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Inspection on 14/09/05 for Foxby Hill Nursing Home

Also see our care home review for Foxby Hill Nursing Home for more information

This inspection was carried out on 14th September 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home undertakes a comprehensive assessment process, which assures residents that their needs can be met. There is further assurance for residents in that there is an appropriately trained staff team, who have knowledge of and understand individual needs. Staff maintain a respectful and dignified approach to care and encourage residents to exercise choice.

What has improved since the last inspection?

Since the last inspection the home has met many of the outstanding requirements and partially met others. There are now appropriate bed rail covers in use and risk assessments for the rails are in place. The home was free from malodours. The home has an up to date fire risk assessment and training for staff is evidenced. Medication administration charts were appropriately completed. The home has also made arrangements for residents meetings to take place, commencing in October 2005.

What the care home could do better:

There are three outstanding requirements from the last inspection regarding consultation with residents and/or relatives about care plans, inventories for personal possessions and risk assessments for the provision/non-provision of privacy locks. Two requirements were made at this inspection in regard to risk assessing and taking any appropriate action about wide opening windows in the upper level unit, and ensuring that all staff receive supervision. Three recommendations were also made in regard to making staff aware of supervision plans; keeping records of concerns/issues raised by staff and the actions taken to address such; and development of a policy in relation to Legionella.

