous inspection had been complied with. The inspector viewed all areas of the home and spoke with staff and management. A number of records were examined including service users care plans, risk assessments and health and safety records. Due to the service users mental health needs their views were not able to be obtained during this inspection. What the service does well: What has improved since the last inspection? What they could do better: The management need to be able to fully demonstrate when they are working at the home and in what capacity. The attendance of day care clients needs to be managed in such a way as not to undermine the smooth running of the care home and the needs of the residents. Care reviews need to be made at significant points in the service users life, for example when they return from hospital and short term needs may have changed. An assessment must be made with regards to how the new needs will be met and the changes must be fully communicated to the staff team. The management must ensure there are sufficient staff on duty at all times to meet these needs. Fourseasons DD51_D01_S57308_FOURSEASONS_V231099_030605_STAGE4.doc Version 1.30 Page 6 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 DD51_D01_S57308_FOURSEASONS_V231099_030605_STAGE4.doc Version 1.30 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 Fourseasons DD51_D01_S57308_FOURSEASONS_V231099_030605_STAGE4.doc Version 1.30 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) 1,3,6 The assessment documentation provides good detail of the service users individual needs. These documents would be enhanced if it was clear that the service user or their sponsor had been consulted and agreed with the proposed actions being taken on their behalf. EVIDENCE: The last service user to take up residency was transferred from another care home. There appeared to be cooperation between the two homes with a full discharge summary completed as well as a transfer of previous care plans reviews, risk assessments and objectives of continuing care needs. There was also a community psychiatric nurses assessment of need and how these needs should be met. A care plan had been generated from these documents, which goes some way to demonstrate how the home will meet the assessed needs. Further information on the services on offer and key issues are provided via the statement of purpose and service user guide. The service user or their sponsor had not signed assessment documentation. This was also the case relating to the individuals or their sponsors agreement with the placement. Intermediate care is not a feature of this service. Fourseasons DD51_D01_S57308_FOURSEASONS_V231099_030605_STAGE4.doc Version 1.30 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 standard(s) 7,8 Through observation and discussion with staff it is clear that not all acknowledged needs of the service users are either recorded or met. EVIDENCE: The care plans observed had been generated from the initial assessment details and reviewed at given intervals. The care plans give some detail with regards to the health needs of the individual and evidence visits to or from health care professionals. The reviews lack detail and whilst specific needs are acknowledged there are no details relating to how these needs should be met. For example an individual was assessed as needing help to stand up from a sitting position. How this assistance should be provided was not included in the service users documents ie verbal encouragement, one-person assists to aid balance, two people or the need to use a hoist. The reasons for the individual’s deterioration was not clear and there were no observations or comments from an occupational therapist. Fourseasons DD51_D01_S57308_FOURSEASONS_V231099_030605_STAGE4.doc Version 1.30 Page 10 A service user was observed as requiring individual support at lunch time. Staff informed the inspector this was due to the individual recently returning from hospital and requiring more attention than usual. The service user file did not detail this nor did it state how the staff would meet these new needs at this particular time. Fourseasons DD51_D01_S57308_FOURSEASONS_V231099_030605_STAGE4.doc Version 1.30 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 standard(s) 12,15 There were insufficient staff on duty to meet the needs of all service users at the time of the inspection. Meal time practices were poor and undermined the dignity of the service user. EVIDENCE: When the inspector arrived, one of the two deputy managers was about to assist a service user in having a bath. Within minutes of entering the home the inspector was aware that a day care client had arrived and the deputy manager needed to talk with the escort with regards to the well being of the day care client. The deputy made arrangements for the only other care staff on duty to carry on with the task of assisting the first individual with preparing for a bath. The inspector went into the communal lounge were there were seven other service users. The staff records evidenced that a senior member of staff had attended a training course relating to providing meaningful activities to the current service user group. This learning had been cascaded to other staff via staff meetings. Care plans gave some detail as to the expectations and aspirations of the service user. One observed plan stated that the individual likes to go out for walks, it was not recorded how this would be met as it was also acknowledged that the individual would be at risk if they accessed the community unaccompanied. Fourseasons DD51_D01_S57308_FOURSEASONS_V231099_030605_STAGE4.doc Version 1.30 Page 12 The lunch time meal was observed. Four service users sat in the main lounge and were served their lunch on their laps, three were not provided with side tables or trays, even after this was pointed out to the deputy manager by the inspector. This caused problems as service users spilt food into their laps and onto the floor. The inspector pointed out that one service user required assistance as they had slumped in the chair with their head near their plate. A staff member came to assist; sat on a table in front of the individual and explained to the inspector the person was not well following discharge from hospital. They made little attempt to encourage the individual, assessed that they were not hungry and returned to serving others in the dinning room ignoring another service user who asked for help. Even though the inspector had pointed out that serving food in this manner was poor practice, and even though it was accepted that one service user was not well, a pudding of jelly was served in a similar manner shortly after. The inspector