Inspection on 29/11/07 for Foxearth Lodge Nursing Home

This inspection was carried out on 29th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Foxearth Lodge Nursing Home 01/12/06

Foxearth Lodge Nursing Home 19/01/06

Foxearth Lodge Nursing Home 11/11/05

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 Jill Clarke Unannounced Inspection 09:55 29 & 30 November 2007 th th 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.V355869.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 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.V355869.R01.S.doc Version 5.2 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 - over 65 years of age (52), Learning registration, with number disability over 65 years of age (1), Old age, not of places falling within any other category (38), Physical disability (1) Foxearth Lodge Nursing Home DS0000024391.V355869.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home may accommodate one named service user who is an older person with a learning disability and dementia as named in variation application dated 4/8/06. 1st December 2006 Date of last inspection Brief Description of the Service: Foxearth Lodge Nursing Home provides nursing care to a maximum of 62 people in the categories of old age, and older people with dementia. The home is also registered to look after 1 person under the age of 65 who has a physical disability, and 1 named person with a learning disability and dementia. 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, all of which have en-suite toilet facilities. There are several lounges, dining rooms and small, quiet communal areas throughout the premises. The home has a condition of Registration that allows it to accommodate 9 named service users with dementia, so long as their needs can be met, outside of Woodlands. The home charges: £728.00 per week for self-funding long stay residents. £125.00 per night for short term care. There are no additional charges except for private dental and ophthalmic fees, dry cleaning and long distance telephone calls. Foxearth Lodge Nursing Home DS0000024391.V355869.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. We (the Commission) undertook this inspection over 2 days (12¼ hours). The first of the 2 days was unannounced. The last Key inspection undertaken in December 2006, ‘focused on the main part of the home’ and the dementia care unit Woodlands was not inspected. Therefore this inspection we concentrated most of our time on Woodlands, however we did visit people living in the main part of the home to hear their views during the second day. During the visits, we assessed the outcomes for the people living at the home, against the key Lines of Regulatory Assessment (KLORA), and ‘Making judgements about the quality of service for people with dementia in care home’ (available to read on our web site www.csci.org.uk). We also looked at how the home were meeting the core National Minimum Standards relating to Older people, and gave a score (see scoring of outcomes section of this report) to show if they are being met. The report has been written using accumulated evidence gathered prior to, during, and contact made following the inspection. Commission for Social Care Inspection (CSCI) feedback surveys were sent to the home to distribute, prior to the inspection. This gave an opportunity for residents, relatives, visitors, and staff, to give feedback on how they thought the service was run. Information obtained from service users (14), relatives/advocates (4) staff (13) has been included in this report. To enable us to gain feedback from people, who due to their mental frailty may be unable to complete a CSCI survey, we completed a Short Observational Framework for Inspection (SOFI) record sheet. Developed in conjunction with the University of Bradford, this enabled us over a period of 2 hours, to watch 5 residents sitting in Woodlands Lounge/dining room. During this time we were able to look, and record how the residents spent their time, their mood/well being, and how well staff engaged (interacted) with the residents. Observations made, have been included in this report, within the relevant sections. Prior to the inspection the home was required to complete their Annual Quality Assurance Assessment (AQAA). This enables staff to inform the CSCI on how well they are meeting the National Minimum Standards. The home is also asked to state what they feel they do well (and where able to provide evidence to back this up), and what areas they feel they could do better in. Information obtained from the AQAA, has also been included in this report. We spent time in both the main home (Foxearth and the Barns) and Woodlands (dementia care), taking in a selection of the communal lounges and Foxearth Lodge Nursing Home DS0000024391.V355869.R01.S.doc Version 5.2 Page 6 dining rooms. We also spent time talking to 4 residents (main home), in the privacy of their bedroom. Records viewed included, care plans, staff recruitment and training records, complaints policy, service users guide and medication records. Both residents and staff we met during our inspection were very helpful, and gave us valuable feedback. What the service does well: What has improved since the last inspection? They have taken action to address the requirements and recommendations made following the last inspection. Staff are writing down how much food people are eating to support them in monitoring their nutritional intake. Where a resident is on bed rest, and require to be tilted from side to side, to releive the pressure on their skin, this is now being recorded. They are following safe practice of only giving 1 resident their medication at a time, to reduce any risk of medicines accidentally being given to the wrong person. They also have arrangements in place to ensure drugs are disposed of safely, and removed from the premises. Staff who start work in the home, before their Criminal Record Bureau (CRB) check (which validates their identity, and if they have a criminal record) has been completed, are now supervised by a suitable member of staff, until the clearance has been received. Foxearth Lodge Nursing Home DS0000024391.V355869.R01.S.doc Version 5.2 Page 7 The home has systems in place to book in and out any resident’s valuables, held in safekeeping. What they could do better: 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. Foxearth Lodge Nursing Home DS0000024391.V355869.