CARE HOMES FOR OLDER PEOPLE
Foxes Moon 40 Ringwood Road St Ives Ringwood BH24 2NY Lead Inspector
Tracey Cockburn Unannounced 04 July 2005 10:00 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 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 D55 S26803 Foxes Moon V216289 040705 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION
Name of service Foxes Moon Address 40 Ringwood Road, St Ives, Ringwood, Dorset, BH24 2NY Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01425 474347 01425 474347 Mrs Christine Ramsey Mrs Jean Lubbock CRH 24 Category(ies) of OP - 4 registration, with number DE(E) - 24 of places MD(E) - 24 Foxes Moon D55 S26803 Foxes Moon V216289 040705 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION
Conditions of registration: 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 21 March 2005 Brief Description of the Service: Foxes Moon was registered to Mrs Ramsey and Mrs Lubbock in January 2002; before this, the home had been registered in the general ‘old age’ category. 1 service user has chosen to continue living in the home. This service user is in the general old age category, however no new admissions in this category have taken place since the change in registration. This person had recently had a review held with their family and the care manager from the local authority and all had agreed that the placement should continue. 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 was entirely landscaped in 2002, with view to providing a safe and stimulating environment for service users, and there is ample seating and space available. Accommodation comprises 23 single bedrooms, some with ensuite facilities, over the ground and first floor of the home, 4 communal bathrooms, and a variety of communal areas. There is a main lounge/dining area, with an adjacent sun lounge and a small lounge area. The home has a block contract with Dorset Social and Health Care Services for two respite rooms. Foxes Moon D55 S26803 Foxes Moon V216289 040705 Stage 4.doc Version 1.20 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place unannounced over 3.5 hours in the late morning and afternoon. The purpose of this inspection was to review core standards as part of the annual planned programme of inspections undertaken by the commission for social care inspection. The care files of two recent admissions to the home were viewed and those residents spoken to. Four members of staff were spoken to including the chef, domestic and care workers. One of the registered providers was present for part of the inspection. A tour of the home was undertaken and residents and staff were observed over lunch. 4 residents were spoken to. Comment cards were left at the home and where received in the Commission office before the draft report was completed therefore they are included in the report. 3 comment cards from health and social care professionals were received, 2 from general practitioners, 3 from relative/visitors and 2 from care managers. What the service does well:
Before any prospective resident moves into the home an assessment is completed. This means that the home is able to decide whether or not they have the staff with the right skills to provide the care that people need. The relatives and representatives are assured that the home can meet a persons needs. Each resident has an individual plan of care which details their needs and how the care staff will ensure their needs are met. Residents are assisted to make decision where possible; staff are able to take into account their varying degrees of ability and are encouraging when they know this will help maintain their ability. Staff maintain residents dignity and privacy by ensuring that they always knock on their door, they support them when they need to and remind. One resident said the staff always knock before they enter her room. Staff were also observed supporting residents to eat their mid day meal. It is not easy to establish if residents find the lifestyle of the home matches their expectations, as many residents do not believe they need the care they receive or are unable to answer the question. One member of staff said that the most important skill they needed was patience, to listen to residents and find out what they want and patience in taking time to go at their pace and not rush as this can be very upsetting for residents. However from observation it is clear that residents are encouraged to participate in activities, which they might be interested in, and the home has employed an activities person who works in the afternoons and encourages participation in games and activities. Residents are also out in the community. The chef has a menu which he tries to ensure incorporates the likes and dislikes of the residents he will make separate dishes if a resident will not eat
Foxes Moon D55 S26803 Foxes Moon V216289 040705 Stage 4.doc Version 1.20 Page 6 something and he will spend time asking peoples opinion on the food and what they might like to see on the menu. Meal times are unhurried and staff are available to support people who may need assistance to eat. The home is currently undergoing major building work but the disruption to residents is kept to a minimum. The home is safe, the garden is well maintained and provides a pleasant oasis in the heat of the summer. The facilities inside are being improved. Each resident’s bedroom is comfortable with the resident’s own possessions around. The home is clean, hygienic and pleasant. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Foxes Moon D55 S26803 Foxes Moon V216289 040705 Stage 4.doc Version 1.20 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Foxes Moon D55 S26803 Foxes Moon V216289 040705 Stage 4.doc Version 1.20 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3,4 Standard 6 was not assesssed as Foxes Moon is not registered to provide intermediate care. Assessment information provides enough detail for the home to be able to decide whether they can meet prospective residents needs. Prospective residents receive confirmation in writing that their needs can be met. This means that they know the home can meet their needs before admission. EVIDENCE: The care records of 2 recent admissions to the home demonstrated that the home is undertaking a pre admission assessment alongside the care management paperwork if a local authority funds them. Both files seen contained paperwork from the care management assessment and the care plan devised by the home was clearly in both files looked at based on information from the original assessment as well as more detailed information regarding mental health and behaviour management from the homes own assessment and advice form community psychiatric nurses. One comment card received from a health and social care professional stated that; “the resident had care needs which exceeded what the home could reasonably offer” but they go on to say that “the person needed respite urgently”. The home will admit people
