Inspecting for better lives Key inspection report
Care homes for older people
Name: Address: Foxes Moon 40 Ringwood Road St Ives Ringwood Dorset BH24 2NY The quality rating for this care home is:
two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: John Clarke
Date: 2 0 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area.
Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection.
This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 25 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home
Name of care home: Address: Foxes Moon 40 Ringwood Road St Ives Ringwood Dorset BH24 2NY 01425474347 01425474347 foxesmoon@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Jean Lubbock,Mrs Christine Ramsey care home 31 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users who can be accommodated is 31. The registered person may provide the following category of service only: Care home providing personal care only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Dementia (Code DE) Date of last inspection Brief description of the care home The house is a detached older style property, which is situated in a residential area off the main A31 road between Ferndown and Ringwood towns. The home is about a mile and a half from Ringwood town centre. There is a large secure garden to the rear of the property, with car parking and Care Homes for Older People
Page 4 of 25 Over 65 0 31 Brief description of the care home shrubbery/trees to the front. The rear garden provides a safe and stimulating environment for residents, along with ample seating. Accommodation comprises 31 bedrooms, most with en-suite facilities, over the ground and first floor of the home. There are five communal bathrooms, one of which is a walk in wet room. There is a main lounge/dining area, as well as a small lounge area. The home has two rooms that are used for people visiting the home for respite care. The current weekly charges ranges between 548.50-725 depending on facilities of accomadation. Care Homes for Older People Page 5 of 25 Summary
This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced visit to the home as part of our inspection. During the visit we looked at a number of documents relating to the care provided in the home. These included pre-admission assessments, care plans, staffing recruitment and training. We also looked at the arrangements for the administering, storage and managing of medication in the home. There was an opportunity during the visit to talk with some individuals about the care they receive and we also spent some time observing staff and the how they responded to individuals. We also spoke to group of staff about what they thought about the quality of the care they provide in the home. As part of this inspection we received from the manager a Annual Quality Assurance Assessment this told us about how the home has changed and improvements they have made since our last inspection in January 2007. This has helped us in making a judgment about the quality of care now provided in the home.
Care Homes for Older People Page 6 of 25 What the care home does well: What has improved since the last inspection? What they could do better: We identified a number of areas which need to be addressed and requirements have been made. Care planning must include the use of assessment tools for skin condition and breakdown leading to pressure sores and nutritional assessments to clearly identify the needs of individuals in these areas of their welfare and health. These are of particular importance when considering the mental health of individuals cared for at Foxes Moon. Individuals with dementia are not always able to verbalise their concerns or feelings which means there must be robust systems in place to monitor risk and strategies and associated tasks (informed to staff through care plans) to alleviate risks to individual health. The undertaking of risk assessments in nutrition and skin integrity provide this robust system and safeguard. Having such assessments in place provides the clear evidence that needs of individuals are being continually monitored and reviewed. Where there is decision to use bed rails there must be evidence of assessment and reason for their use and this decision to be agreed by the individual or if unable their representative and/or general practitioner. Any use of bed rails must be based on the welfare and safety of individuals the undertaking of specific assessments provide evidence of good practice in identifying the need for such equipment. Where there is use of controlled drugs, which can if used in-appropriately have a detrimental effect on the health and well being of individuals, the administering must be witnessed by a member of staff. This will help in safeguarding the individual and making sure they are only given when necessary and when prescribed. Control of liquid medication in this instance tempazapam stock must be safer in that by having as found by us in this inspection three bottles in use rather then one makes it harder to manage and regulate the use of this medication. Again this helps in monitoring its use and auditing the amount being given and to whom. It is noted that medication audits which take place in the home failed to identify these shortfalls in practice. Recruitment practice must be more robust in making sure that references are obtained from previous employer. This will then alleviate the risk of individuals being employed Care Homes for Older People
Page 7 of 25 who are not suitable for the post or where there has been concerns about their conduct and employment which may effect the decision to employ at Foxes Moon. We have also made recommendation about offering a real choice of meals to individuals rather then only writing on a menu board which for individuals with dementia may have little if any meaning. This should be about actually showing the choice to individuals and it is our experience that over time the preferences and choices will become known and therefore not a need for the chef to necessarily cook double of all that is available for that specific meal. It would be more supportive for individuals and improve their experience of having a meal if there were more staff available during the meal period to offer assistance and prompt individuals in the eating of their meal. It is noted by the inspector that a number of individuals need one to one assistance to make sure they eat their meal however perhaps these individuals could have their meal later or earlier so freeing staff when the majority of individuals are having their meal. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 25 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 25 Choice of home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home undertakes comprehensive pre-admission assessments so that they can make an informed judgment about the ability of the home to meet identified care needs. Evidence: We looked at a number of pre-admission assessments they were detailed and provided good information about the individuals health and social care needs including mental health. Copy of social services assessment obtained by the home as part of admission arrangements. Care Homes for Older People Page 10 of 25 Health and personal care
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care Planning and arrangements for meeting health care provide staff with the necessary information so that the health and social care needs of people that live in the home are generally met. However the failure to undertake specific assessments potentially place individuals health and welfare at risk. Arrangements for managing medication make sure the health needs of individuals who live in the home are generally protected. However there must be more robust practice in recording of administered medication and managing of stock so that individuals welfare is fully protected. The practice of staff and policies of the home help to make sure that residents are treated with respect and their dignity is upheld. Evidence: The home has introduced a computer based care planning system. It provides a very standardized format and structure with comprehensive information about the individual. Emotional needs, risk assessments re falls, behaviour, health needs and conditions, mobility assessment. Personal preferences as to diet, interests, daily routine. We looked at care plans for 4 individuals. For one individual falls team had