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Foxearth Lodge Nursing Home DS0000024391.V355869.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5. (the home did not have any people admitted for intermediate care, therefore standard 6 was not assessed). Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can expect to have their needs assessed, invited to look around the home and be given enough information, to support them in deciding if the home offers the level of service they are looking for. EVIDENCE: We were given a copy of the home’s latest ‘Service Users Guide’ booklet (2007 2nd edition). There was no information given in the guide, as to whether it could be supplied in different formats, to support people with their individual communication needs. The guide sets out the home’s ‘policy directive, philosophy of care and aims and objectives’. It informs people that ‘rules and regulations for patients are kept to a minimum’, and includes ‘a Charter of Rights for people living in Nursing Homes drawn up by the charity, Age Concern’. The guide uses a style, which is more formal, referring to people living at the home as a ‘patient’. On some pages we found the font size quite small, which some people may have difficulty in reading. There is no index, Foxearth Lodge Nursing Home DS0000024391.V355869.R01.S.doc Version 5.2 Page 10 views of the people using the service, or local information, such as meal times, or when the hairdresser visits. On page 2, it referred the reader to the pages to read in the ‘Foxearth Lodge Nursing Home Polices and Procedures, rather than this information being given in the booklet. The guide contained a summary of our last inspection at the home, informing the reader that there are copies of the report in ‘it’s entirety’ available ‘in the foyer’ (which we noted when we arrived). All but 3 of the people completing our survey said that they had received enough information about the home. They said this had supported them in deciding if it was the right place for them, with 2 people saying, that the decision had been made by their family. The Service User guide confirms that ‘prospective patients’, will be provided with an information pack and ‘invited to visit the home for a meal where possible’. They said they would let people know ‘prior to admission’ if they are able to meet their needs, and ensure ‘the patient is happy with the location and ethnic, religious, cultural and social mix of the home’. They do not mention if they go out to assess a person in their own home (which supports them in gaining a greater insight into the persons lifestyle, physical needs and social contacts/interests), or current care setting. When we spoke to staff they said that they do go out and visit people to undertake a pre-assessment, however sometimes this “is undertaken over the phone”. The AQAA informed us that people are encouraged to ‘visit several times and bring other members of the family’ to look around and ask further questions. They said that ‘prospective service users or their representatives are allowed to visit the home as often as they wish at different times of the day, announced or un-announced before making a decision’. People are also able to stay for a short period of time, to help them know if ‘the time is right for them’ to move into Foxearth. A resident we spoke to, said that they had been made aware of the fees the home charges, before they moved in. This was further evidenced by the 2 contracts we looked at, which included information on the room to be occupied, and what is included in their ‘all-inclusive fee structure’. The service user guide also gave a list of what is meant by ‘all inclusive’, and the only additional costs that may be ‘incurred’ are for private dental and optical treatment/supplies, dry-cleaning and long distance telephone calls. Foxearth Lodge Nursing Home DS0000024391.V355869.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People can expect their nursing and physical care needs to be monitored, and appropriate action taken by trained staff when their needs change. However, people cannot be assured that their care will not be interrupted by phone calls, and that the home holds sufficient stocks of their prescribed medication. EVIDENCE: The AQAA tells us that information taken from pre-assessments are used to develop a ‘comprehensive care plan, drawn, when possible, with the involvement of the service user or their representative’. We looked at 2 care plans, selected from the people we had observed during the SOFI session, as it helped us identify some of the people’s care and social (see next section of this report) needs. The care plans gave detailed information on their physical and nursing needs. This included, monitoring their diet intake, to ensure they are getting enough nourishment and fluids. Where it is identified that a person requires “extra