Foxes Moon D55 S26803 Foxes Moon V216289 040705 Stage 4.doc Version 1.20 Page 9 for respite when they have a bed available. The registered provider admitted that they have found that they do not always get the full picture before someone comes in for respite especially if it is urgently required. The registered provider says they have learnt form this experience and require all paperwork before they make a decision about admitting someone. It is difficult to establish with residents if they were informed that the home could meet their needs before they were admitted however there is evidence on care files that they are sent a letter confirming that the home can meet their needs. Foxes Moon D55 S26803 Foxes Moon V216289 040705 Stage 4.doc Version 1.20 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10 Individual plans of care set out the health, personal and social care needs of residents which means that care staff have a good understanding of the support that individual residents need. Good communication systems ensure that when health care needs are identified they are acted up quickly, ensuring that appropriate professionals meet resident’s health needs. The home has a policy and procedure for dealing with medicines this is not always implemented leaving residents vulnerable. Personal support is offered in the home in a way, which ensures that residents feel their privacy and dignity are respected. EVIDENCE: There are individual plans of care in place for each resident which outline their care needs including their personal care, mental health and social care needs. 1 resident is identified in the care plan as being verbally and physically aggressive at times, the care plans details the triggers for the behaviour and the actions, which need to be taken by staff to minimise the behaviour. The
Foxes Moon D55 S26803 Foxes Moon V216289 040705 Stage 4.doc Version 1.20 Page 11 care plan also included a personal profile which details the important people in the persons life as well as; important things to know about their routine, past jobs, present interests, difficult areas. Records viewed for one recent admission to the home identified the need for the person to see the chiropodist, daily records demonstrate that this was done the day after admission. On the day of the inspection one resident was very unwell and had been seen by the district nurse in the morning and the home were still concerned about her condition so the GP ad been asked to visit in the afternoon. One resident had a condition, which required the staff to take the necessary precautions to reduce the spread of the infection. The member or staff reminded the inspector what to do if they were going into the room and the care staff knew why it was important to follow the correct procedure. Care records seen also demonstrated that risk assessments are completed in relation to fall and wound care were appropriate and identified in the initial assessment as areas of concern. There was evidence that the advice of GP’s are sought regularly and the registered provider said the home has a very good relationship with the local surgery. The medication policy and practice were not inspected on this occasion but as during the course of the inspection a prescribed cream for a named current resident was found lying beside the bath in one of the bathrooms on the 1st floor by room 18. This was brought to the attention of 1 of the registered providers. Residents maintain contact with family and friends, there were residents going out the afternoon of the inspection to be with friends and their were relative visiting. Residents preferred term of address is written in their personal files. Staff were observed supporting residents with their mid day meal and encouraging them to eat. Staff were also observed gently leading residents to the bathroom and talking with them quietly. Foxes Moon D55 S26803 Foxes Moon V216289 040705 Stage 4.doc Version 1.20 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,15 The home has information on individual life histories, which informs the social, cultural, religious, and recreational activities organised. Family and friends are in contact with residents, which means residents are able to maintain links with the people they know. Resident’s receive an appealing diet, which is mindful of their nutritional needs and provided in familiar surroundings. EVIDENCE: There were 4 resident files seen during the inspection which contained information in a personal profile from family and friends regarding interests, previous occupations, important people in their life, important things to know about their daily routine, present interests, areas which they find difficult and how to support and manage this. Staff are responsible for ensuring that this information is updated and put into practice. During the inspection several residents were waiting to go out with family and friends however due to the nature of their mental health needs it is difficult to establish if they see the people they want to. Most residents are not always able to express their opinion on who they want to see. Staff were observed reassuring residents about where they were going and who they were seeing.
