Inspection on 11/11/05 for Foxearth Lodge Nursing Home

This inspection was carried out on 11th November 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.

Other inspections for this house

Foxearth Lodge Nursing Home 29/11/07

Foxearth Lodge Nursing Home 01/12/06

Foxearth Lodge Nursing Home 19/01/06

Foxearth Lodge Nursing Home 17/11/04

Foxearth Lodge Nursing Home 16/04/04

Similar services:

Claremont House

Oak Ridge

Coopers Mill Ltd

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Paradise Lodge

Bilney Hall

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

CARE HOMES FOR OLDER PEOPLE Foxearth Lodge Nursing Home Little Green Saxtead Woodbridge Suffolk IP13 9QY Lead Inspector Mary Jeffries Announced Inspection 11th November 2005 10:00 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 Foxearth Lodge Nursing Home DS0000024391.V250452.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. Foxearth Lodge Nursing Home DS0000024391.V250452.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Foxearth Lodge Nursing Home Address Little Green Saxtead Woodbridge Suffolk IP13 9QY 01728 685599 01728 685599 admin@foxearthlodge.co.uk 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) Mrs Eileen Patricia Cantrell Mr Brian Cantrell Mrs Eileen Patricia Cantrell Care Home 62 Category(ies) of Dementia (24), Old age, not falling within any registration, with number other category (38) of places Foxearth Lodge Nursing Home DS0000024391.V250452.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th November 2004 Brief Description of the Service: Foxearth Lodge Nursing Home provides nursing care to a maximum of 62 elderly service users, comprising of 38 older persons (OP) and 24 older persons with a diagnosis of dementia (DE). The home is in a rural location, a few miles from the market town of Framlingham and is set in large grounds, which are accessible to service users. Woodlands Unit (which caters for up to 24 older people with dementia) is on ground floor level and comprises 2 double and 20 single bedrooms, all with en suite toilet facilities. Foxearth main and Barn units are on two floors, linked by a shaft lift, and comprise 2 double and 34 single bedrooms, of which all except one have en suite toilet facilities. There are several lounges, dining rooms and small, quiet communal areas throughout the premises. Foxearth Lodge Nursing Home DS0000024391.V250452.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection was conducted on 11th November 2005 with the assistance of Eileen Cantrell (Proprietor), Pascale Hadley (Deputy Nurse Manager), James Cantrell (General Manager), and Michelle Minter (Trainee Manager). These individuals, along with the staff on duty and service users within the home, contributed fully to a constructive inspection process. There were sixty-one service users residing at the home at the time of the inspection. Time was spent with and observing service users on the dementia unit, Woodland, and one service user on the mainstream unit, the Barn, was spoken to at length. Two relatives of service users with dementia were spoken with. The inspection lasted nine hours. What the service does well: What has improved since the last inspection? What they could do better: Staff recruitment documentation still needs to improve. Two important policies require updating. There is a high level of use of lap belts; this should be reviewed. Most of the comments made concerning dementia care are recommendations, but taken together, and in the light of the use of restraint, indicate that the home could develop its’ provision for service users with dementia through some changes to the environment and approach. Foxearth Lodge Nursing Home DS0000024391.V250452.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. Foxearth Lodge Nursing Home DS0000024391.V250452.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 Foxearth Lodge Nursing Home DS0000024391.V250452.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): 1,2,3,4, Although the home does always carry out its own pre-admission assessments, service users would benefit from the home insisting on single assessments from social care services, when social care is placing a service user. EVIDENCE: The assistant manager advised that service users had been given a copy of the service user’s guide, and a service user spoken with had their copy in their bedside cabinet. The home provided copies of the service user’s contacts, one for permanent, care, one for respite care. These conditions were detailed, but did not contain any scope for detailing any specialist pieces of equipment that must be provided by service users, as had been recommended at the previous inspection. The inspector was advised that the home did their own pre – admission questionnaires, and that they used to get a COMPASS STARS single assessment, but do not currently receive them, and have had difficultly obtaining these. These were not present on three files inspected, but Foxearth Lodge Nursing Home DS0000024391.V250452.R01.S.doc Version 5.0 Page 9 information from a hospital on discharge was available for one. Pre-admission questionnaires were done by the Nurse Manager, often visiting service users in hospital. If the service user was at home, the nurse manager advised that she involved