support” their care plan is marked with a red star to “alert staff”, which they said works well. Staff were Foxearth Lodge Nursing Home DS0000024391.V355869.R01.S.doc Version 5.2 Page 12 also monitoring people’s skin, for any signs that of it becoming red or broken. Where concerns were identified, records were being kept of the action taken to relieve any pressure to that area of skin. This included keeping a record of when the person was moved from side-to-side. Care records were being looked at monthly, or earlier if a persons care needs changed. The front ‘admission sheet’, completed on the day of admission, included brief information on the person’s medical history, religious and cultural needs. The information given, focused on physical, nursing care, and did not give information on what a person could do for themselves, and how staff were supporting them to maintain their independence. There was evidence of relative involvement, especially in putting together ‘The person you are, the person you were’ (life history). The useful information booklet, gave us an insight into the person’s life, family connections, interests, past events that if remembered or mentioned, could bring back unpleasant memories. However, this information was kept in a separate file, instead of forming an important part of the care plan, looking at the person’s social and emotional needs (see next section of this report). Staff complete a daily ‘continuation sheet’, with written brief comments on any care/nursing intervention, including information on the person’s ‘oral intake’. It also covers people’s safety, for example if they have been risk assessed as needing to use ‘bed rails’, where there was concerns that the person may roll out of bed and hurt themselves. There was a signed consent form, completed by the resident’s family, and General Practitioner, to use a lap belt as a method of restraint, to stop the resident getting out of their chair - when staff were not around. If was felt that if the person did get up unsupervised, their was a high risk of the them injuring themselves. Staff also informed us that they would involve Social Services who “will come and visit”. The home has set policies and procedures for staff to follow, when using this form of restraint. Records held on the care plan showed that this included keeping ‘a log of when it is being used’, when it could be used, and that it ‘must not be used’ if the person was ‘showing any signs of distress’. There was information, which showed that people were receiving regular visits from a local Doctor who undertakes routine weekly visits to the home, as well as visiting when needed. Staff said they had “good working relationship” with the local surgery. Residents surveyed, in response to being asked are you receiving the medical support you need, 10 had replied ‘always’, 3 ‘usually’. A relative had also commented ‘I am impressed with the regular visits of the local GP’. Where a resident had ‘not ticked a reply box’, they had commented that they needed ‘very little medical support’. Records also showed that people’s optical and chiropody needs were being monitored. Foxearth Lodge Nursing Home DS0000024391.V355869.R01.S.doc Version 5.2 Page 13 Relatives surveyed told us that they are ‘always’ kept up to date with important issues affecting their next-of-kin. Staff surveyed confirmed that they had ‘routine access to care plans, to check anything that needs clarification’, and were given ‘updates’ on residents health during ‘handover’ at the ‘beginning of every shift’ from the ‘registered nurse in charge’. Under what could the service do better, 8 staff had given their views, which included ‘staff must be encouraged to listen before they act – to see each patient as an individual who has choice’, other comments included ‘encourage all staff to give better care to all residents’. However, staff had also said (what does your service do well) ‘gives patient centred care’ and ‘meets the needs of all service users to the national standards’. Relatives surveyed, felt that the home were ‘always’ or ‘usually’ able to meet people’s needs. Comments included ‘compassionate and realistic care at all times’, and ‘extremely satisfied with my mother’s care’. The resident’s response, to being asked if they received the care and support they needed, all but 4 said ‘always’, with 3 saying ‘usually’ and 1 ‘sometimes’. Whilst visiting people in the privacy of their bedrooms, staff were observed to knock prior to entering, and address people politely, respecting their privacy and dignity. However, whilst sitting with the residents in the lounge we identified 2 shortfalls. The first involved a resident, who was unable to lift the spoon to feed themselves, therefore reliant on staff. The member of staff assisting them also had the home’s mobile phone, which went off twice, resulting in lengthy conversations taking place. No action was taken by the other staff memeber present in the room, to either takeover the phone call, or assist the resident with their meal. The next incident happened when the afternoon staff came on duty, who then came into the lounge without greeting the residents. They then looked at a resident saying “we can hoist her – do we need a chair”, and went on to assist the person. However, 1 of the staff did come back into the room later, acknowledging that they had not said hello to everyone earlier, and apologised. We looked at the systems the home has in place for storing, recording, dispensing and disposing of medications, held on behalf of residents, to ensure they are following safe practice. The home produces their 28-day Medication Administration Records (MAR) chart