CARE HOMES FOR OLDER PEOPLE Foxby Hill Nursing Home Foxby Hill Gainsborough Lincs DN21 1PN Lead Inspector Wendy Taylor Unannounced Inspection 14th September 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 Foxby Hill Nursing Home DS0000002578.V249816.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. Foxby Hill Nursing Home DS0000002578.V249816.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Foxby Hill Nursing Home Address Foxby Hill Gainsborough Lincs DN21 1PN 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) 01427 611231 Mrs Juliet L Smith-Evans Mrs M P Smith Mrs Lesley Ann Richards Care Home 35 Category(ies) of Dementia - over 65 years of age (5), Old age, registration, with number not falling within any other category (25), of places Physical disability (5) Foxby Hill Nursing Home DS0000002578.V249816.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users in the category of Physical Disability must be aged 47 years or over. 21 April 2005 Date of last inspection Brief Description of the Service: Foxby Hill is a care home, which provides both personal care and nursing care for 35 older people over 65 years of age, including 4 residents over the age of 47 years with a physical disability and one resident under the age of 50 years. Foxby Hill is a detached property set in 1 acre of ground and is situated on the outskirts of Gainsborough, close to local facilities. The home has a sunroom and an enclosed garden with raised beds, and a fishpond. There is some parking space available. The home’s mission statement states that ‘Foxby Hill Care Home’s philosophy is to provide the highest possible standards of care based on individual needs’. The owners visit on a weekly basis to ensure that both the care standards and training are maintained. Foxby Hill Nursing Home DS0000002578.V249816.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one day in September 2005. The inspector spoke to residents, staff and relatives. A tour of the building was carried out and resident and staff records were looked at. There are three outstanding requirements from the last inspection. Throughout the visit the atmosphere in the home was relaxed and comfortable, and staff were interacting with residents in a respectful and calm manner. Residents and relatives spoke of staff as being ‘very nice’ and ‘excellent and very hard working’. What the service does well: What has improved since the last inspection? What they could do better: There are three outstanding requirements from the last inspection regarding consultation with residents and/or relatives about care plans, inventories for personal possessions and risk assessments for the provision/non-provision of privacy locks. Two requirements were made at this inspection in regard to risk assessing and taking any appropriate action about wide opening windows in the upper level unit, and ensuring that all staff receive supervision. Three recommendations were also made in regard to making staff aware of supervision plans; keeping records of concerns/issues raised by staff and the actions taken to address such; and development of a policy in relation to Legionella. Foxby Hill Nursing Home DS0000002578.V249816.R01.S.doc Version 5.0 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. Foxby Hill Nursing Home DS0000002578.V249816.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 Foxby Hill Nursing Home DS0000002578.V249816.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): 2,3 Residents’ benefit from the provision of contracts for their placement at the home and from comprehensive needs assessments. They are assured that their needs can be met as a result of the assessment. EVIDENCE: Placing authority and self-funding contracts were seen on individual files. Files also contained evidence of initial assessments, which include areas such as tissue viability, continence, nutrition, falls and medication. Placing authority assessments were available on files where appropriate. Letters to the resident/relative confirming that the home can meet needs are contained in individual files. Foxby Hill Nursing Home DS0000002578.V249816.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): 7,9,10,11 Although there are still some improvements to be made in regard to evidencing consultation with residents/relatives in care plans and recording of actions taken to maintain resident’s privacy, the home maintains respect for individual wishes and promotes safety and dignity within the care provision. EVIDENCE: Individual care plans contain a section for arrangements and wishes relating to death and dying. The manager said that although this issue is always discussed with the resident/relatives and the person’s GP, it is done on an individual basis and at appropriate times for the person and their relatives. She said that this might not be done as soon as the person moves into the home as it a very emotional subject. There is a policy available in the home in relation to this subject. Throughout the inspection staff were interacting with residents in a respectful manner and ensuring dignity and privacy was maintained, for example ‘do not disturb’ signs were used on bathroom doors when personal care was being provided even though the door was locked. Foxby Hill Nursing Home DS0000002578.V249816.R01.S.doc Version 5.0 Page 10 Medication administration records were completed satisfactorily and appropriate administration procedures were observed by the inspector. Controlled medication was stored and recorded appropriately. The home has a comprehensive medicines policy and there is a list of specimen signatures of the staff that administer medication. There was evidence in records that medication training is provided for those staff that carry out administration. There are outstanding requirements for the home to carry out risk assessments for provision/non provision of privacy locks; and to provide evidence of involvement and consultation with the resident/relatives in relation to care plans. Foxby Hill Nursing Home DS0000002578.V249816.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): 15 Residents enjoy a varied and nutritious diet, which is based on their likes, dislikes and needs. They benefit from being able to exercise choice in their diet. EVIDENCE: Individual files contain nutritional assessments and care plans where required. Staff demonstrated knowledge of the resident’s likes, dislikes and needs during a lunchtime meal. Residents said that the food is always good and there is plenty of it. They said that they could choose what they want to eat if they don’t like the menu. The head cook said that he speaks to residents every morning about what is on the menu and takes orders for alternative choices. There are lists of likes, dislikes and dietary needs, and records of what people have eaten, kept in the kitchen area. Menus are available on a nine week rotation. The atmosphere in the dinning room at lunchtime was relaxed and there was a calm and supportive approach from staff. Food was well presented and the portions were ample. A new system for mealtimes had been introduced on the day of the visit whereby all meals would be served in the lower floor unit of the home to encourage residents to socialise. The issue of space in the dinning room was discussed with the manager and a recommendation has been made. Foxby Hill Nursing Home DS0000002578.V249816.R01.S.doc Version 5.0 Page 12 Foxby Hill Nursing Home DS0000002578.V249816.