home carers. If the prospective service user lived a very long way from Suffolk, these might be done over the telephone. Pre admission questionnaires were seen to be completed on a number of service users files selected at random. The home met the needs of elderly service users and service users with a diagnosis of dementia in the Woodlands unit, which accommodates 24 service users. The Nurse manager confirmed that all service users on Woodlands were aged over 65 years of age, and had a diagnosis of dementia. The home’s pre inspection questionnaire indicated that the home had 36 service users with dementia. This was discussed with the Nurse Manager, and advice was given that a number of service users on the older people’s unit, did have a diagnosis of dementia, but did not have challenging behaviour. Three service users were identified by the home as having a diagnosis of dementia and not residing on Woodlands. The inspector was advised that two were individuals who had lived at the home for some time, initially on Woodlands, and moved following review when it was considered that their needs could be met on the ordinary unit. The inspector was told that one had been assessed by a psycho-geriatrician since moving to the home. The records of all of these were inspected and confirmed this advice. The Nurse manager subsequently confirmed that nine service users on the older people’s unit had a diagnosis of dementia. They confirmed that some had been diagnosed since admission, some had been transferred from the dementia unit when their care could be managed appropriately on the mainstream older people’s unit, and some had been admitted with the diagnosis. One relative’s feedback form had commented that the nurses on the conversion course were sometimes difficult to understand; this was discussed with management who advised that they provide a 2hrs per week conversation class for those for whom English is not a first language. A service user spoken with confirmed that they did not like having foreign carers but acknowledged that there was no particular reason for this. Foxearth Lodge Nursing Home DS0000024391.V250452.R01.S.doc Version 5.0 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 the following standard(s): 7,8,9,10 Service users can expect to receive good health care in accordance with thorough care plans. Service users can expect to be treated with dignity and respect. EVIDENCE: It was clear that pre-admission assessments had been used to formulate the service user plans and that the service users and their close family members had been consulted during the process. Service user plans (called ‘patient needs assessments’) seen were found to contain thorough consideration of service users needs, including general risk assessments, lifting and handling assessments, restraint records, carer and family involvement, continence, social interests and hobbies, activities and religious and cultural needs. Where necessary the reader was referred to more detailed care plans and risk assessments for specific areas of care. Risk assessments in relation to service users’ susceptibility to developing pressure ulcers and to falling had been undertaken. Foxearth Lodge Nursing Home DS0000024391.V250452.R01.S.doc Version 5.0 Page 11 The restraint records inspected for one service user showed a longer use of a lap belt than the risk assessment on the service user’s plan indicated was appropriate and had been agreed. (Also see standard 14) Full records of specific nursing care provided, consultations with GPs and consultations with other healthcare professionals were present in the service users’ care records. Care records and discussion with staff confirmed that service users access health care services such as chiropody, General Practitioners and opticians. Specialist equipment and aids to prevent pressure sores and manage incontinence are available in the home. Service users files also contained life histories, and two relatives spoken with specifically spoke of being impressed that the nurses and care staff seemed to relate to the service users with a sense of the whole person that they had been. A member of staff was asked about the use and value of these, and advised that it was so that they could have conversation with service users with dementia. The relative commented, “ I always feel that they respect the person with their past, they bring into account the person with their past, they take into account that she was a coping strong woman with a good sense of humour.” Daily care notes were filled in by senior staff at least three times every day and all entries examined were appropriate. Daily records of three service users on the dementia unit were inspected. They had good information on care provided and but minimal comment on social activities. The inspector was advised that nearly all of the staff work across the home; service users with dementia on the ordinary unit did not therefore have less well or appropriately trained staff than service users on Woodlands. Of the three service users with dementia who were not on Woodland, one spent all of their time in bed, and could be managed appropriately on the unit without risk to them self or others. One however had a lap belt in use when they were in their chair, in addition to bedrails. Risk assessments were in place for these. The service user who was described by staff as mostly compliant. A service user who did not have dementia was asked whether they were bothered in any way by the service users who did, they replied, “no, why should they bother me.” A relative spoken to about a service user on Woodlands said, “…………..