on the computer. Information given on the MAR charts included the resident’s name, what they had been prescribed, including, date, time and dosage. Staff initial, or use a code letter (given at the bottom of the chart) to confirm the medication has been given, or as otherwise indicated by the code letter used. Good practice was seen with staff marking the MAR chart, to show when they had opened a new container of tablets, to support them in identifying how much medication they had used/and had left. This helps in identifying if they will have enough medication left for the rest of the 28-day period. Foxearth Lodge Nursing Home DS0000024391.V355869.R01.S.doc Version 5.2 Page 14 The MAR charts for the main side of the home (Foxearth/Barns) showed that a medicine had been out of stock from the 21st – 25th November, staff said that this was due to the Doctor’s surgery (who dispense the medication) being unable to get hold of it. We were shown an ‘Out of stock medicine incidents’ sheet, where staff record ‘the reason for medication being out of stock’, and what action they are taking to get a supply which was mostly that the drug ‘was on order’. The log sheet showed that they had run out of 6 medications in September, 5 in October, and 6 in November. We fed back our concerns to the manager that their stock control was not sufficient to ensure residents were receiving their prescribed medication. Following the inspection they contacted us, to say what action they have already, and will be taking to address this situation. Medication was held securely, and staff had a good knowledge of the different medications used, and why people were on them. The storage area was clean, and tidy. A copy of the home’s medication policies and procedures was attached to the lockable medication trolley. There was a list of ‘homely’ medication displayed on the wall, which staff can purchase at a chemist, which had been agreed by the resident’s doctor, to be used if required, for example cough linctus. The list showed that Rectal Diazepam had been crossed off. We confirmed with staff, who assured us, that they were not holding Rectal Diazepam as a homely medicine, and would be only given following a doctor prescribing it. Foxearth Lodge Nursing Home DS0000024391.V355869.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People can expect to be offered nutritious home cooked meals, their visitors made to feel welcomed, and be invited to join in with group activities. However people cannot be assured that they will be able to take part in meaningful activities, to support their individual needs. EVIDENCE: When we asked (surveys) residents if the home arranged activities they could take part in 9 replied ‘always’, 1 ‘usually’, 2 ‘sometimes’. Where 2 residents had not given a rating, they had commented ‘not well enough at the moment’ and ‘yes if you want to take part’. A relative said that ‘there is a need in my mother’s care for ‘running a home activity’, rather than games. Games which she cannot understand do not seem meaningful’, they then went onto make the suggestion ‘how about having ‘kitchen’ tasks – helping to prepare a meal or polishing a piece of silver?’. When we joined the residents in the small lounge on Woodlands, 3 were taking an active interest in a game, where a member of staff was encouraging people to throw the ball back to them. There was 1 resident reading a paper, and another enjoying a sherry. Passing residents would look into the small lounge Foxearth Lodge Nursing Home DS0000024391.V355869.R01.S.doc Version 5.2 Page 16 and decide if they wanted to stay a few minutes, or go for another walk around. During our 2-hours SOFI session sitting, we focused on 5 residents, to try and gain a ‘snap shot’ of how they spend their day. We observed that 1 resident liked to ‘twist and fiddle’ with a blanket on their lap for long periods. Some of the other residents were enjoying, and singing along to a musical on the television, however this resident made no attempt to look at the screen, or interact. Their ‘Life history’ gave information on their past employment, hobbies, interests. However, there was no evidence on how staff were using this information to provide fulfilling activities tailored to their needs. Some residents chose to sit at the dining table, which was nicely set out, and were offered wine. Frailer residents remained in their armchair, waiting for lunch. We noticed that 1 resident received their food much earlier than the others, as their appeared to be a hold up in sending the meals out from the kitchen. As only 1 person was eating, the resident sitting next to them took a keen interest. They had not been provided with a drink, and waited until staff could give assistance. When it did come, staff got in a good position so they could have eye contact with the resident. A relative commented in their survey that ‘ everyone seems consistently kind – though some are unaware of the need for social conversation’. This reflected our findings, with the conversation whilst assisting the person being instructional “open wide – good girl”, rather then describing the meal. Residents sitting at the table described the lunch as “delightful” and that someone “should tell cook it was nice”. After lunch, a member of staff came in and asked the residents “what would you like to do – watch a video?” then supported the residents to choose. This resulted in My Fair lady being put on the large screen television. The film stimulated good conversation “thruppence for flowers – that’s expensive” between 3 of the more able residents. Another resident sat smiling, and appeared contented, another closed their eyes. When