Care Homes for Older People Page 11 of 25 Evidence: completed assessment following history of falls and increasing risk. Individual with diabetes had a Food Dairy completed daily. Where there is use of bed rails (as for one individual whose care plan we looked at)no consent or assessment for their use has been obtained or completed. There is no use of Waterlow (risk of pressure sores) or Nutritional assessments tools. None of the care plans we looked at included these assessments. No evidence of involvement of individual or their representative. Individuals who live in the home have full access to community health services such as chiropodists, dental and optician. Where necessary district nurses visit the home and daily records seen confirmed this. The home refers individuals to other specialists such as mental health team where this is necessary for the intervention of community psychiatric nurse or re-assessment of individuals mental health. Administering records for medication were looked at and showed that medication given had been recorded as required. Controlled drug register kept not recorded for one individual though on administering sheets and only one signature of staff (no witness signature to confirm medication given) for one individual. For one individual there were three bottles of opened liquid medication (Temazapam) Record of returned medication kept with signature of pharmacist or their representative. Medication stored as required with refrigerated storage (temperature recorded daily) Staff were observed throughout our visit treating individuals with respect and in a sensitive manner. Staff were observed assisting with moving and handling and explained what they were doing with the individual. Where individuals needed assistance or support with personal care this was always done in a discreet and supportive way. One individual we spoke with said they were always treated well by staff cant fault what they do. Care Homes for Older People Page 12 of 25 Daily life and social activities
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements for meeting the social and recreational needs of residents are good and there are opportunities for residents to maintain links with family, friends and the local community. The homes practice and routines are flexible and enable residents to exercise choice and have control over their lives. The home provides meals, which are balanced and meet the dietary needs of individuals in the home. Evidence: The home arranges a range of activities for individuals including memory box, puzzles, board games. On the day of our visit an entertainer had been arranged and this was well received by individuals and staff encouraged participation (singing and dancing). When talking to staff they said that one of the things they would like to see improved was the opportunity to have time to sit and chat and said that individuals who live in the home dont get enough stimulation. One individual we spoke with said that staff dont have time, always very busy when asked if staff sit and just have a chat with people. We spoke with two individuals who live in the home they said there was enough to do enjoyed the games we play. Visitors are welcome to visit at any time and a relative we spoke with said they can come to visit anytime and its very
Care Homes for Older People Page 13 of 25 Evidence: relaxed. On the day of our visit we observed lunch being served and the meal being offered was well presented and looked appetizing. A notice board in the dining area showed what the meal was that day (though it was not immediately visible and staff member informed the inspector that there was plan to make it picture based). Records seen of meals being served showed a wide and varied menu being provided and where needed specific diets are catered for. One individual we spoke with said the meals were reasonable but said there was no choice though if something comes I dont like they will give me something different. During the meal a number of individuals needed assistance and staff did so sensitively and at a pace to suit the individual. One staff member was available to assist and another to give meals out. It was observed that because of their dementia a number of individuals needed prompting and support to start and continue with their meal. There were periods during the meal when this was not available because other staff were feeding individuals or elsewhere in the home. It was noted that whilst there is always a staff member available in the main lounge area to respond to individuals there was a sense that this inhibited the ability of individuals to just get up and walk a round. The inspector observed on more then one occasion individuals being in effect stopped from leaving the lounge area. One individual was agitated and wanted a shave staff responded quickly to this request which relieved his agitation. Another was calling out and the staff member sat with her to calm her. Staff spoke of how they always try and give choice to individuals its their home. Care Homes for Older People Page 14 of 25 Complaints and protection
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has procedures in place so that individuals who live in the home or their representative can make a complaint. The home has Safeguarding policies and procedures in place so that they can respond to any concerns or allegations relating to possible abuse of individuals who live in the home. Evidence: The home has a formal complaints procedure and the homes complaint log confirmed that no complaints have been made since our last inspection. We spoke to one individual who said they would speak to the manager if they were unhappy about anything. A relative told us they would always say something to the staff and how they felt the manager was approachable and would certainly complain about anything but have not needed to. There is a Safeguarding policy in place and training records confirmed that staff had undertaken training in adult protection. Care Homes for Older People Page 15 of 25 Environment
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a well maintained, clean and pleasant environment for those that live and work in the home. Evidence: Since the last inspection a further 4 rooms have been added to the home, 24 of the homes rooms have en-suite facilities. Continued refurbishment and re-decoration of room is taking place. The home is clearly well maintained and has a warm and relaxing atmosphere providing a very pleasant environment. Some individuals rooms were seen and had personal decorations. All of the rooms had personal names and pictures on the doors to help individuals identify and recognise their own room. The home was clean and one individual told us its always well kept. A relative told us that the home is always clean and there are never any smells. The home has infection control guidence in place and staff undertake infection control training and are provided with protective clothing where this is needed to prevent cross infection and maintain good standard of hygeine. Care Homes for Older People Page 16 of 25 Staffing
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing arrangements in the home are generally satisfactory so that the needs of residents can be met in an efficient way with care being provided by skilled and competent staff. The manager must make sure that all staff undertake dementia training. The recruitment and selection of staff is undertaken to make sure that as far as possible the health and welfare of resident is protected. However there needs to be more robust arrangements regarding the taking up of references. Evidence: We looked at staffing arrangements in the home and examined staff rota for a period of 4 weeks. These showed that there are generally 5 carers on duty am, 4 pm and 3 waking night staff. On the day of our visit there was this number of staff on duty. We looked at recruitment records for a number of staff and these showed full and detailed application forms, Criminal Record Bureau checks and POVA had been obtained. There was no reference from previous employer for one individual. Training records for 4 members of staff showed that all had undertaken mandatory training i.e. moving and handling, POVA, Fire Safety, Infection Control. In addition Dementia training had been completed by two of the four staff members. Other training provided included medication for those who have responsibility in this area, Mental Capacity Act, Food Hygiene.