spoke with the deputy at some length over the observed practice and made an immediate requirement to ensure there would be staff to meet the needs of all service users at all times. Fourseasons DD51_D01_S57308_FOURSEASONS_V231099_030605_STAGE4.doc Version 1.30 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 standard(s) No standards were inspected relating to complaints and protection during this unannounced inspection. EVIDENCE: Fourseasons DD51_D01_S57308_FOURSEASONS_V231099_030605_STAGE4.doc Version 1.30 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 standard(s) 19,24 The home is clean and once the curtains are refitted in the conservatory area would be considered to be well maintained. EVIDENCE: The risks associated with the environment are noted in the individuals care records. Service user’s bedrooms are furnished and decorated to a good standard. Service user’s rooms reflect individual taste in décor and furnishings. Staff confirmed they were able to bring items of personal furnishings to their room. The communal areas are generally pleasant with many of the fixtures and fittings of a domestic nature. The large conservatory which is used to serve some service users meals requires to have sun blinds / curtains refitted to ensure that that the area is not too hot. All rooms were lit with domestic style lighting supplemented by emergency lighting in the case of fire. The hot water temperature is centrally controlled. Fourseasons DD51_D01_S57308_FOURSEASONS_V231099_030605_STAGE4.doc Version 1.30 Page 15 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 comments made under the section Daily living and Social activities are relevant here. There were insufficient staff on duty and the staffing rota was incomplete. EVIDENCE: In order to establish staffing levels the inspector looked at the current and previous six weeks of the staffing rota. Even though it was a requirement at the last inspection the rotas have not been maintained as required. The manager’s hours of work are not always recorded. The rotas did not indicate if the manager was working at the home or elsewhere, carrying out care assessments or attending meetings etc. This was also found to be the case with regards to one of the deputy manager’s, whose role whilst defined on paper, remains unclear to staff. On the day of the unannounced inspection one of the deputies was marked as attending dental appointment. The records indicated that this was an all day appointment. No cover had been arranged. As day care clients arrive and depart this is a key time when information is passed between the home and the individual escorts or carers. The staffing rotas do not demonstrate that this is acknowledged and staff are expected to cope regardless of changing levels of dependency. Fourseasons DD51_D01_S57308_FOURSEASONS_V231099_030605_STAGE4.doc Version 1.30 Page 16 Whilst there is evidence that staff have received training in key service areas there is insufficient evidence that the staff put learning into practice. This is with reference to assisting with feeding as discussed earlier. Fourseasons DD51_D01_S57308_FOURSEASONS_V231099_030605_STAGE4.doc Version 1.30 Page 17 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) 32,36 Management must be able to identify and take action to prevent poor practice in order to ensure that service uses are treated with respect and dignity at all times. EVIDENCE: Most of the previous requirements made at the last inspection have been carried out with the exception of including the managements hours of work, where they’re based and in what capacity. A new system of care planning, risk assessment and health and social needs has now been introduced by the management. These records contain many of the details required and demonstrate willingness by them to move forward. The staff records show that they are receiving formal supervision to introduce the new approach of person centred care planning. Fourseasons DD51_D01_S57308_FOURSEASONS_V231099_030605_STAGE4.doc Version 1.30 Page 18 When the inspector pointed out that at least three service users were being fed in circumstances that were not appropriate the management intervention had no impact and did not change these circumstances. Fourseasons DD51_D01_S57308_FOURSEASONS_V231099_030605_STAGE4.doc Version 1.30 Page 19 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 3 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 1 COMPLAINTS AND PROTECTION x x x x x 3 x 3 STAFFING Standard No Score 27 1 28 x 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x 2 x x x 3 x x Fourseasons DD51_D01_S57308_FOURSEASONS_V231099_030605_STAGE4.doc Version 1.30 Page 20 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 7 Regulation 15(1)(2) (b) Requirement The registered person must ensure service users care plans are reviewed each month, or earlier if the needs of the service users change.These plans and reviews must accurately reflect the service users needs. The registered person must ensure service users are treated with dignity and respect at all times. The registered person must provide the Commission with an action plan detailing how it will ensure staffing levels meet the assessed needs of the residents and day care clients. An requirement was made at the time of the inspection relating to this issue. The registered person must ensure that all staff hours are accurately recorded on the rota. This requirement is outstanding since the last inspection. The registered person must ensure that the rota informs the reader of who is on duty and in what capacity. This requirement is outstanding since the last inspection. Timescale for action 1/07/05 2. 10 & 31 12 (5) (a)(b)(4) (a) 18(1)(a) 3/06/05 3. 27 25/07/05 4. 27 Schedule 4(7) 3/06/05 5. 27 Schedule 4(7) 3/06/05 Fourseasons DD51_D01_S57308_FOURSEASONS_V231099_030605_STAGE4.doc Version 1.30 Page 21 6. 24 23(p) 7. 24 23(n) The registered manager must ensure that the blinds / curtians are rehung in the conservatory which is also used as a communal dining area. The registered manager must ensure that aids are made available to assist service users who may wish to take their meals away from a dinning table 3/06/05 3/06/05 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 Good Practice Recommendations Fourseasons DD51_D01_S57308_FOURSEASONS_V231099_030605_STAGE4.doc Version 1.30 Page 22 Commission for Social Care Inspection Suite C, Avonbridge House Bath Road , Chippenham Wiltshire SN15 2BB 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 Fourseasons DD51_D01_S57308_FOURSEASONS_V231099_030605_STAGE4.doc Version 1.30 Page 23 - 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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