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 Residents’ benefit from robust complaints and adult protection procedures; and they and their relatives are confident that their complaints and/or concerns will be taken seriously and acted upon. EVIDENCE: The home has comprehensive complaints and adult protection policies, including local authority guidelines. There have been no complaints or adult protection issues raised since the last inspection. Records demonstrate that staff receive training in adult protection issues, and staff were able to describe what they would do if they witnessed or suspected such. Induction packs include information on adult protection. Residents said that they could talk to the staff when they have a problem, and a relative said that if they have any concerns they could speak to staff or the manager and feel confident that the issues will be addressed. The home has arranged for the first residents meeting to be held in October 2005. Foxby Hill Nursing Home DS0000002578.V249816.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): 21,23,25 Residents benefit from a generally safe and well maintained environment although safety aspects relating to some windows need to be addressed. EVIDENCE: During a tour of the building the home found to be clean, tidy and free from offensive odours. COSHH substances were stored appropriately and data sheets were available for the substances. Environmental risk assessments were available for issues including security in the building and grounds, hot water temperatures (weekly checks seen), use of the mini bus, clinical waste and hand washing systems. The home has recently won a food safety award due to the high standards achieved in the kitchen area. There were a range of shower and bathing facilities, and ample toilet facilities available. Resident’s bedrooms were found to be personalised and contain specialist equipment referred to in care plans, including airflow mattresses and hoists. Call bells were within reach of residents and they were answered promptly. Residents said that they liked their rooms and found them comfortable. There Foxby Hill Nursing Home DS0000002578.V249816.R01.S.doc Version 5.0 Page 15 are wide opening windows in the upper level unit with a considerable drop from the window to the ground. The manager was asked to risk assess the situation and take any necessary action required to minimise the risk of residents falling from or climbing out of windows. Foxby Hill Nursing Home DS0000002578.V249816.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): 29,30 Residents are protected by robust recruitment procedures and they benefit from an appropriately trained staff team who understand their individual needs. EVIDENCE: Staff files contained all documentation required under Schedule 2 of the Care Homes Regulations 2001, including Criminal Record Bureau checks, identification and two references. The home has a training policy and a dedicated training manager. There is an annual training plan available. The training manager said that new staff have a 2 weeks supernumery induction within the home and a 6 week plan to complete induction subjects such as fire safety, moving and handling, managing abuse and care planning. Records also demonstrate that on-going training such as administration of medicines, continence, tissue viability, venepuncture and health and safety is provided. Throughout the inspection staff demonstrated a clear knowledge and understanding of the resident’s needs. Foxby Hill Nursing Home DS0000002578.V249816.R01.S.doc Version 5.0 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 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): 33,36,38 Record keeping systems show that the health, safety and welfare of residents is promoted although consistent provision of staff supervision would improve protection for residents. EVIDENCE: The home has completed bed rail risk assessments and provided safety covers as required at the last inspection. There is a fire risk assessment, fire safety policy and evidence of fire safety training, which was completed in February and March 2005. Records are satisfactorily maintained for weekly fire call point checks, emergency lighting checks, escape route checks and fire drills. The home has installed a new call bell system that links the upper and lower level units. The home does not have a policy regarding Legionella but there is evidence in records that all necessary actions are carried out such as showerhead flushing/cleaning. A recommendation was made. Foxby Hill Nursing Home DS0000002578.V249816.R01.S.doc Version 5.0 Page 18 The home has an ethnic minority policy statement, which includes information on a range of cultures and religions. Records and feedback from staff indicates that not every one has yet received formal supervision. The manager and deputy manager confirmed this but also highlighted the supervision plan, which demonstrates that all staff will receive supervision within the next six weeks. Staff said that team meetings are held regularly and minutes were available in the home. Most staff said that they feel able to express their views and have confidence that the manager will address any issues raised. A recommendation was made in relation to recording issues raised. There is an outstanding requirement for inventories of personal possessions although it is acknowledged that the requirement is almost fulfilled. Foxby Hill Nursing Home DS0000002578.V249816.R01.S.doc Version 5.0 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 3 X X x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 3 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 X X 3 X 3 X 2 x STAFFING Standard No Score 27 X 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X X 2 2 2 Foxby Hill Nursing Home DS0000002578.V249816.R01.S.doc Version 5.0 Page 20 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 OP7 Regulation 15(2) Requirement Care records must evidence the involvement of and consultation with residents or their relatives. This requirement is outstanding from 31.08.05 The registered person is to ensure the risk assessment of provision/non provision of user friendly privacy locks to bedroom doors. It is acknowledged that some work has been carried out but further risk assessments need to be done. The requirement has been outstanding from 01.06.03 The responsible person must ensure that wide opening windows in the upper level unit are risk assessed and any appropriate action taken to minimise the risk of residents falling or climbing out of them. The responsible person must ensure that all staff working at the care home are appropriately supervised. Inventories of resident’s property and possessions must be kept. DS0000002578.V249816.R01.S.doc Timescale for action 31/10/05 2 OP10 12(4)(a) 12/10/05 3 OP25 13(4)(a) (c) 31/10/05 4 OP36 18(2) 30/11/05 5 OP37 16(2)(1) 21/09/05 Foxby Hill Nursing Home Version 5.0 Page 21 It is acknowledged that there is only one inventory outstanding and the registered manager agreed to ensure this was completed within one week of the inspection. 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 Refer to Standard OP36 OP36 OP38 Good Practice Recommendations It is recommended that all staff are made aware of the plans for providing individual supervision. It is recommended that a record be kept of any issues/concerns raised by staff, and the actions taken to address them. It is recommended that the home develop a policy in regard to Legionella. Foxby Hill Nursing Home DS0000002578.V249816.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN 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 Foxby Hill Nursing Home DS0000002578.V249816.R01.S.doc Version 5.0 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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