staff returned to the room after handover, 1 resident (who had been falling asleep), went back to their bedroom for a rest. Staff sat with 2 of the residents, who had not been involved in watching the film, and massaged their hands, which staff said they always enjoyed, and was a regular occurrence. We found the majority of the staff interaction with residents was good, they smiled and acknowledged the person they were talking to. Although 1 member of staff asked how a person was doing, but as the resident looked up to see who was talking to them, the member of staff who had not waited for the resident to acknowledge them – had left the room. During our second visit to the home, we spent the lunchtime walking around the Foxearth/Barns side, talking to 4 residents who were having lunch in their bedrooms. They said they “prefer to have meals in their room”, and the food “was not bad”. From the residents surveyed, all but 1 of the people asked said Foxearth Lodge Nursing Home DS0000024391.V355869.R01.S.doc Version 5.2 Page 17 they ‘always or ‘usually’ liked the meals provided in the home, with 1 saying ‘sometimes’. Comments included ‘they always look and smell appetising’, and ‘some meals are too big, so I have to ask for small meals from now on’. A resident showed us the menu list, which they were completing for the evening meal. The ‘main meal for the evening’ was ‘Quiche potato salad and cherry tomatoes’. Residents were also able to choose from the following alternatives ‘poached, scrambled, or boiled eggs, omelette, jacket potato, fish fingers, fish cakes, soup, and sandwiches. For dessert, vanilla ice cream, yoghurt/jelly, fresh fruit salad, apple or orange juice, tea, coffee, wine or spirits. Residents were asked to tick the choices they wanted. Residents visited all had drinks in their room, 1 had their drink, in a specialist cup out of reach, said they needed staff to help them. When we asked a resident if they enjoyed the social activities arranged by the home, said I “don’t know what they do”. In Woodlands they now have delegated a member of care staff to arrange the activities for the day. In the main part of the home, the resident’s information board gave a list of activities that residents could undertake – they just needed to inform staff. None of this information had been given in the residents service users guide, to support those who do not freely move around the home. There was also a list of ‘arranged activities’ which for December was a trip to Ipswich shopping (3rd) which people were talking about and looking forward to, Holy Communion and flower arranging (12th) Music with Edith (14th & 28th) and their Christmas party on the 19th, with visiting singers. The AQAA told us that (how we have improved in the last 12 months) ‘we record group activities in activity books. This is particularly helpful to share these activities with relatives and friends’. They also said they are looking to ‘record social activities in the cardex more accurately’; this would give a better idea how residents are supported with making their days fulfilling and stimulating. The home informed us that ‘service user empowerment is considered as an important aspect of care and this reflected further through staff’s general attitude to care’. Residents surveyed all replied ‘yes’ when asked if staff listen and acted on what they said, with 2 people commenting ‘sometimes’. A relative had commented that staff ‘are sometimes busy and cannot act immediately. To a person with dementia, this is a difficult situation’. People we spoke to in the main side of the home, were able to give their views of the home. When we were in woodlands, we used SOFI to help us. However, there was no information in the AQAA, or Service User Guide on how staff gain feedback from residents who are unable to complete surveys, or communicate their views. Foxearth Lodge Nursing Home DS0000024391.V355869.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can expect any concerns to be listened too, and appropriate action taken by staff, who are committed to safeguarding their interests. EVIDENCE: Residents asked if they knew who to talk to if they were unhappy, 7 replied ‘always’, 3 ‘usually’ with the left blank with the comments ‘not sure’ or ‘not applicable’. All but the 2 people who had written ‘not sure’ knew how to make a formal complaint. Comments included ‘any concerns have always been resolved satisfactorily’ – I have the utmost faith in the kindness and professionalism of the staff – I find it hard to envisage a problem which would not be dealt with’. This reflected another resident’s comments ‘no need to complain’. The complaints procedure is given in the home’s Statement of Purpose, and Service Users Guide, and also displayed in the home. People we spoke with during the inspection, said they would voice any concerns with senior staff. Staff surveyed said if people raised any concerns with them, that they would pass the concerns onto the ‘Nurse in Charge’ or ‘Manager’ so their concerns can ‘be investigated’. Information supplied in the AQAA showed that the home had received 10 complaints (at the time of completing the AQAA), that 90 had been resolved within 28 days (1 was waiting for an outcome), of which 2 complaints had been upheld. Records seen showed that all complaints were Foxearth Lodge Nursing Home DS0000024391.V355869.R01.S.doc Version 5.2 Page 19 being ‘responded to within 28 days’, and they had systems in place to log all concerns made. The home is safeguarding the people they care for by ensuring that Criminal Bureau Records (CRB) checks are being undertaken for staff. Checks are being made to ensure staff’s names