….beams with delight every time a nurse comes in, you just have to see her face. It wasn’t always like that, she used to be quite tormented.” A service user spoken with described how a carer helped them with her bath, and how she had no worries about it; she said that the carer who helped her was very good. Medication administration and recording systems were inspected for all service users on Woodlands, the unit providing care for people with dementia. These were all complete and correct. A powder with active ingredients was seen in Foxearth Lodge Nursing Home DS0000024391.V250452.R01.S.doc Version 5.0 Page 12 the room of one service user with dementia, which should have been kept within a locked cupboard. This was addressed on the day. Specimen signatures of staff who administer medication were kept with the recording system. The home advised they had addressed a recommendation made at the last inspection, regarding service users preferences of lunchtime medication. This could not be reassessed, as medication practices were not observed. They will be observed at the next. A service user stated that they were able to get up and go to bed whenever they wished to. All interactions observed between staff and service users were appropriate, professional and friendly. Staff were heard speaking courteously to service users and were aware of how they liked to be addressed. A service user said, “They always knock on your door, they are very good, I like them.” Two relatives spoken with on the day had very positive reports of the care at the home, one said, “I have been totally satisfied with (their) care. (They) are always well looked after and is very happy.” They described how the care staff got the relative outside on nice days, and how the home always ensure she was well dressed and made up. The relatives also praised the support that the home gave in supporting relatives with the difficulties they had in coping with the service user’s dementia, and the efforts the home made to keep them informed. “ When……………..first came her they had a fall. They didn’t hurt themselves, but they phone and let me know and they delivered the news well, so that I wasn’t unduly worried.”. Foxearth Lodge Nursing Home DS0000024391.V250452.R01.S.doc Version 5.0 Page 13 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): 12,13,14. Service users can expect to have access to a good programme of activities and for their relatives to be made welcome within the home. The use of lap belts on ordinary chairs is not common practice, and it is concerning that this use of restraint is in place for 5 service users. EVIDENCE: A relative responding to the pre inspection survey said that they could visit at any time, but were not exactly welcomed. All others responding confirmed that they were welcomed to visit at any time. Two relatives and a service user spoken with confirmed that visitors were welcomed at any reasonable time. The relatives spoken with were very impressed with the support that the home had given to them in terms of dealing with the service users needs. One spoke of their heart lifting when they approached the home, such was the care and comfort offered by the environment. A programme of recreational activities is displayed throughout the home, taking place both internally and externally. These included an in house communion services. Seven of eight service users who completed pre inspection questionnaires indicated that they thought suitable activities were provided, one indicated that they thought sometimes suitable activities were provided. Care records, observation and discussion with a service user Foxearth Lodge Nursing Home DS0000024391.V250452.R01.S.doc Version 5.0 Page 14 confirmed that daily routines are flexible. Staff were seen engaging service users with dementia in activities on a one to one basis. The inspector attempted on two occasions to speak with service users on the frail elderly units, but found them totally engrossed in a video on Buckingham palace that they were enjoying watching. One service user who had missed the start of the video, and decided therefore not to watch it was spoken with. One relative stated on pre-inspection material provided, that they would like to know what their relative had been doing as it would help them communicate with them. Staff confirmed, that relatives may ask to see the service users daily notes, however, their was little information on social activities participated in on the daily notes of three service users inspected. There was a fish tank in the main lounge in the dementia unit, but little other evidence of sensory stimulation. The trainee manager advised that the home has a box of games and activities that can be done with service users, and one of the workers was seen to get this out to use during the day, but there was no evidence of other sensory stimulation freely available to service users such as fumble boxes, textured cushions or picture