CARE HOME ADULTS 18-65
Foxdown Paley Street Nr Maidenhead Berkshire SL6 3JT Lead Inspector
Chris Schwarz Unannounced Inspection 23 February & 23 March 2007 09:30
rd rd Foxdown DS0000047598.V323932.R01.S.doc Version 5.2 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 Foxdown DS0000047598.V323932.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. 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. Foxdown DS0000047598.V323932.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Foxdown Address Paley Street Nr Maidenhead Berkshire SL6 3JT 01628 776507 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) Owl Housing Limited Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Foxdown DS0000047598.V323932.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection Brief Description of the Service: Foxdown is a six bedded detached bungalow situated in a quiet location in Paley Street near Maidenhead. The home caters for the needs of people with learning and associated physical disabilities some of whom may display challenging behaviours. All service users’ bedrooms are single occupancy and have been decorated and arranged to different tastes. Communal areas are spacious and bright and the home overlooks countryside. The aims and objectives of the home are to provide 24 hour care and support, promoting equality and independence in accordance with the individual’s needs and aspirations Fees for the service were £1278.56 per week, according to information supplied during the inspection. Foxdown DS0000047598.V323932.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was conducted over the course of two days and covered all of the key standards for younger adults. Prior to the visit, a questionnaire was sent to the manager alongside comment cards for distribution to service users, relatives and visiting professionals. Two relatives replied, indicating overall satisfaction with care at the home, awareness of the complaints procedure, indication that they are made to feel welcome and are consulted about care and that sufficient staff work at the home. Neither had needed to make a complaint. The visits consisted of discussion with staff and management, observation of the routines within the home, a tour of the premises and examination of some of the required records was also undertaken. A key theme of the inspection was assessment of how the home meets needs arising from equality and diversity. At the end of the inspection, feedback was given to the manager. What the service does well:
The needs of prospective service users are assessed prior to admission, to ensure that the service does not offer a placement to someone whose needs it cannot meet. Service users are enabled to make decisions and be as independent as possible, providing them with choice and involvement. Service users are enabled to take responsible risks, ensuring that their independence is promoted. Service users take part in appropriate activities and make use of the local facilities, providing stimulation and variety. Service users are enabled to keep in contact with friends and family, maintaining important social links. The rights of the individual are respected, promoting fulfilment and affording service users respect. Meals are appropriately managed to ensure that service users receive the nutrients they require to keep them healthy. Physical and emotional health care needs are well managed to ensure that service users keep well. Effective complaints procedures are in place to listen to the views of service users and their representatives. Adult protection is well managed with appropriate policies, procedures and staff training in place to reduce the risk of harm to service users.
Foxdown DS0000047598.V323932.R01.S.doc Version 5.2 Page 6 A clean, comfortable and homely environment has been created for service users, ensuring that they have appropriate surroundings in which to live. Competent and qualified staff work at the home, ensuring that service users are cared for by people with the skills and knowledge necessary to meet their needs. Thorough recruitment practices are undertaken, to ensure that service users are protected from unscrupulous persons working with them. Training is undertaken by staff to ensure they are equipped to meet the needs of service users. There is effective monitoring by the provider to ensure that standards of care meet the needs of service users. What has improved since the last inspection? What they could do better:
Care plans and accompanying risk assessments need to be updated, to ensure that accurate information is documented about current care needs. Service users need to be moved in accordance with their care plans and in line with best practice, to avoid the risk of accidental injury. Accurate records need to be maintained of medicines administered to service users, to ensure that service users are receiving their prescribed medicines. The missing person procedure needs to be amended to reflect the Commission for Social Care Inspection as the regulatory body, to ensure that staff are able to notify appropriate agencies promptly when anyone goes missing. Staff need to receive training on using the “pen” device for medication, to ensure that they are following safe practice. Foxdown DS0000047598.V323932.R01.S.doc Version 5.2 Page 7 Measures need to be put in place to prevent service users gaining access to the boiler flue pipe, to reduce risk of injury. 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. The summary of this inspection report can be made available in other formats on request. Foxdown DS0000047598.V323932.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Foxdown DS0000047598.V323932.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. The needs of prospective service users are assessed prior to admission, to ensure that the service does not offer a placement to someone whose needs it cannot meet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have not been any new admissions to the service since the last inspection of Foxdown. Previous visits have concluded that admission was appropriately managed for each service user and included multi-disciplinary assessment of care needs. Foxdown DS0000047598.V323932.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is adequate. Care plans and risk assessments need updating, ensuring that current needs have been identified and can be met. Service users are enabled to make decisions and be as independent as possible, providing them with choice and involvement. Service users are enabled to take responsible risks, ensuring that their independence is promoted. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A sample of care plans and accompanying risk assessments was looked at. Each file contained a photograph of the service user and basic information such as next of kin and surgery details. Other information included guidance on managing epilepsy, where appropriate, and support plans on mobility, morning routine, support required to bathe, communication needs and behavioural support plans. The care plans examined were in need of updating, as information had been handwritten in between typed notes and some of the documents were dated 2005. In one instance, the wording on part of the
