CARE HOMES FOR OLDER PEOPLE
Foxby Hill Nursing Home Foxby Hill Gainsborough Lincolnshire DN21 1PN Lead Inspector
Ann Day Unannounced 21 April 2005 10:00 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. Foxby Hill Nursing Home C53 C04 S2578 Foxby Hill V222469 210405 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Foxby Hill Nursing Home Address Foxby Hill Gainsborough Lincolnshire DN21 1PN 01427 611231 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) Mrs Juliet Smith-Evans / Mrs M P Smith Mrs Lesley Ann Richards Care Home (CRH) 35 Category(ies) of Old age, not falling within any other category registration, with number (OP) - 25 both of places Dementia - over 65 years of age (DE(E)) - 5 both Physical disability (PD) 5 both Foxby Hill Nursing Home C53 C04 S2578 Foxby Hill V222469 210405 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Dementia - over 65 years of age (5), Old age, not falling within any other category (25), Physical disability (5)Service users in the category of Physical Disability must be aged 47 years or over. Date of last inspection 6.12.04 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 service users over the age of 47 years with a physical disability and 1 service user under 50 years of age. 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 sun-room and an enclosed garden with raised beds, and a fish pond. There is some parking space available. This home’s mission statement was seen and 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 C53 C04 S2578 Foxby Hill V222469 210405 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The current Manager, Karen Johnson was on a day off on the day of the visit in April; but came into the home to host the inspection. The inspection took place over one day Case tracking was employed as the main inspection tool, which involves following the experience of a sample of service users and assessing the service they receive. All service users spoken to during the inspection were complementary about the service they receive. The inspector took a tour of the home spoke to service users and members of staff; and examined documentation in the home. Attention was paid to the requirements left at the last inspection and any progress made since the last inspection. The home has recently had a change of manager; the newly appointed manager is yet to apply for registration with the Commission. What the service does well: What has improved since the last inspection?
Considerable work has been undertaken since the last inspection, a number of requirements have now been met within given time scales. Parts of the home have been redecorated and carpets have been replaced. Foxby Hill Nursing Home C53 C04 S2578 Foxby Hill V222469 210405 Stage 4.doc Version 1.30 Page 6 Statement of Purpose has been reviewed and updated; and is now available for distribution. Written confirmation is now sent to prospective service users confirming that the home can meet their needs. The home now has sufficient suitable aids and adaptations in all toilets. Documentation was available for examination recording safe water temperatures, throughout the home. The home now has a quality assurance programme in place. A programme of formal staff supervision has been implemented. Recommendations from the last inspection have also been implemented: Body maps are used to record any accident that results in a bruise or abrasion. Work has been undertaken to help ensure that the home will have 50 of their workforce trained to National Vocational Qualifications Level 2 by 31st December 2005. What they could do better:
Four requirements from the last inspection had not been acted upon. Specifically, recording on the Administration of Medication Records (MARS) was inconsistent and some signatures had been omitted. Service user-friendly locks need to be fitted to bedroom doors to ensure the privacy and dignity of service users or risk assessments completed if not and a reason why not. Fire risk assessment must be undertaken and staff must attend fire training. Property inventories must be completed for every resident. It was also recommended that dates should be set for service user/relatives meetings, enabling them to express their views and maximise their capacity for choice. Two requirements were identified at this inspection. Where used, bedrails must be protected for the safety of service users and/risk assessments carried out for each individual. An immediate requirement was made at the inspection. There is a need to eliminate odours from the home. Care plans need to be signed by the individual (where possible) or a relative. All entries in care records must not be subjective or judgemental
Foxby Hill Nursing Home C53 C04 S2578 Foxby Hill V222469 210405 Stage 4.doc Version 1.30 Page 7 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 C53 C04 S2578 Foxby Hill V222469 210405 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Foxby Hill Nursing Home C53 C04 S2578 Foxby Hill V222469 210405 Stage 4.doc Version 1.30 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 standard(s) 1,3,4,5 The home provides prospective residents and their families with the information they need to make an informed choice about where they live EVIDENCE: The statement of Purpose and Service Users Guide have been updated and reviewed, since the last inspection and are now available for distribution. Individual care records examined included a comprehensive assessment. Written confirmation is now sent to prospective residents confirming whether the home can meet their individual needs. The manager told