are not held on a central Protection of Vulnerable Adults (POVA) register of people who should not be working with vulnerable people. Staff ‘induction’ checklists showed us that staff had received ‘POVA’ training. This reflected what we were told by staff who were surveyed, who all confirmed that they knew the procedures in place for safeguarding the people they care for. The home in their AQAA said that they will ‘continue to inform/update staff in abuse prevention’. They had also informed us (under our evidence to show that we do it well) that they have evidence of staff general acceptance of physical and verbal aggression from service users’. There was no further information given as to what training staff receiving in supporting people, they identify as having challenging behaviour. However, the manager informed us that staff now receive dementia training as part of their induction. A new member of staffs file showed that they had attended Alzheimer’s, 1-day intro into dementia care. A relative (under is there anything else that you would like to tell us) wrote ‘I have no fear of ill treatment and I visit roughly every other day and see what is going on with other residents’. Foxearth Lodge Nursing Home DS0000024391.V355869.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 24 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can expect a well-maintained, clean, fresh, comfortable environment, and staff will respect their personal possessions. EVIDENCE: We found the home to be fresh and clean, which reflected the information given in the residents surveys, with 1 relative confirming that the ‘home never smells of urine’, although there was sometimes there ‘may be a smell of faecal matter and from the meals’ (Woodlands area), and wondered if a better ‘ventilation system’ was needed. The AQAA informed said that they had installed a new ‘air-conditioning unit, at the beginning of summer’, which may have addressed the relatives concern. They went on to say that ‘the cleaning staff work hard – carpets are frequently shampooed’. Another relative told us that staff always treated her mother’s treasured ‘personal possessions and photographs with great care’. Foxearth Lodge Nursing Home DS0000024391.V355869.R01.S.doc Version 5.2 Page 21 Bedrooms visited were personalised, and a resident said they enjoyed their view of the gardens. A resident said on moving in they found the clock had been positioned over their bed head so they asked staff to “move it to the opposite wall” which they had. Generally the maintenance was good, however 1 bedroom visited, a small part of the curtain was hanging off the rail, due to missing hooks. The décor in the ‘Barn’ area of the home was light and fresh, and there was a relaxed atmosphere, enhanced by soft music playing as we walked around the main home. A relative surveyed informed us that the ‘décor and atmosphere’ in Woodlands’ is ‘inferior’ to the rest of the home. They went on to say that ‘the lighting needs to be improved in parts of the corridor and it would be beneficial if the handrail could be extended around the whole corridor’ We visited the Woodlands unit, which is easily accessed, however to leave the unit, people need to tap in a code. As we walked into the unit, there is a large ‘nurses station’, there is also a dining table, and small seating area. A painted mural on one of the walls gave a good focus of interest for 1 resident, and we stood discussing what was in the picture. There was limited signage to support people to locate toilets and bathrooms, or identify different areas of their home. When fed back to staff they said they had started by painting toilet doors a different (but still pale) colour, following a dementia workshop they had attended. They were aware more could be undertaken, and when we discussed a resident who was quite mobile, confirmed that they “would need directing to the toilet”, as they get “disorientated, due to their short-term memory”. The corridors, as the relative commented earlier appeared, darker than in the main home. Residents were seen walking around the unit, however, beside the 1 mural, the other corridors offered no items, or areas to stimulate peoples senses and interests. A relative informed us that the ‘black and white tile flooring in the reception and one corridor gives a cold and unwelcoming appearance’. We shared our concerns with staff on how residents, with poor eyesight, and mental frailty due to their dementia, viewed the black and white squares, and if it hindered their mobility/increased their anxiety. The AQAA informed us of work undertaken to improve the environment for residents during the last 12 months. This included building an aviary in Woodlands courtyard, installing fish tanks around the home, setting up more nesting boxes, and an ‘art deco bird feeder’, as points of interests for residents. They said that staff will also ‘continue replanting aromatic plants in the gardens’ . Foxearth Lodge Nursing Home DS0000024391.V355869.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service can expect to be cared for by trained, skilled staff in sufficient numbers to support their assessed needs. EVIDENCE: Staff surveyed were asked if they felt the staffing levels on each shift gave them enough time to meet the assessed needs of the residents, 6 replied ‘yes’, 5 replied ‘sometimes’, 1 had replied ‘no, and 1 had not completed this section. Comments from 2 of the staff who had replied ‘yes’ said that they ‘would always like more time’ to ‘chat with the residents’. This reflected a relatives wishes that they would like to see staff be ‘more pro-active on the conversational aspect – not just offering essential care, but chatting as a friend!’