Foxdown DS0000047598.V323932.R01.S.doc Version 5.2 Page 11 support plan was inappropriate, referring to the service user “I can be quite spiteful.” A requirement is made to ensure that care plans and risk assessments are updated and it would be expected that as part of the preparation for this, that the manager advises staff on appropriate wording and presentation of the documents. During the course of the inspection a member of staff was observed moving a service user inappropriately and contrary to the care plan, which could have caused injury to the service user. A requirement is made to ensure that staff only move service users using methods agreed on the care plan and in line with current moving and handling best practice. Service users’ money is managed by the home. A sample of records and balances were checked and found to be in good order. Staff spoke with service users appropriately and offered choices to them of drinks and food. No service user meetings were taking place at the home but the manager was aiming to introduce these to focus on menus, activities and appointments as a starter. There is a missing person procedure in place in the event of a service user being absent from the home. This document referred to notifying the National Care Standards Commission of a missing service user and should refer to the Commission for Social Care Inspection as the regulatory body. It is recommended that this be amended to ensure that staff would be able to make contact with appropriate agencies promptly in the event of anyone being missing. Foxdown DS0000047598.V323932.R01.S.doc Version 5.2 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is good. Service users take part in appropriate activities and make use of the local facilities, providing stimulation and variety. Service users are enabled to keep in contact with friends and family, maintaining important social links. The rights of the individual are respected, promoting fulfilment and affording service users respect. Meals are appropriately managed to ensure that service users receive the nutrients they require to keep them healthy. This judgement has been made using available evidence including a visit to this service. EVIDENCE: From reading daily notes and shift summaries, it was possible to see that service users are involved in a range of different activities and pastimes. These included attending day services, going out for lunch, attending Wednesday Club, music therapy, accompanying staff with food shopping for the home, aromatherapy, line dancing and cookery. One person was not involved with
Foxdown DS0000047598.V323932.R01.S.doc Version 5.2 Page 13 day services and the manager was looking at suitable alternatives to best fill his time. There was evidence from written records of service users being in contact with their families and friends and visiting some of the other homes in the area to meet up with friends for parties and to celebrate birthdays. Photographs on the home’s computer provided evidence of a successful holiday to Disneyland Paris last year. Staff had thought about possible holiday options for this year to suit the different interests of service users although no plans had been made yet. Meals at the home looked well managed on both days of the inspection, with food prepared from basic ingredients rather than reliance upon processed or pre-packed products. Service users were given a choice for their meal and a third option was prepared for one service user. Menus reflected a range of different meals which were wholesome and nutritious. Fresh fruit was available in the kitchen and items in the fridge were appropriately wrapped after opening with date labels added. Foxdown DS0000047598.V323932.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is adequate. Updated personal support requirements need to be recorded in care plans to ensure that service users receive the assistance they require. Medication practice needs some improvement to ensure that practice follows guidance. Physical and emotional health care needs are well managed to ensure that service users keep well. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans contain information about health care and support needs although these need updating, as identified earlier in the report, to ensure that current needs are noted. The manager considered that the necessary equipment was in place to meet current needs. Daily notes indicated what personal care had been given to each service user and by whom. Medical appointments were documented in service users’ files and discussion with a member of staff demonstrated that there was good understanding of a service user’s needs and the need to arrange a doctor’s appointment. Guidance was in place to manage challenging behaviour, with strategies clearly identifying to try and calm or
Foxdown DS0000047598.V323932.R01.S.doc Version 5.2 Page 15 distract the person first and using prescribed medication as a last resort. Records of incidents were noted in service users’ files. A monitored dose system of medication administration is used and the medicines cabinet was locked when not in use. Current blister packs showed that two doses of medication for separate service users had not been given but were signed as administered on the medication administration records. Staff were not therefore always maintaining an accurate record of medicines given to service users and a requirement is made to address this. It is additionally recommended that training be undertaken by all staff who administer medication using a “pen” device, to ensure that they are following safe procedures. Policies on medication practice and physical intervention were in place and dated 2006. Foxdown DS0000047598.V323932.