the inspector that prospective residents and their relatives are encouraged to visit the home before admission. The home’s documentation and brochures confirmed this. The home does not provide intermediate care. Foxby Hill Nursing Home C53 C04 S2578 Foxby Hill V222469 210405 Stage 4.doc Version 1.30 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10, Residents of the home are treated with respect, their right to privacy is upheld and their health care needs are fully met. The home needs to pay attention to its recording systems and ensure that care plans are objective in nature and evidence the involvement of service user or their relative and are evaluated. EVIDENCE: Individual care records were comprehensive and well kept, care records recorded residents likes and dislikes, the involvement of general practitioners, district nurses and community psychiatric nurses was recorded and consent forms for the use of bedrails were also included; however they contained care plans that were not signed by the resident or a relative and monthly evaluations had not been completed. One care record entry was subjective and judgemental in nature and this was brought to the attention of the manager. The home uses the MDS system and a pharmacist from Boots chemist visits regularly every 3 months, visiting the nursing and then the residential part of the home alternately. Senior carers attended administration of medication training on 20.04.05. Foxby Hill Nursing Home C53 C04 S2578 Foxby Hill V222469 210405 Stage 4.doc Version 1.30 Page 11 On inspection the MARS sheets examined were found to have omissions of signatures and the refusal of medication and out of stock items were recorded inconsistently. Members of staff were seen treating residents with respect, consideration and sensitivity; staff/resident rapport was seen to be good. Members of staff were seen knocking on individual bedroom doors before entering. Only six bedroom doors are fitted with user-friendly privacy locks, no risk assessment has been recorded in relation to the provision/non-provision of door locks. Foxby Hill Nursing Home C53 C04 S2578 Foxby Hill V222469 210405 Stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14 The home has a varied leisure activities programme and residents are encouraged to exercise choice and control over their lives. EVIDENCE: The home employs an activities coordinator and a notice of the next 3months activities are displayed in the home. The home has a quarterly newsletter that includes individual birthdays and the activities available in the home. A pianist visits once a week and the home has its own minibus. On the day of inspection the mobile library was making its regular visit to the home. Activities available include coffee mornings, Easter egg hunt, summer fete, in house entertainment, shopping trips and lunches out. Residents are asked what they would like to do. Reality Orientation boards are in use, for those residents who are disorientated and confused at times. One resident has an individual support worker who visits and takes the individual out for the day. This resident also comes and goes from the home, attending computer lessons, shopping; always keeping staff aware of their whereabouts. Family and friends visit the home and are made welcome by the staff. The home’s “Visitors Book” recorded visits that took place across the week, weekends and during the evening.
Foxby Hill Nursing Home C53 C04 S2578 Foxby Hill V222469 210405 Stage 4.doc Version 1.30 Page 13 There are not set times for residents to go to bed or to get up and residents are encouraged to exercise choice and control over their lives. Service users/relatives meetings are to be reinstated, the current manager was encouraged to set dates in the near future to allow service users to express their views. Foxby Hill Nursing Home C53 C04 S2578 Foxby Hill V222469 210405 Stage 4.doc Version 1.30 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,17,18 Service users are protected from abuse, their legal rights are protected and they and their relatives can be confident that their complaints and or concerns will be listened to, taken seriously and acted upon. EVIDENCE: The home has received 2 complaints in the last year, both were appropriately investigated and procedures were followed. One complaint was unsubstantiated and one was resolved. Complaints log, complaints documents and policy were seen Postal voting has been organised for the residents of the home. Two residents have individuals who act as Power of Attorney in relation to their financial affairs. The home does not act as appointee for any of the residents. Only four residents receive personal allowances by weekly giro. Residents have lockable facilities in their rooms to keep valuables and money securely. Residents monies and petty cash transactions are fully recorded, all monies in the home are kept securely. The administrator was advised to have her signatures to transactions witnessed. Two allegations, which were dealt with under local adult protection procedures, were undertaken during the year. On both occasions local protocols procedures were adhered to; one has since been concluded, the allegation was unsubstantiated. The other matter is still subject to further investigation. Foxby Hill Nursing Home C53 C04 S2578 Foxby Hill V222469 210405 Stage 4.doc Version 1.30 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,22,24,26 In general the home is safe, well decorated and provides comfortable surroundings; however an offensive odour was noted in one toilet and several of the bedrooms. EVIDENCE: Several of the communal areas and individual bedrooms have been redecorated since the last inspection. The home’s maintenance man was decorating one of the bedrooms on the day of the inspection. Code locks on external doors and between the units ensure the safety of those residents who are confused and disorientated. Individual bedrooms were comfortably furnished and contained personal possessions and individual adaptations and specialist equipment was available to maximise residents’ independence. On a tour of the home an offensive odour was noted in one downstairs toilet (1)and in bedrooms: 32,34, & 35