Care Homes for Older People Page 17 of 25 Evidence: 70 of staff have NVQ professional qualification and remaining staff are currently undertaking this training including domestic staff. Care Homes for Older People Page 18 of 25 Management and administration
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager has the required qualification and experience to manage the home but has failed to identify, respond to significant areas of the home practice that potentially impact on the health and welfare of individuals who live in the home. There are good opportunities for residents and others to express their views about the service they receive. The practices of the home help to make sure that the health, safety and welfare of residents and staff are protected. Evidence: The manager of the home has extensive experience of caring for older people specifically those with dementia and was formally a mental health nurse. Staff described the management of the home as approachable always available. Our previous inspection highlighted the need for assessments for the use of bed rails. The manager has failed to address this issue as noted elsewhere in this report. The AQAA provided by the manager stated that nutritional assessments had been completed for a number of individuals however there was no evidence of this during our inspection. Whilst audits take place of systems and procedures in the home such as medication
Care Homes for Older People Page 19 of 25 Evidence: and care plans these did not identify the significant shortfalls in practice regarding medication and lack of assessments relating to health and welfare of individuals. The manager has not reviewed the audit practice and outcomes against practice in the home to ensure that they are effective and improve practice. The home undertakes quality assurance questionnaires on an annual basis seeking the views of individuals who live in the home as far as possible, relatives and professionals who have contact with the home. There are also audits of systems and procedures such as medication and care plans. There are 3 monthly audits of accidents and incidents and the action taken such as increasing staffing levels where this is indicated to reduce the level of risk and improve staffing ratios in the home. Individuals we spoke with said they felt able to make suggestions and comments about the care they receive and we are listened too. Records relating to fire and safety were seen and showed that staff have undertaken the necessary fire training and regular fire drills. The fire system was last serviced in September 2008. Weekly tests of the fire alarm take place and monthly tests of the emergency lighting. Care Homes for Older People Page 20 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 21 of 25 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 7 15 The manager to make sure that consultation with the individual or their representative in the completion of care plans. This refers to the need to evidence the involvement of individuals or where this is not possible their representative in the completion and formulating of care plans. 01/03/2009 2 7 12 The manager must make 01/03/2009 sure that the care home is conducted so as to promote and make proper provision for the health and welfare of individuals who live in the home. This relates to the need to evidence an assessment and consent for the use of bed rails. In addition to use recognized assessment tools such as Waterlow and Care Homes for Older People Page 22 of 25 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action Nutritional where these are needed to ensure the needs of individuals are accurately assessed, monitored reviewed and required action taken. 3 9 13 The manager to make sure 01/03/2009 that there are arrangements for the safe administration of medication. This refers to the need to complete records relating to controlled drugs as required namely the witnessing and signature of witness to medication given. In addition to limit the opened stock of medication in this instance Tempazapam liquid so that there can be accurate record and audit of its use. 4 29 19 The manager must make sure that they do not allow an individual to work in the care home unless information specified in Schedule 2 have been obtained. This relates to the need to obtain referneces from previous employer. 5 30 18 The register manager must make sure that persons employed to work at the 01/04/2009 24/02/2009 Care Homes for Older People Page 23 of 25 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action care home receive the training appropriate to the work they are to perform. This realtes to all staff having dementia training. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 1 15 The manager to look at the availibility of staff during the lunchtime period and as far as possible make sure there are adquate number of staff available to assist and support individuals. To make sure there are clear choices available to individuals and they are made aware of the choice this may mean actually showing individuals the choice that is available rather then purely writing on menu board or telling individuals what is available. Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 25 of 25 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