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good. Effective complaints procedures are in place to listen to the views of service users and their representatives. Adult protection is well managed with appropriate policies, procedures and staff training in place to reduce the risk of harm to service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A complaints procedure was in place and referred to the Commission for Social Care Inspection as the regulatory body. The complaints log did not contain any complaints. The Commission is not aware of any complaints by service users or their representatives. An adult protection procedure was in place as well as the local authority interagency guidelines. Staff training records showed that, for the sample looked at, staff had received Protection of Vulnerable Adults training in 2006. A whistle blowing procedure was also in place. The Commission is not aware of any adult protection concerns for this service. Foxdown DS0000047598.V323932.R01.S.doc Version 5.2 Page 17 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 Quality in this outcome area is good. A clean, comfortable and homely environment has been created for service users, ensuring that they have appropriate surroundings in which to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is a detached bungalow with spacious areas both inside and out. Communal areas are bright, well decorated and arranged to look homely and bedrooms have been arranged individually to reflect different interests and tastes. There are two bathrooms, one adapted with a hoist, and an additional separate toilet. The kitchen/dining area is domestic in scale and has the necessary equipment and storage space for a home of this size. Service users have a large garden which is not overlooked and there is ample space for parking. The premises were clean throughout and laundry was being managed effectively. The only matter raised for attention was possible access by service users to the boiler flue pipe, located in the laundry, which could cause injury if
Foxdown DS0000047598.V323932.R01.S.doc Version 5.2 Page 18 touched. It is recommended that measures be put in place to prevent access to the pipe. Foxdown DS0000047598.V323932.R01.S.doc Version 5.2 Page 19 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 Quality in this outcome area is good. Competent and qualified staff work at the home, ensuring that service users are cared for by people with the skills and knowledge necessary to meet their needs. Thorough recruitment practices are undertaken, to ensure that service users are protected from unscrupulous persons working with them. Training is undertaken by staff to ensure they are equipped to meet the needs of service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On both visits to the home, there was sufficient staff cover to ensure that service users’ needs could be met. On each shift, a designated responsible person or shift leader is identified to co-ordinate tasks and events. Staff complete training before undertaking this role. Shift leader summaries were being completed three times a day to note significant issues. A new member of staff was spoken with who described a comprehensive induction process with some training already undertaken as part of it. Good support for new staff was described.
Foxdown DS0000047598.V323932.R01.S.doc Version 5.2 Page 20 Minutes of team meetings were read and showed that a range of topics are discussed and ways of improving practice explored. There had been six meetings during 2006. One of the service user’s keyworkers was spoken with as part of the inspection. She had a good understanding of his care needs and non-verbal communication. A sample of recruitment records was looked at and found to contain all required documentation including Criminal Records Bureau checks. Staff training records were looked at and showed that mandatory courses were up-to-date. Courses had also been attended on supplementary matters such as epilepsy, valuing diversity, effective communication and crisis intervention and prevention. Medication competency assessments were also in place, where appropriate. There was evidence on staff files that they had been given copies of the General Social Care Council code of practice. Foxdown DS0000047598.V323932.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Quality in this outcome area is adequate. The home has a new manager, to ensure that there is continuity of care and that needs are met. There is effective monitoring by the provider to ensure that standards of care meet the needs of service users. Health and safety is well managed overall, although updated service user risk assessments are needed to reduce risk of harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A manager from another of the provider’s homes had been working at Foxdown since the beginning of March this year. This is on a part-time basis until a replacement is found to manage the other home. She will then need to apply to register with the Commission and until registration has been Foxdown DS0000047598.V323932.R01.S.doc Version 5.2 Page 22 completed, the standard cannot be scored as fully met. This should not be viewed as an indication of the manager’s capabilities. There were reports of regular monitoring visits undertaken on behalf of the provider, to monitor quality of care. Additionally, there were quarterly service performance reports. Fire safety tests were up-to-date with evidence of regular drills and servicing of the system. Records showed that regular checks are made of fridge and freezer and hot water temperatures and these were satisfactory in both cases. Policies were in place for fire safety, infection control, handling clinical waste, control of substances hazardous to health, moving and handling and health and safety, all dated 2006. Portable electrical appliances had been tested in December 2006 although no report had been received at the home yet to detail the findings. The adapted bath had been serviced in August 2006. Service user risk assessments need to be updated to ensure that the home is adequately protected from accidental injury. Foxdown DS0000047598.V323932.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 x 2 x 3 x x 2 x Foxdown DS0000047598.V323932.R01.S.doc Version 5.2 Page 24 no 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 YA6 Regulation 15 Timescale for action Care plans and accompanying 01/07/07 risk assessments are to be updated, to ensure that accurate information is documented about current care needs. Service users are to be moved in 01/07/07 accordance with their care plans and in line with best practice, to avoid the risk of accidental injury. Accurate records are to be 01/05/07 maintained of medicines administered to service users, to ensure that service users are receiving their prescribed medicines. Requirement 2 YA6 13(4)c 3 YA20 13(2) 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 YA9 Good Practice Recommendations It is recommended that the missing person procedure be amended to reflect the Commission for Social Care Inspection as the regulatory body, to ensure that staff are
DS0000047598.V323932.R01.S.doc Version 5.2 Page 25 Foxdown 2 3 YA20 YA24 able to notify appropriate agencies promptly when a service user is missing. It is recommended that staff receive training on using the “pen” device for medication, to ensure that they are following safe practice. It is recommended that measures be put in place to prevent service users gaining access to the boiler flue pipe, to reduce risk of injury. Foxdown DS0000047598.V323932.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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