books. A tour of the home confirmed that many of the service users’ bedrooms were nicely personalised and this was clearly encouraged by the home’s staff and valued by the service users. One relative providing pre inspection information stated that they would like to see a little more attention to detail, referring to the impact of the environment in meeting service users needs’. They gave an example of purposefully taking in bright flowers, as their relative had failing eyesight, and putting them close enough for the relative to see, but finding them moved out of the way. This relative did also comment, that on the whole their relative’s care was very good. One service user had a lap belt used in an ordinary chair. A risk assessment for this service user conducted two months previously showed that the service user had had falls for ten days running, and that this was due to the service user forgetting they could not walk. The risk assessment stated that the lap belt was to be used when staff were not available to supervise closely, that the service user was not to be left alone for long, and that the lap belt was for intermittent use only. The record of restraint for the previous day showed that this had been put on a 6.30 am, and taken off at 6.30 pm. Records of restraint for the previous month showed that this had been used most days, most of the time. The carers were spoken with and asked whether this service user had the belt in situ all of the waking day, and advised that they did, unless they were with the service user feeding them. Restraint records for another service user for whom a lap belt was used showed that it had been used for six and a half hours the previous day, and five hours each of the previous two days. Again there was a risk assessment in place, signed by the doctor and relatives. Foxearth Lodge Nursing Home DS0000024391.V250452.R01.S.doc Version 5.0 Page 15 This was discussed with staff and management who said that it was only used as a last report, and always with full consultation with other professionals and families. Immediately following the inspection, the home provided information that in addition to the service users detailed above, three service users on the mainstream part of the home, the Barn, also had lap belts in use on ordinary chairs. Care plans and risk assessments for the three service users for whom lap belts are used that were not inspected on the day were forwarded to the CSCI immediately following the inspection. Foxearth Lodge Nursing Home DS0000024391.V250452.R01.S.doc Version 5.0 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 The home’s management are open to complaints, and to dealing constructively with them, but the procedures and documentation that are need to support this need reviewing. EVIDENCE: The complaints procedure was on display within the home and contained all information as required by Regulation. The home’s management had a positive attitude to the receipt of complaints, with all expressions of dissatisfaction made to the home being taken seriously. A relative spoken with advised that one of her family had made a complaint; it had been established that there was a misunderstanding, …………….. got the wrong end of the stick, but the home handled it well. I’ve never had the feeling they would respond less than well.” All eight of the service users responding to the pre inspection questionnaire advised that they knew who to speak to if they needed to complain. A service user spoken with however, who demonstrated a good knowledge of the home and their own care, was not sure who to complain to. They advised the inspector that only two matters had ever concerned them at the home, and one of these was that when they asked the staff on their unit if they could speak to a manager they were told we don’t have a manager, and nothing else was done. The service user was directed to the recently acquired Service User’s Guide as a reference document, but when examined with them it was found that the summary of the complaints policy did not include who to Foxearth Lodge Nursing Home DS0000024391.V250452.R01.S.doc Version 5.0 Page 17 complain to. The summary stated that the policy was given with the contact at the time of admission, however, this information needs to be easily available. The home has a prevention of abuse policy. The policy states that all allegations of abuse must be referred to the CSCI in the first instance. This does not reflect the Suffolk revised Protection of Vulnerable adults interagency policy (June 2004), which give Social Care Services the lead. The policy did not make clear that after establishing the facts, an agreed strategy possibly with other professionals such as police, must be in place prior to any investigation. The policy was overdue for review, which had been scheduled for July 2005. The Nurse manager was spoken with about procedures, they had attended a Protection of Vulnerable Adults study day. The home’s whistle blowing policy was also overdue for review, as had been scheduled for July 2005. The Whistle blowing policy did not make clear the responsibility of staff to report abuse, nor did it include advice that if the referrer fears that they may be victimised, dismissed or perceived as a trouble maker, the provisions of the Public