Foxby Hill Nursing Home C53 C04 S2578 Foxby Hill V222469 210405 Stage 4.doc Version 1.30 Page 16 Foxby Hill Nursing Home C53 C04 S2578 Foxby Hill V222469 210405 Stage 4.doc Version 1.30 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 Residents’ needs are met by the numbers and skill mix of nursing and care staff at the home. EVIDENCE: On the day of the inspection the home accommodated 3 residential service users; 7 high dependency residents; 8 high dependency 11 and 16 nursing service users. The home employs 3 fulltime nurses and 4 bank nurses; 1 fulltime, 1 part-time and 1 bank nurse work night duty. The home occasionally uses agency staff from 3 agencies; usually the same members of agency staff are used to ensure continuity. The staffing roster showed sufficient numbers of staff on duty over the period. Foxby Hill Nursing Home C53 C04 S2578 Foxby Hill V222469 210405 Stage 4.doc Version 1.30 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35, 36, 37,38 Service users financial interests are safeguarded, however, in the absence of a fire risk assessment and staff training their safety from fire is not sufficiently promoted or protected. EVIDENCE: The current manager has only been recently appointed and is yet to apply to be registered with the Commission. Members of staff are in receipt of regular supervision, records are kept and were available for examination. The administrator of the home showed the inspector the safe and secure arrangements for the handling of residents’ monies. Some residents are able to sign for their own monies. Records and monies kept individually were found to be accurate and in order. For those unable to manage their own finances relatives receive a copy of the transactions every month. Individual property,
Foxby Hill Nursing Home C53 C04 S2578 Foxby Hill V222469 210405 Stage 4.doc Version 1.30 Page 19 possessions inventories were not available. This requirement is outstanding since the last inspection. The registered person is required to consult with the fire service and take adequate protection against fire. Fire Precautions (workplace) 1997-Fire Risk assessments and staff training. This is outstanding form the previous inspection. Bedrails to fifteen beds were found to be in place without bumpers and without individual risk assessments. An immediate requirement was left at the conclusion of the inspection. The manager has since informed the Commission that risk assessments have now been completed. Foxby Hill Nursing Home C53 C04 S2578 Foxby Hill V222469 210405 Stage 4.doc Version 1.30 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 x
COMPLAINTS AND PROTECTION 3 3 x 3 x 3 x 2 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 x x x x 3 3 2 1 Foxby Hill Nursing Home C53 C04 S2578 Foxby Hill V222469 210405 Stage 4.doc Version 1.30 Page 21 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 38 Regulation Reg13 Requirement Risk assessements must be completed with regard to the provision of bedrails/bumpers; unnecessary risks to health & safety of service users are identified and as far as possible eliminated The Registered person must consult with the fire service and make adequate protection against the risk of fire- Fire risk assessements and staff trainingthis requirement is oustanding since the last inspection. (Timescale of 26/02/05 not met) The Registered Person to ensure the environment is free from odour. The registered person is to ensure the risk assessment of provision/none provision of user friendly privacy locks to bedroom doors- requirement outstanding for the last three inspections ( Timescale of 01/06/03 not met) The Registered person must make arrangements for the accurate recording, handling and adminstration of medication.This is outstanding since the last Timescale for action This has been actioned 2. 38 Reg 23(4)` 31st August 2005 3. 4. 26 10 Reg.3 Reg.12(4) (a) 31st. August 2005 31st August 2005 5. 9 Reg.13(2) 31st. August 2005 Foxby Hill Nursing Home C53 C04 S2578 Foxby Hill V222469 210405 Stage 4.doc Version 1.30 Page 22 6. 37 Reg.16(2) (1) 7. 7 Reg. 15 (2) inspection.( Timescale of 26/02/05 not met) Inventories of service users property and possessions must be kept.This requirement is outstanding from previous inspections ( Timescale of 09/09/02 not met) Care Records must evidence the involvement of and consultation with the service user (where this is possible)or their relative. Entries must not be subjective or judgemental. 31st Augsut 2005 31st. August 2005 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 33 Good Practice Recommendations That dates for service users /relatives meetings are set in the near future to enable them to better express their views and maximise their capacity for choice. Foxby Hill Nursing Home C53 C04 S2578 Foxby Hill V222469 210405 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection CSCI 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
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