Inspection on 24/01/07 for Foxes Moon

This inspection was carried out on 24th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Foxes Moon 20/01/09

Foxes Moon 24/01/06

Foxes Moon 04/07/05

Foxes Moon 21/03/05

Foxes Moon 23/08/04

Foxes Moon 30/03/04

Similar services:

Fairfields Country Rest Home

Fairfax House

Claremont Nursing Home

Doveridge Care Home

Dunmore

Chatsworth

Dunraven Lodge

Eastleigh Care Homes, South Molton

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

CARE HOMES FOR OLDER PEOPLE Foxes Moon 40 Ringwood Road St Ives Ringwood Dorset BH24 2NY Lead Inspector Debra Jones Unannounced Inspection 24th January 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Foxes Moon DS0000026803.V328722.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. Foxes Moon DS0000026803.V328722.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Foxes Moon Address 40 Ringwood Road St Ives Ringwood Dorset BH24 2NY 01425 474347 01425 474347 foxesmoon@btconnect.com 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 Christine Ramsey Mrs Jean Lubbock Care Home 27 Category(ies) of Dementia - over 65 years of age (27), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (27), Old age, not falling within any other category (4) Foxes Moon DS0000026803.V328722.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The registered persons in control work towards complete registration of the home in the categories DE(E) & MD(E) as OP vacancies occur. Room 18 may accommodate two service users known to the CSCI. Date of last inspection 24th January 2006 Brief Description of the Service: 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 shrubbery/trees to the front. The rear garden provides a safe and stimulating environment for residents, along with ample seating. Accommodation comprises 26 bedrooms, half 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 £326 and £700. Foxes Moon DS0000026803.V328722.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over 2 days and was the anticipated key inspection of the year. The first day was the main inspection visit and lasted from 10am until after 4pm. During the first day of inspection some records were looked at. The Inspector walked around the building and met and chatted with a few residents. The registered people and their staff helped the inspector in her work. The second visit was on one afternoon the following week from 2.30 – 5.30pm. During this visit residents who live at Foxes Moon were carefully observed to see how they spend their time in the home and how staff give them support. The management were aware the inspector would be making this second visit. Only one recommendation was made at the last inspection to be followed up. One requirement was made at this inspection and the recommendation made last time still applies. The home was alerted to the recent amendments to the Care Home Regulations relating to contracts, quality and improvement plans. Foxes Moon continues to be well managed and has a sustained track record of good performance. Prior to the inspection the home sent out comment cards on behalf of the Commission to people living in and interested in the service so that they could give feedback about their experience of the home. Twenty- seven comment cards were returned. Thirteen were from residents, 9 were from relatives/ friends, 2 were from health and social care professionals, 2 were from care managers and 1 was from a GP surgery. All comment cards returned were positive about the staff and service provided at Foxes Moon and all said that they were satisfied with the overall care provided there. ‘In the early years she was very distressed but now is very contented. She is 91. She loves her food and cup of tea.’ (a relative) ‘My husband is very well looked after by a friendly and dedicated staff and I am very happy with his treatment!’ (another relative) ‘We are really impressed with Foxes Moon and their care.’ (another relative) ‘The staff are excellent in all ways.’ (another relative) ‘Foxes Moon residential care home proprietors and staff give excellent care 24 hours with good food and a friendly, clean atmosphere.’ (another relative) ‘Xx has been at Foxes Moon for 6 years so that is proof enough that she is contented and looked after. ……we are well pleased with the refurbished home.’ (another relative) Foxes Moon DS0000026803.V328722.R01.S.doc Version 5.2 Page 6 ‘I find Foxes Moon can handle some difficult dementia patients very well and keep the home running smoothly. Paperwork is always filled out and they do report if problems arise.’ (a care manager) What the service does well: Foxes Moon is well organised and the care and contentment of residents is at the heart of the way the home is run. The home has a welcoming, tranquil, relaxed atmosphere and residents are clearly at ease. A good admissions procedure is in place that ensures that only people whose needs can be met are offered places at the home. Assessments and care plans are of a good standard. They are thoroughly completed and regularly updated to make sure that staff know how to support and care for the residents living at Foxes Moon. A range of community health professionals support the care staff in caring for residents. There is a good system for medication administration at the home promoting the health and well being of residents. Staff were observed throughout the inspection to be treating residents with courtesy, patience and kindness ensuring that their privacy and dignity are respected at all times. Residents are encouraged to participate in things going on at the home. Foxes Moon has an activities co-ordinator who works in the afternoons encouraging residents to join in with games and activities. Visitors are always welcome and residents are encouraged to maintain and develop relationships with people in the home, their families and friends. Meals are varied and the dining area is very pleasant, light, spacious and comfortable. Meal times are unhurried and staff are available to support people who may need assistance to eat. The complaints and adult protection procedures reassure residents and their representatives that the well-being and comfort of residents is important to the home and that any concerns raised will be properly investigated and resolved. The home is, and has been, being developed to increase and improve facilities for residents. Staff do their best to keep the disruption to residents is to a minimum and make the home comfortable and safe for all living there and anyone visiting. Each resident’s bedroom is comfortably furnished and residents are able to keep their own possessions around them. The home is kept clean and smells pleasant. Foxes Moon DS0000026803.V328722.R01.S.doc Version 5.2 Page 7 The numbers and skill mix of staff are sufficient to meet the needs of residents. Staff are appropriately qualified and well trained in dementia care work. The home has a robust recruitment practice to ensure that only suitable people are employed at Foxes Moon. Every year the home carries out a survey to find out what people with an interest in the home think about it. Any areas for improvement highlighted by this survey are then addressed and an annual development plan written. Clear records are kept for those residents whose finances are managed by the home. Systems are in place and records kept, that demonstrate the homes commitment to keeping residents safe. What has improved since the last inspection? What they could do better: At the conclusion of this inspection one requirement is made and one recommendation repeated. All documents that should be on file were, with the exception of proof of the Protection of Vulnerable Adults list (POVA 1st) check which has to be obtained should any member of staff begin working at the home before their full criminal record bureau check has come through. Staff at the home said that they had been applied for and received prior to people starting work at the home but the proofs had not been kept. The home has a good NVQ programme and staff are working towards achieving the qualification, at the time of the inspection this was not quite 50 of the workforce. A number of good practice suggestions were discussed, the home are agreeable to introducing them all. This is a summary of them. It is suggested that :• All residents have a manual handling assessment to determine if they have any needs that should be covered in the care plan. • Where staff make changes to the MARs the home get another member of staff to countersign these entries. • A sheet with their signatures be kept at the front of the medication file. Foxes Moon DS0000026803.V328722.R01.S.doc Version 5.2 Page 8 • • • • • • • • • The home carry out regular self audits of medication and keep records to show this is done. The home adds medication to care plans. The full names of staff are put on the roster; that the manager is also added and it is clear who is in charge of the home at all times. The home carry out regular accident analyses to help them spot trends and where appropriate put measures in place to minimise risks. When the manual handling policy is next reviewed it is expanded e.g. to include legal responsibilities. Thorough assessments are carried out for the use of bed rails; with documentation being specific about why the rails are being used and how. (Ideally these assessments should include appropriate professionals involved in the residents’ care.) Bed rails are added to regular maintenance checks to ensure that they remain safe. The risks involved in the use of bed rails be discussed with relatives who are asked to give permission for their use. The accessibility of denture cleaning tablets around the home be considered, risk assessed and possibly removed from bedrooms. 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. Foxes Moon DS0000026803.V328722.R01.S.doc Version 5.2 Page 9 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 Foxes Moon DS0000026803.V328722.R01.S.doc Version 5.2 Page 10 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): 3 Standard 6 does not apply. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Assessment information provides enough detail for the home to be able to decide whether they can meet prospective residents needs. EVIDENCE: Files for residents who had recently moved into the home or were about to, were inspected. These showed that the home has a good pre admission procedure in place. Prior to anyone moving to the home their needs are fully assessed and where appropriate information obtained from Social Services. The home has two respite beds for people who need to come to the home on a temporary basis. Foxes Moon DS0000026803.V328722.R01.S.doc Version 5.2 Page 11 Ten of the 13 residents who returned comment cards said that they had been issued with a contract. Two could not remember. One said they had not but their relative commented ‘I am sure we have a contract somewhere; mother in law has been at Foxes Moon for 6 years I have kept mostly all the original papers.’ Eleven said that they had enough information before they moved in to the home so they could decide if it was the right place for them. Two said that they didn’t. People shared their experiences of moving to the home, some moved there permanently after having spent time there receiving respite care. Foxes Moon DS0000026803.V328722.R01.S.doc Version 5.2 Page 12 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 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a good care planning system in place to make sure that staff have the information they need to meet the needs of the residents. The health needs of the residents are also well met with evidence of good support from community health professionals. The medication at this home is well managed promoting the good health and well being of residents. Personal support is offered in the home in a way, which ensures that residents have their privacy and dignity respected. EVIDENCE: Files sampled contained thorough care plans, which were clearly laid out and specified the needs of the residents. Care plans cover the same general areas for all residents, including their personal care and mental health, but are tailored to the individual e.g. where there are specific conditions such as Foxes Moon DS0000026803.V328722.R01.S.doc Version 5.2 Page 13 diabetes these are covered. Plans are good in the way that they focus on what the residents can do for themselves and what they need assistance to do. They also record how residents are likely to behave and react to situations and give staff guidance on how they should respond to residents as individuals. The care plans include personal profiles, mostly provided by relatives, which detail the important people in the residents life as well as important things to know about their routine, past jobs, present interests. Plans are based on a series of assessments that are updated regularly. Assessments include the use of an emotional cognitive care assessment record and planning tool and risk assessments e.g. in relation to falls and pressure areas. It is suggested that all residents have a manual handling assessment to determine if they have any needs that should be covered in the care plan. Day and night notes demonstrate how the care plans are delivered. Care plans and assessments are reviewed every month. When asked ‘do you get the care and support you need?’ Six of the 13 residents who returned comment cards prior to the visit replied ‘always’, with another 3 saying ‘usually,’ and 2 ‘sometimes.’ When asked ‘do the staff listen and act on what you say?’ Eleven residents said ‘yes,’ with one saying ‘sometimes.’ One relative commented ‘most of the staff know us personally and we can talk through any differences.’ Six of the 9 relatives/ friends who responded by comment card said that they were informed of important matters in respect of their relatives and consulted about their care, 3 said they were not. Care managers who returned comment cards said that there were plans for the people that they placed at the home and they were being followed and reviewed within the home. Care records also showed the interventions of community professionals. Residents have access to community services such as GPs, nurses, chiropodists, dentists and opticians. Some residents are in need of aids to help them around the home, or in and out of bed. These were seen to be available to them e.g. hoists, pressure cushions, bath seats, wheel chairs, zimmer frames etc. Where residents need walking aids these were near to hand for them. Residents are therefore able to move freely. One resident obviously found it reassuring to have her zimmer frame nearby to hold onto even when she was not wanting to go anywhere. Six of the 13 residents who returned comment cards said that they ‘always’ received the medical support they needed, with 4 saying this was the case ‘usually.’ Others did not answer or had not had any medical needs whilst at the home. Foxes Moon DS0000026803.V328722.R01.S.doc Version 5.2 Page 14 Comments from relatives included :- ‘x has received excellent care. The home doctor is very good and when I have had to get in touch with him he has an exceptionally nice approach and manner. He has phoned me at home and we have no qualms over the medical side.’ ‘the medical support has been excellent at all times.’ ‘Whenever xx has needed to go to hospital it has always been priority to them for her best needs and benefit, No problems.’ The GP surgery and the health professionals that returned comment cards to the Commission said that the home communicated clearly and worked in partnership with them. They also said that the home took appropriate decisions when they could no longer manage the care needs of residents. GPs, health professionals and care managers all said that staff demonstrated a clear understanding of the care needs of residents. Only members of staff who have been trained give out medication at Foxes Moon. Medication administration records (MARs) sampled were up to date and properly completed. Any allergies known are recorded, and where there are none known this is noted. The quantities of medicines coming to the home were signed as received on the MARs. Where staff make changes to the MARs the home should get another member of staff to countersign these entries. It is also suggested that a sheet with their signatures be kept at the front of the file as per good practice. Most medicines at the home are delivered in monitored dosage packs and so it is easy to match medicines taken with the records and to know how much should be on the premises. Some medicines are in ordinary packets and bottles. Staff write on the packets / bottles the date the medicines are brought into use. Home staff were confident that they would be able to tell how much medicine was on the premises at any time. It is suggested that the home carry out regular self audits of medication in the home and keep records to show this is done. Medication was tidily stored in appropriate places e.g. medication cupboards and the trolleys. No medicines were being stored in the fridge at the visit. No residents are currently looking after their own medicines. It is suggested that the home adds medication to care plans. This would be an ideal place to record if any resident was self medicating, under what circumstances ‘when required’ medicines are to be given etc. The GPs and health professionals who returned comment cards said that in their opinion medication was appropriately managed in the home. Information about medicines in use at the home was readily available. Staff were observed throughout the visits to be treating people with respect. All residents were addressed politely yet warmly and staff were consistently gentle, encouraging and enabling in their responses to residents. At no time was the dignity of any resident compromised and staff were discrete in their approach to assisting residents needing personal care. Foxes Moon DS0000026803.V328722.R01.S.doc Version 5.2 Page 15 All those who returned comment cards to the Commission confirmed that they were able to see residents in private when they visited. Foxes Moon DS0000026803.V328722.R01.S.doc Version 5.2 Page 16 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 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home finds out about residents life histories, which inform the social, cultural, religious, and recreational activities organised at Foxes Moon. Visitors are made welcome at the home and can come whenever it suits the residents. The management approach and staff training in the home encourage residents to exercise choice and control over their lives. The meals in this home are good and varied and are served in a pleasant dining area. EVIDENCE: As stated earlier in this report resident files contain information in a personal profile from family and friends regarding interests, previous occupations, important people in their life, important things the staff need to know about their daily routines, present interests etc. This information helps staff devise Foxes Moon DS0000026803.V328722.R01.S.doc Version 5.2 Page 17 the activities programme for the home and help residents occupy their time enjoyably. The home has an activities co-ordinator working at the home every weekday afternoon. He spends time with both groups and with individual residents, basing his work on the needs and preferences of the residents. An entertainer comes to the home every week. He was performing on the afternoon of the second visit. He played songs that residents recognised and some were able to sing along to. He responded to requests from the floor and due to his regularity at the home and his nature had developed a rapport with the residents who really enjoyed his visit. Residents were relaxed and engaged with the entertainment and the activities co-ordinator was on hand to encourage those interested, and able to join in, to play percussion instruments. Most residents sat round the keyboard in a group but some did not. Those removed from the group were encouraged to participate with instruments as well and staff spent time with them ensuring they did not feel left out. A hairdresser visits fortnightly. The home has a ‘salon’ where the hairdressing takes place. A chaplaincy service is provided and Holy Communion is held regularly. Of the 13 residents who returned comment cards 4 said that it was ‘always’ the case that there are activities arranged by the home that they can take part in and 1 said that this was true ‘usually,’ 4 residents said that it was the case ‘sometimes.’ Four chose not to answer. Visitors are welcome at any time. All the relatives who returned comment cards to the Commission, and thought it appropriate to comment, said that they felt welcome in the home at any time. The visitors’ book confirmed the number and range of visitors to the home. ‘When we visit mum weekly we take her out of the communal room and have her to ourselves.’ (a relative) Relatives are encouraged to join in with the activities laid on for residents. On the second day of the visit some relatives were enjoying the entertainment with their loved ones, enabling them to share a stimulating experience. There was plenty of room for them, plenty of chairs and plenty of refreshments. Staff clearly knew them well and the friendly atmosphere made their visit easy. Residents are encouraged to make choices about how they live their lives at Foxes Moon. They can do as they wish, choose to eat what they like and join in with activities as it suits them. Residents are encouraged to maintain their individuality and have the things around them that make them the people they are, e.g. one gentleman has his hat with him all the time, some ladies have their handbags, residents all had clean glasses, handkerchiefs and tissues to hand and wore watches. Residents interested in reading had magazines and papers near by. Foxes Moon DS0000026803.V328722.R01.S.doc Version 5.2 Page 18 Menus supplied to the Commission prior to the inspection showed that a varied and wholesome diet is supplied. A notice board in the dining room says what the lunch is each day. The meal on the first day of inspection was lamb casserole served with mashed swede, cabbage and potato croquettes. Dessert was rice pudding. All residents had their lunch in the pleasant dining area, but they could have their meals in their rooms should they have wished or needed to. Lunch was observed to be at the pace of individual residents. Staff in attendance were attentive and supportive of any residents who needed encouragement to eat. Only one or two residents required assistance to manage their meal. Where staff were physically feeding residents they were sitting alongside them and talking gently, as they helped. The chef takes advantage of seasonal fruit and vegetables, which are bought locally and included in the meals. He confirmed that he does not have any restrictions on his budget and is able to buy the food he wants to cook and serve. Special diets are catered for e.g. soft diets, diabetic diets. The chef also makes cakes for afternoon tea and special occasions such as birthdays. In the last year the chef completed a dementia training course ‘positive dementia care’ which he said has given him a better understanding of the residents he is catering for. He talked of how he was soon to go on a malnutrition training course. Evidence of how the training had impacted on practice in the home included ensuring that tabletops were clearly a different colour to the floor, and tableware was a different colour again, all aiding recognition and making it easier for residents to be as independent as possible. Mealtimes are well spread out so there is not a long period of time between the evening meal and breakfast. This also has the effect of making the day longer for residents so they are more active for longer and sleep better. During the second visit tea was served during and after the entertainment. Residents and relatives all had tea or coffee from china cups / mugs and saucers. One resident who needed more assistance was encouraged and enabled to do as much as she could for herself and at no time was she hurried or did staff take over what she was doing. Staff were attentive and quick to clear up any spillages to maintain a safe environment. Eight of the 13 residents who returned comment cards said that they ‘always’ liked the meals at the home, 3 said they ‘usually’ like them. One did not answer. Comments included : ‘the lunch was lovely I could have licked my plate.’ (a resident at the visit) ‘Mum can’t wait for her lunch every day, XX is a very good chef – very friendly and kind’ (a relative) ‘My wife appears to like and enjoy her meals / food.’ (another relative) Foxes Moon DS0000026803.V328722.R01.S.doc Version 5.2 Page 19 ‘I have asked my wife and she doesn’t complain although my wife is a poor eater and isn’t fussy about choice of food, the home does cater with a choice of meals and does provide diabetic meals.’ (another relative ‘They always look really good.’ (another relative ‘My husband always enjoys his meals.’(another relative) Foxes Moon DS0000026803.V328722.R01.S.doc Version 5.2 Page 20 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 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A system is in place to deal with complaints that might be made by residents or their representatives. The home’s adult protection policy, pre employment checks and ongoing staff training demonstrate the home’s commitment to understanding abuse and protecting residents. EVIDENCE: Foxes Moon has a formal complaints procedure in place. Neither the home nor the Commission have received any complaints since the last inspection. Any negative comments made to the Commission since the last inspections were taken up during the course of the inspection. The comment cards sent to residents asked the question ‘Do you know who to speak to when you are not happy?’ Thirteen residents sent back cards. Eight answered ‘always’ to this question, 2 ‘usually,’ and 3 did not answer.’ In respect of knowing how to make a complaint 9 said yes ‘always’, one ‘usually’ and one said ‘sometimes.’ Two people did not answer. One resident said ‘If needed to I would complain but not for petty things.’ Foxes Moon DS0000026803.V328722.R01.S.doc Version 5.2 Page 21 Four of the 9 relatives / friends who returned comment cards said that they were aware of the complaints procedure. Four said they were not, one did not answer. One person said ‘I always speak to the owners re any concerns’ Six people said they had not had to make a complaint, 1 said they had once and one did not answer. Other comments about raising concerns included:‘Christine and Jean are very co-operative and the under manager is also very kind.’ ‘If it were to occur my wife would tell me and I would refer back to the person in charge or proprietor.’ The home has an adult protection policy, which is in line with the local Dorset guidance based on the Department of Health ‘No Secrets’. There was evidence to show that staff are trained in adult protection. As part of the recruitment procedure new staff are checked against the protection of vulnerable adults list, held by the Department of Health. Foxes Moon DS0000026803.V328722.R01.S.doc Version 5.2 Page 22 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 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Ongoing investment in the upkeep and improvement of the home go towards providing a comfortable and safe environment for the residents living there and anyone visiting. Bedrooms are well decorated, well furnished and personalised to suit the residents. Adequate facilities are available to meet the number and needs of the people living there. The home is kept clean and smells fresh thereby making daily life for all in the home more pleasurable. EVIDENCE: Since the last inspection the home has increased the number of bedrooms available in the home by three. They have also created a hairdressing room and a walk in wet room. Foxes Moon DS0000026803.V328722.R01.S.doc Version 5.2 Page 23 The main communal area has also been expanded and a spacious room has been created which combines the main lounge and dining area. Residents are able to move freely around this area and the owners said that having a much bigger space had reduced the risk and number of accidents. Lounges and the dining area are comfortably furnished. In the home’s annual survey someone from social services commented in the considerable improvement of the environment in the last year. Over the next 6-8 months the home will be doing further building works and are intending to create a further 5 bedrooms and improve 3 existing bedrooms by installing en suites to them. Plans also include relocating the laundry area and extending the kitchen. The home has a warm and relaxed atmosphere and is mostly well decorated. Some areas are being prepared for decoration. These areas are being kept clean and tidy. The garden is accessible and safe and provides a very pleasant environment, which stimulates resident’s senses. The gardens are accessible from the lounge. The garden is laid out in such a way that residents following paths are not lead into dead ends. All bedrooms are currently single occupation and about half have en suite facilities. In addition there are a number of communal bathing areas around the home along with the new wet room. Aids and adaptations are available throughout the home e.g. raised toilet seats, grab rails etc - and some residents with particular needs have their own personal equipment to assist with their independence. Names and pictures of meaning are on bedroom doors at a good height to help residents recognise their own rooms. Residents are able to personalise their rooms with furniture and general belongings as they wish and in agreement with the home. All the bedrooms are comfortably furnished providing, space for hanging clothes, seating for 2 people, curtains and both overhead and bedside lighting. All residents have a locked area in their room in which they can safely stores items of value to them. There is a passenger lift in the home, enabling easy access between the floors. There are emergency alarm bells throughout the home – in each bedroom and in communal areas. Areas of the home visited were clean and there were no unpleasant odours. ‘Mum’s room is always very clean and tidy.’ (a relative) Foxes Moon DS0000026803.V328722.R01.S.doc Version 5.2 Page 24 The laundry was also clean and tidy. It is equipped with suitable washing machines. All laundry is done at the home. There are plans to upgrade the laundry facilities in the next phase of development. The home has obtained the June 2006 Infection Control Guidance from the Department of Health and has their own infection control policy. In the last 12 months the home have appropriately notified the Commission of infection outbreaks. Six of the 13 residents that returned comment cards said that the home is ‘always’ fresh and clean, with four saying that this was the case ‘usually,’ and one ‘sometimes.’ One relative commented ‘Foxes Moon has some very difficult patients and the home always smells sweet.’ Other relatives talked of the recent building work and how this had resulted in the home being in a ‘state of flux’ for a while and of how it had been hard for the staff to keep the home clean and sweet smelling. Foxes Moon DS0000026803.V328722.R01.S.doc Version 5.2 Page 25 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 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Sufficient, well-trained staff are employed and deployed to ensure that the needs of residents can be met. Recruitment procedures are in place to protect residents from the risk of unsuitable staff working at the home. EVIDENCE: Since the last inspection the home have appointed a deputy care manager and a team leader. On the main day of the inspection there were 5 care staff on duty in the morning, as well as a domestic and the chef. Four care staff were on duty in the afternoon. At night there are two members of care staff on duty from 8pm –8am and another from 10pm to 8am. An additional member of staff is employed for 2 hours each week day afternoon to specifically do activities with the residents. Staff are supported by the owners / manager, office administrator and maintenance staff. Clear staffing rosters are in place that show who is on duty and when. The home are urged to have the full names of staff on the roster, to add the manager to the roster and to show clearly who is in charge at the home at all Foxes Moon DS0000026803.V328722.R01.S.doc Version 5.2 Page 26 times. A list of who is on duty at the home is clearly displayed in the dining area. Throughout the observation on the second day staff were seen to take time with all residents, including those who were more quiet and withdrawn. There were enough staff on duty to spend quality time with residents and to take time responding to any who appeared agitated and needed reassurance. Their kindness and caring attitude shone through and the warm responses they got from residents reinforced how much they are appreciated by the residents and how well they are doing their jobs. Residents were asked ‘are the staff available when you need them?’ Eight of the 13 who responded said ‘always’ with 3 saying ‘usually,’ and one ‘sometimes.’ One person commented ‘there is always someone near at hand.’ Most of the relatives who returned comment cards to the Commission said that in their opinion there were always sufficient numbers of staff on duty, one said there weren’t and one did not comment. Fourteen care staff are employed at the home. Six of them have the National Vocational Qualification (NVQ) in care at level 2 and four others are due to start studying for this in February 2007. Four staff have also gone on to study for their NVQ 3 and another has their level 4 and is studying for the registered manager’s award. Well ordered staff records/ personnel files demonstrate the homes’ recruitment procedure in action. The files of two of the latest members of staff to join the home were inspected. All documents that should be on file were with the exception of proof of the POVA 1st check. This was said to have been applied for and received prior to the person starting work at the home. There is a clear learning culture at the home, which can only be to the benefit of residents. Records are kept of training that staff undertake. Staff receive induction and foundation training based on the industry standard. During the last twelve months staff have had training in moving and handling, emergency aid, basic food hygiene, infection control, fire training, health and safety and protection of vulnerable adults. This list is not exhaustive. Half of the care staff currently working at the home have been on a 5 day dementia care course. All staff have had some basic training in caring for people with dementia. Where advice is needed about specific conditions the home liaises with the professionals able to provide the information / training needed. Foxes Moon DS0000026803.V328722.R01.S.doc Version 5.2 Page 27 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 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well organised and the daily management and running of the home centres round the care and contentment of residents. Good management practices, systems in place, and records kept, confirm the health and safety of all in the home. EVIDENCE: The owners, Christine Ramsey and Jean Lubbock, both take a very active part in the daily running of the home. Christine is the registered manager. She originally trained as a mental health nurse and keeps her registration ‘live’ on the nursing register. Foxes Moon DS0000026803.V328722.R01.S.doc Version 5.2 Page 28 In the home’s annual survey one member of staff commented on the ‘kind caring management who were always there for you when they were needed.’ Staff also said they felt the home looked after residents well and made sure that relatives were kept very well informed. All records were available as requested at the inspection. An up to date insurance certificate was on display along with the home’s registration certificate. The home sent out and made available comment cards for the Commission as requested prior to this inspection. Those that came back were generally very positive about the home. Every year the home carries out an annual quality assurance survey, whereby they find out more what people think about the home. The response was positive and the results of the 2006 survey have been collated and are available in the home. A variety of stakeholders responded including residents, relatives, staff, GPs, district nurses, community psychiatric nurses and chiropodists. Feedback from residents was positive. Comments from others included ‘clearly very caring towards patients and achieve a high level of care in a challenging group of patients.’ (a GP) ‘Suggestions re hand washing responded to well by staff.’ (a District Nurse) A Community Psychiatric nurse commented on the home’s person centred approach to care, how they recognised the rights of individuals, were creating a homely and safe environment and worked well in partnership with other professionals. The questionnaire asked what the home did well. One relative said in answer to this question ‘making them feel special, when you call their name and speak nicely, excellent in all respects. Your food is 5 star.’ Where concerns were raised records showed that these had been addressed. The home is yet to write their annual development plan following on from the 2006 quality audit. The registered provider said that practically all residents have their finances managed by their relatives / representatives. Where residents are in need of things on a day-to-day basis the home pays for their expenses and bills the person who holds their money. The home assists one resident access their weekly money and clear records are kept of this. In order to ensure a safe environment for residents to live in equipment is regularly maintained. Fire records seen were up to date and internal checks of fire safety equipment are being carried out at appropriate intervals. An external company carries out Foxes Moon DS0000026803.V328722.R01.S.doc Version 5.2 Page 29 quarterly checks of the fire equipment. Staff receive regular fire training and records are kept. The last fire drill took place in November 2006. The fire risk assessment for the home is next due for review in May 2007. Accident records were looked at. Accident forms seen were well completed. Records were clear about how staff came across accidents or if they had witnessed them, what they did and any follow up that was needed. It is suggested that the home carry out regular accident analyses to help them spot trends and where appropriate put measures in place to minimise further risks to residents and anyone visiting or working at the home. Appropriate notifications about incidents and accidents are made to other bodies. The home has a manual handling policy. It is suggested that when this policy is next reviewed it is expanded as advised at the inspection visit e.g. to include legal responsibilities. Two residents at the home have bed rails on their beds. The home was advised to carry out thorough assessments for the use of this equipment, being specific about why the rails are being used and how. Ideally these assessments should include appropriate professionals involved in the residents’ care. Assessments should then be regularly reviewed. The home are also asked to add the rails to their regular maintenance check to ensure that they remain safe. The latest MHRA bed rails advice was given to the home and it is further suggested that the risks involved in their use be discussed with relatives who are asked to give permission for their use. The home are also urged to consider the accessibility of denture cleaning tablets around the home, risk assess them and possibly remove them to minimise the risk to residents who might mistake them for sweets and accidentally eat them. Foxes Moon DS0000026803.V328722.R01.S.doc Version 5.2 Page 30 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 3 3 Foxes Moon DS0000026803.V328722.R01.S.doc Version 5.2 Page 31 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 OP29 Regulation 19 Requirement Proof of any POVA 1st checks must be kept to show that they were obtained prior to any person starting work at the home. Timescale for action 01/02/07 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 OP28 Good Practice Recommendations 50 of the staff team should achieve NVQ level 2. Foxes Moon DS0000026803.V328722.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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 Foxes Moon DS0000026803.V328722.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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