Interest Act 1998 may protect the alerter in raising concerns outside of the workplace, given certain stated provisions. The home’s prevention of abuse policy did state, very clearly, “it is your responsibility to act if you come across a situation of abuse”. The home has an appropriate missing persons policy. Foxearth Lodge Nursing Home DS0000024391.V250452.R01.S.doc Version 5.0 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,22,23,24,25,26 A safe, very clean, attractive and well-maintained environment is provided, and all necessary aids and adaptations are available and regularly serviced (where necessary). EVIDENCE: The Woodlands unit had been designed for service users with dementia. It was evident in the Woodlands unit that service users were free to wander around the unit and its enclosed gardens. No areas were locked with the proper exceptions of the medication room and the cleaning cupboard. This contributed to a relaxed atmosphere in the unit. Service users had free access to an enclosed courtyard garden that was well maintained. The internal garden had been planted with lilac and roses, which provide sensory stimulation for service users, and there were a few small pots of pansies to give some winter colour. One relative had provided pre inspection feedback that they thought more could be done to make the garden more attractive in winter. The manager advised that they had used to have a fountain, but found this hard to maintain as service users with dementia had had put plants into it. The Woodlands unit Foxearth Lodge Nursing Home DS0000024391.V250452.R01.S.doc Version 5.0 Page 19 was an especially calm, open plan and relaxed environment with service users able to move around freely whilst being discreetly monitored by staff. Service users in the Foxearth and Barn unit had access to more open gardens. All bedrooms in the Foxearth and Barn units were South facing, ensuring pleasant sunlight in the morning and at lunchtime. The home has four double rooms and fifty four single rooms. Only one room, one of the singles, does not have ensuite facilities. The home is warm and airy with good lighting throughout. Radiators observed were those with a guaranteed low surface temperature and were able to be thermostatically controlled within the rooms. Hot water temperatures were taken at one washbasin and one bath and were found to be approximately 43 degrees Celsius. The home was clean throughout the inspection. No unpleasant odours were detected in any part of the care home. One of the relatives feed back forms indicated that they were concerned by the number of flies in the home. Only one was seen in a service users room on the day of the inspection, but two heavily loaded fly papers and a fly squatter evidenced the problem. Managers advised this was an inevitable consequence of the home being next to a pig farm, and although measures were taken to control the problem; including some meshed windows, special lights in the kitchen, and a contract with a pest prevention firm who, the inspector was advised painted the kitchen ceiling with special paint. This contract was seen: it did not specify specific measures taken. Another relative provide the written comment “ very clean everywhere, and no odours” The home had an appropriate control of infection policy, which minimises the risk of cross infection. A service user spoken with confirmed that the carers and nurse wore gloves for intimate care tasks, but not for general bathing. The home’s environment was well designed, with assisted facilities and adaptations in evidence throughout. An appropriate call bell system was present in each service user bedroom, each bathroom and each assisted toilet. Mobility aids, such as hoists, assisted toilets and baths were available throughout the home. The home was well presented and decorated to a high standard. A service user described some recent decorating that had occurred, and was very satisfied that they had known when the decorators were coming, and that they had been asked if they liked what was being done. They like the colour of their room which had been decorated, and said that if she hadn’t she thought they would probably have shown her some other colours. All parts of the home were accessible to service users via a shaft lift. There is a separate room for service users who smoke. Foxearth Lodge Nursing Home DS0000024391.V250452.R01.S.doc Version 5.0 Page 20 Service users’ bedrooms were generally well equipped in line with this standard and many were nicely personalised in line with their wishes, and had lockable draws. Service user’s rooms on the dementia unit, each had their name, as they preferred to e called on the door, but did not have any picture relating to their identity to assist recognition or sense of personhood. A relative provided pre inspection comments that their relative always had a plastic sheet under their draw sheet on the bed, but since pads were used they were concerned that the potential discomfort of a sweaty bed did not warrant this. A relative spoken to said that they thought their relative did have a draw sheet with plastic underneath, but was not concerned, “………doesn’t seem to mid at all, she would say.” The Nurse Manager advised that most service users have drawer sheets on their beds, and