Foxes Moon D55 S26803 Foxes Moon V216289 040705 Stage 4.doc Version 1.20 Page 13 The chef explained to the inspector that all menus are completed a week in advance, which takes advantage of seasonal fruit and vegetables, which are bought locally. The chef also said that he talks to residents about their likes and dislikes and will incorporate these changes into his menu planning. The chef said he does not have any restrictions on his budget and is able to buy the food he wants to cook and serve. At the time of the inspection there was one special diet catered for and 4 people had a soft diet, the chef explained that he would puree the meat only and the care staff would assist residents to cut up the vegetables. The chef also makes cakes for afternoon tea and cakes for special occasions such as birthdays. The majority of residents ate in the dining area with one or two residents choosing to eat in their room. Lunch on the day of the inspection was observed to be at the pace of individual residents with staff in attendance and supportive of those people who needed encouragement to eat. Only one or two residents required some assistance to eat their meal. A notice board in the dining room had the lunch menu for the day. This was only available in one format. Hot and cold drinks where available throughout the day. Foxes Moon D55 S26803 Foxes Moon V216289 040705 Stage 4.doc Version 1.20 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These standards were not assessed at this inspection. EVIDENCE: Foxes Moon D55 S26803 Foxes Moon V216289 040705 Stage 4.doc Version 1.20 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,24,26 The home is a safe and well-maintained environment, which ensures that residents protected. The communal areas both inside and outside the home are accessible and safe which means that residents are able to wander where they want without risk. The home provides private space for residents, which is safe, comfortable and enables them to have their own possessions around them. The home provides a clean, pleasant and hygienic environment, which gives a good impression to prospective residents. EVIDENCE: The home is currently undergoing some extensive building work to ultimately add 7 rooms. The kitchen and laundry room are being modified and extended to provide larger spaces in both areas of the home. The building work is being carried out away from residents and their daily life is not being disturbed. The garden is accessible and safe and provides a very pleasant environment, which
Foxes Moon D55 S26803 Foxes Moon V216289 040705 Stage 4.doc Version 1.20 Page 16 stimulates resident’s senses. The gardens are accessible from the lounge. The lighting in the home is domestic in character and there is natural light in the lounge. The dining room is able to accommodate most of the residents at mealtimes. All the bedrooms are comfortably furnished providing, space for hanging clothes, seating for 2 people, curtains and both overhead and bedside lighting. The laundry room in the home is very small but there are plans to make it bigger in the refurbishment. There is a washing machine and dryer in this small space. Resident’s clothes are put into number baskets according to their room number. The home has an infection control policy. Foxes Moon D55 S26803 Foxes Moon V216289 040705 Stage 4.doc Version 1.20 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28 The home provides sufficient staff to meet resident’s needs. Ensuring that there are the right number of staff with the skills needed to provide a stimulating and caring environment. EVIDENCE: On the day of the inspection there were 5 care staff on duty in the morning as well as a domestic and the chef and 3 in the afternoon. 1 member of staff spoken to said that she had worked in the home for 3 years and she would be undertaking the Gemma Jones course in September 2005. She also said she had had training in moving and handling, first aid and infection control. There was also a young person working in the home as part of work experience, she had duties, which did not include personal care. Foxes Moon D55 S26803 Foxes Moon V216289 040705 Stage 4.doc Version 1.20 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These standards were not assessed at this inspection EVIDENCE: Foxes Moon D55 S26803 Foxes Moon V216289 040705 Stage 4.doc Version 1.20 Page 19 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3
COMPLAINTS AND PROTECTION 3 3 x x x 3 x 3 STAFFING Standard No Score 27 3 28 2 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x x x x x x x Foxes Moon D55 S26803 Foxes Moon V216289 040705 Stage 4.doc Version 1.20 Page 20 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 9 Regulation 13 (2) Requirement Prescribed medication must not be left out after use. Timescale for action 31/07/05 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 28 Good Practice Recommendations 50 of the staff team should achieve NVQ level 2. Foxes Moon D55 S26803 Foxes Moon V216289 040705 Stage 4.doc Version 1.20 Page 21 Commission for Social Care Inspection Unit 4, New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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