. Other comments from relatives included ‘would benefit from one to one attention – but appreciate that staff issues in this aspect are not always possible’ and ‘I believe that Foxearth Lodge is a fine example of good patients centred care for older people’. Discussions with staff showed that normal staffing levels in the morning on Woodlands was 1 Nurse and 4 carers, with another member of staff working from 8 –2.30, with the dedicated responsibility of shaving the male residents. In the afternoon the staffing levels are 1 Nurse and 3 carers. There was also the Senior Nurse-in-Charge of Woodlands, on duty when we inspected, who was also undertaking some training. Residents asked if staff were available Foxearth Lodge Nursing Home DS0000024391.V355869.R01.S.doc Version 5.2 Page 23 when they needed them, 7 said ‘always’, 5 ‘usually’ and 2 ‘sometimes’. When we sat in the lounge observing on Woodlands, there was a carer in the small lounge for most of the time (except for the staff handover period between shifts), where 7 to 8 residents were sitting. There was constant visits from 3 senior staff including the manager. When we asked if this was the normal staffing levels for the lounge, it was felt it was more due to the inspection, with staff wanting to be helpful, and on-hand to answer any questions. Once they had got used to us sitting in the lounge, the more normal routine of 1 to 2 staff in the lounge over lunch, with a Nurse giving out medication. When the carer was left on their own assisting a resident with their food, the carer was alert to the needs of all the people in the room. For example when a comment was made by a resident sitting at the table that they had not been given their pudding, the carer quickly got up and served them. Residents we spoke to raised no concerns over staffing levels, or that their care needs were not being met. A comment was made by a resident that they could not always understand what the overseas staff are saying. This reflected comments made by 2 of the relatives that ‘the spoken English’ of some of the staff ‘needs to be improved especially when using the telephone to convey messages to relatives’. They gave an examples which, if written may lead to a resident being identified. The AQAA informed us that 3 of their ‘overseas staff are attending a privately funded English course and many of the overseas staff attend an ESOL (English Speaking Overseas Language) course’. The manager also confirmed this with us during the inspection, saying the training was on going. However, they felt that it was more due to “staff speaking too quickly”, than their command of the English language. Another member of staff we spoke to, said it was “a problem at times”, and that “staff between themselves get used to the accent”. Information supplied in the AQAA showed 14 out of their 21 care staff held a National Vocational Qualification (NVQ) level 2 or above, with a further 2 members of staff currently undertaking the course. They also told us that the home ‘provides in-house courses covering a wide range of training’, and a training record is kept for ‘each member of staff’. Staff surveyed confirmed that they received training relevant to their role, which helped them understand and meet the individual needs of the residents. They also said it kept them up to date with new ways of working. However, some discussions with staff on dementia care, did not reflect this, especially in the area of environmental and stimulation needs. When we asked why people were referred to as patients, reminding people they are being cared for in a nursing environment, rather than their home, we were informed that this was from research undertaken 4 years ago. This led to discussions around the findings of specialist societies such as the Alzheimer’s society, and the outcome of their latest research. There was evidence to show that Nurses were keeping their professional knowledge and skills updated, and care staff are receiving a comprehensive Foxearth Lodge Nursing Home DS0000024391.V355869.R01.S.doc Version 5.2 Page 24 ‘Skills for Care’ induction when they started. This included working ‘supernumery shifts’, where they shadow an experienced member of staff, which was happening during our inspection. The home confirmed that each member of staff ‘receive a minimum of 3 days training annually and is provided with other learning opportunities relevant to their area of practice’. Discussions with a member of staff confirmed the homes “committed” in providing “training”. Another member of staff commented that when they started (several years ago) the induction programme was not as comprehensive as it is now for new staff’. Staff surveyed, told us that they felt their recruitment had been undertaken fairly and thoroughly. We looked at the recruitment paperwork for 2 new members of staff. The first was for a member of staff who had been recruited via an agency specialising in overseas staff. There was evidence to confirm their knowledge of English language had been tested, and work permits were in place. Both staff had paperwork to validate their identity, and written references. However not both members of staff had given a full employment history. Therefore the home would be unable to discuss any gaps in their employment, and validate the reason why they left any previous employment working with vulnerable people. As soon as this was pointed out to the manager they said they would do checks to ensure a person has given their full employment history. This linked in with their AQAA (our plans for improvement in the next 12 months) to ‘develop our existing recruitment procedures’. Foxearth Lodge Nursing Home DS0000024391.V355869.R01.