that these have plastic underneath, but that if a relative or service user was not happy with this it could be discussed and changed if appropriate. There were several lounges, day rooms and quiet rooms available for the use of service users, offering a full choice over where and with whom they could sit. Foxearth Lodge Nursing Home DS0000024391.V250452.R01.S.doc Version 5.0 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29,30 Recruitment documentation was not fully compliant with the regulations, this exposes service users to some risk. EVIDENCE: Scrutiny of the staffing rotas, observation of staff on duty and discussion with members of the management team confirmed planned staffing levels were good, and were consistently met, with conversion staff who live on site being called upon to cover for any unplanned absences. Five of the six relatives providing pre inspection questionnaires thought that there were always enough staff on duty. The inspector examined eight staff files, including conversion nurses and younger persons working in a domestic capacity. Work permits had been obtained as necessary and appropriate risk assessments had been carried out. Pre employment health questionnaires had been undertaken. Written references had been obtained for, however, they were missing on two of the conversion nurses files, and one reference on the file of a conversion course nurse was not satisfactory. It was on plain paper did not state the capacity in which the applicant was known to the referee, other than to state they had not worked with them, and gave no indication of the referees status or credentials. Criminal Records Bureau (CRB) checks, for all staff were inspected, and found to be in place. Three records had been destroyed, but numbers of the Foxearth Lodge Nursing Home DS0000024391.V250452.R01.S.doc Version 5.0 Page 22 disclosures had been recorded. Discussion took place regarding the need to renew CRB checks at appropriate intervals. Proof of identification was seen for seven of these staff members- one was not available as it was understood to be in the workers induction file which they had with them. There was a positive training culture at the home, and at the previous inspection it had been found that 61 of care staff held NVQ 2 or above. Trained nurses had received training in care of the elderly. Overseas staff were training to become registered nurses and were undertaking appropriate conversion courses under supervision. The home received the Alzheimer’s newsletter, and all staff were encouraged to undertake a one day course, “Caring to make a difference”, which also provides a video to take to study. No training analysis was available so it was not possible within the time available to ascertain how many staff had undertaken this. The home was not aware of the 3-day dementia course that runs at Kerrison. Foxearth Lodge Nursing Home DS0000024391.V250452.R01.S.doc Version 5.0 Page 23 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): 31,32,33,38 The home is efficiently managed, and very professional, with the service users health being given every consideration. The increasing number of service users with dementia is likely to have an impact on service users who do not have dementia. A business plan should address this and service users views, but as it was not available, service users already living on the mainstream unit may experience a change in their daily life that they had not anticipated and the environment on the mainstream unit may not be best suited to service users with dementia. The needs of service users with dementia could be better met with more emphasis on a person centred approach, rather than efficiency. Health and safety in the environment is generally very well considered. EVIDENCE: Foxearth Lodge Nursing Home DS0000024391.V250452.R01.S.doc Version 5.0 Page 24 The registered manager was a well-qualified registered nurse with 21 years experience of operating and developing the home. The manager was well backed by a management team who all contributed positively to the inspection process and the general running of the home. The inspector noted a calm atmosphere around the home throughout the inspection day, with service users able to make choices about what they did during the day. Staff all had name badges. These were worn clipped onto lower pockets, and were difficult to see. The Nurse manager advised that this was done so that service users were not scratched by the badges. A service users questionnaire had been administered during October, and a copy of this was provided, although the results had yet to be collated. The home did not have a business plan. Records pertaining to service users were kept in a locked office. Working care records were kept in accessible files at the nursing stations. Evidence was available that the home took appropriate input from service users and relatives in the preparation and maintenance of the care records. The notice of the inspection was prominently displayed, and comment cars available within the home. The last inspection report, the Statement of Purpose and relatives comments cared were also on display and readily accessible. A valid certificate of public liability insurance was on display. The home’s pre inspection questionnaire indicted that all policies requiring review up to July 2005 had been reviewed, however the policies provided at the inspection for Protection of Vulnerable adults from abuse and whistle blowing appeared not to have been, and still contained the next review date as July 2005. Information provided on the pre – inspection questionnaire stated that all routine maintenance checks had been made. Fire extinguishers were seen to have been serviced. A relative confirmed that the fire alarm had gone off when they were present, but that everyone knew it was a drill. They said that the alarm was clear and audible. A service user spoken with also confirmed they had heard it, less than a month ago. Records of monthly drills were seen. The home had a fire risk assessment, and had training delivered 3 times a year by a consultant. Emergency lighting checks were evidenced, as was portable electrical appliance testing. Risk assessments were seen to be in place for smokers. The doors on a cupboard marked fire doors were not locked. Evidence was seen of up to date servicing for all lifts and hoists. Foxearth Lodge Nursing Home DS0000024391.V250452.R01.S.doc Version 5.0 Page 25 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 3 3 3 2 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 X COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 3 X 3 3 3 3 2 STAFFING Standard No Score 27 3 28 X 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X X X X 2 Foxearth Lodge Nursing Home DS0000024391.V250452.R01.S.doc Version 5.0 Page 26 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 OP1OP16 Regulation 5 Requirement The Service User’s Guide should include a summary of the complaints policy, including who to complain to and how to complain. Where restraint is used, it must be in line with any agreed risk assessment and measures agreed by parties to it. The use of restraint must be limited in line with the mental incapacity bill, which states that any restriction of liberty must be the shortest and least restrictive possible, and regard must be had that the purpose for which it is used can be achieved in any other less restrictive way. The homes policy on prevention of abuse must be reviewed and made consistent with local interagency policy. The homes policy on whistle blowing must be reviewed and revised, and include advise on protections if whistle blowing outside of the home, in accordance with local interagency policy. DS0000024391.V250452.R01.S.doc Timescale for action 14/01/06 2 OP7 13(8) 11/12/06 3 OP14 13(7) 15/12/05 4 OP18 13(6) 14/01/06 5 OP18 13(6) 31/01/06 Foxearth Lodge Nursing Home Version 5.0 Page 27 6 OP29 17,2,S4,6 &19,1bi,S 2 7 OP29 17,2,S4,6 &19,1bi,S 2 8 OP38 23(4) The registered persons must 24/12/05 ensure that two written references are obtained in respect of each staff member prior to them commencing employment at the home. These documents must be kept securely on file and made available for inspection. The registered persons must 14/12/05 ensure that documentary proof of identification is obtained prior to staff members commencing employment at the home. These documents must be kept securely on file and made available for inspection. This requirement is repeated from the last inspection. Fire doors on cupboards should 11/12/05 be kept locked. 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 OP2 Good Practice Recommendations The registered persons should ensure that the standard form of contract for the provision of services and facilities is updated to be explicit about what equipment is routinely provided at the home, what equipment must be provided by the service user and that no service user would be admitted to the home unless all requisite equipment was in place as identified by the pre-admission assessment. The registered persons should consult service users who are prescribed lunchtime medicines as to whether they would prefer to take their medicines before, during or after their meals (unless medicinal instructions are prescriptive in this regard). Fumble baskets and or other sensory and recognition stimuli should be available for service users with dementia. DS0000024391.V250452.R01.S.doc Version 5.0 Page 28 2 OP10 3 OP12 Foxearth Lodge Nursing Home 4 5 OP12 OP19 6 7 8 9 OP30 OP30 OP32 OP34 Records should be maintained of social activities undertaken by service users with dementia. Service Users with dementia should have relevant pictures or cartoons or images on their individual room doors to assist recognition and orientation and increase and develop their sense of personhood. A training analysis should be conducted. More extensive training in the care of dementia and the impact of person centred care and the environment on behaviour should be provided for workers on Woodlands. Staff name badges should be clearly visible to service users, particularly those with dementia. The home should have a business plan for the establishment, reviewed annually. Foxearth Lodge Nursing Home DS0000024391.V250452.R01.S.doc Version 5.0 Page 29 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ 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 Foxearth Lodge Nursing Home DS0000024391.V250452.R01.S.doc Version 5.0 Page 30 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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