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can expect the management and staff at the home is be approachable, and open to hearing new ideas and suggestions, as part of their commitment to developing the service. EVIDENCE: When we arrived at the home on the first day the ‘Trainee Manager’, showed us into a room whilst they went to get the Head Nurse. We were also joined by the Nurse-in-charge of the dementia care unit. They all gave feedback on what was happening at the home. The ‘trainee manager’ Miss Sindhu Aji, confirmed that she had applied to be registered as Manager with the Commission, and was waiting for her application to be processed. Until this process is completed the current owner, Mrs Cantrell’s name has been given as manager at the front of this report. Foxearth Lodge Nursing Home DS0000024391.V355869.R01.S.doc Version 5.2 Page 26 Discussions with staff, identified that not all staff were aware that Mrs Aji was to be the overall manager, this reflected our confusion over the organisational structure, when we arrived. Time spent talking with the manager on their own, during the second day, showed their commitment to providing quality care, and putting into practice, knowledge they had learnt from obtaining training days. An experienced qualified registered Nurse, Mrs Aji has completed ‘Management in Practice course’. They were eager to further their develop their knowledge in dementia care, so they can support staff in making changes to their practice. Although Mrs Aji had ‘trainee manager’ on their name badge, we said as they had applied to be registered, we viewed her as being the manager. Mrs Aji, worked well with the Senior Nurses, she respected and had good insight into their individual skills and knowledge they brought to the management team. Time spent with nursing staff showed that they were eager to hear different views, and undertake their own research to see how it can benefit the people they care for. The AQAA confirmed that they had undertaken a quality assurance questionnaire, which they had received good feedback. There was no other method, such as using dementia mapping, to gain feedback from people who are unable to complete a survey. Information given in the AQAA showed that they had reviewed all areas of their service over the previous 12 months, to look at what they did well, and what areas they want to develop/improve during the next 12 months. Some of the areas reflected our findings, for example ‘alter our service user’s guide’. From the feedback relatives gave over the ‘welcoming’ staff, showed that they are happy to approach any of the staff and management team to discuss any issues. Information supplied by the home confirmed that they have Policies and Procedures in place for staff to follow, to safeguard the interests of the people living and working at Foxearth. The AQAA showed that they had all been reviewed during the last 12 months. This includes keeping written records of all residents’ monies and valuables held in safekeeping. A ‘description of valuables kept’ were written on residents care records. We looked at the fire records which showed that fire equipment and systems were being regularly serviced, and the fire alarm system and automatic fire doors being checked weekly to ensure they are kept in good working order. Training records showed that staff were receiving training in assisting people with their mobility safely, and reducing the chance of any infection spreading. Foxearth Lodge Nursing Home DS0000024391.V355869.R01.S.doc Version 5.2 Page 27 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 2 3 3 X 3 N/A 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 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 2 X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Foxearth Lodge Nursing Home DS0000024391.V355869.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No 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 OP9 Regulation 13(2) Requirement The home must have systems in place to ensure they hold enough prescribed medication in stock, so people are receiving their medication as prescribed by their doctor. Timescale for action 11/01/08 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 OP1 Good Practice Recommendations The home should look at how they can produce ‘the Service User Guide’, to be more informative, and user friendly, in a suitable format and wording to meet the range of needs of people living at the home. The home should look at the content of their care plans, to see if the contents promote the same level of emotional and social intervention as the physical support being given. This will enable staff to show how they support people to have fulfilling and meaningful days, linked to their individual preferences. 2 OP7 Foxearth Lodge Nursing Home DS0000024391.V355869.R01.S.doc Version 5.2 Page 29 3 OP10 The home should have systems in place to respect a person’s right to be assisted with their meal, without the social interaction being disturbed by staff answering the telephone. The home should look at how they can change/adapt the décor and furnishings for people living on Woodlands to make it a more stimulating environment, which promotes independence, and supports their individual needs. 4 OP22 Foxearth Lodge Nursing Home DS0000024391.V355869.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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 © 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.V355869.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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