CARE HOMES FOR OLDER PEOPLE
Foxholes Nursing Home Pirton Road Hitchin Hertfordshire SG5 2EN Lead Inspector
Marian Byrne Key Unannounced Inspection 12th November 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 Foxholes Nursing Home DS0000019352.V358153.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. Foxholes Nursing Home DS0000019352.V358153.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Foxholes Nursing Home Address Pirton Road Hitchin Hertfordshire SG5 2EN 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) 01462 459899 01462 458956 care@foxholesnh.freeserve.co.uk Foxholes Nursing Home Limited Mrs Susan Barton Care Home 37 Category(ies) of Old age, not falling within any other category registration, with number (37), Physical disability over 65 years of age of places (37) Foxholes Nursing Home DS0000019352.V358153.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. This home may accommodate 7 older people who require personal care. This home may accommodate 7 older people with physical disability who require personal care. This home may accommodate 37 older people who have physical disability and require nursing care. This home may accommodate 37 older people who need postoperative and respite nursing care. 27th October 2006 Date of last inspection Brief Description of the Service: Foxholes is a privately owned care home providing nursing care and accommodation for 37 older people. The home is situated on the outskirts of Hitchin and is set in 18 acres of landscaped gardens with views of the countryside. Accommodation is provided on the ground floor, first and second floors and bedrooms are of varying style and size. There are both assisted and non-assisted bathrooms on the upper floors with a shower facility on the ground floor. The home has large central halls on each floor where service users can sit. The main sitting areas are on the ground floor where there is a linked lounge, conservatory and dining area. The majority of the homes bedrooms are single accommodation and 6 are with en-suite facilities. There is a passenger lift provided and the home has well maintained gardens, which are accessible to all service users. The current accommodation charges are £400 to £550 per week. Charges for hairdressing and chiropody are additional. A copy of the most recent inspection report can be found in the reception area. Foxholes Nursing Home DS0000019352.V358153.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over one day by one regulatory inspector. Time was spent talking to service users, and staff. The registered manager was available throughout the inspection to answer any questions. Time was also spent inspecting care plans and other documentation required. What the service does well: What has improved since the last inspection?
Staff have undergone training on the safeguarding adults and the environment has improved in so far as the requirements on flooring left at the last inspection were met.
Foxholes Nursing Home DS0000019352.V358153.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Foxholes Nursing Home DS0000019352.V358153.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Foxholes Nursing Home DS0000019352.V358153.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Admissions are not made to the home until a full needs assessment has been undertaken. The home are then able to confirm that they can meet the needs of the individual through the service they deliver as detailed in the statement of purpose. EVIDENCE: The registered manager carries out a comprehensive needs assessment prior to admission. If she feels that the home cannot meet the service users needs they will not admit. The detail taken at admission is not sufficient to ensure that a person centred care plans can be drawn up. The Registered Manager is aware of this and is endeavouring to get more personal information on service
Foxholes Nursing Home DS0000019352.V358153.R01.S.doc Version 5.2 Page 9 users at admission. Prospective service users can visit the home prior to moving in and a meeting is held after six weeks to review suitability. Foxholes Nursing Home DS0000019352.V358153.R01.S.doc Version 5.2 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. 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. The care plan is used as a working tool and is understood by all staff. It is written in clear language and can be used in an emergency by people who are not familiar with its content. Each care plan includes a comprehensive risk assessment, minimising risks to service users. It does not include enough detail about the service users to facilitate person centred care. EVIDENCE: The care plan is used as a working tool and is understood by all staff. It is written in clear language and can be used in an emergency by people who are not familiar with its content. Each care plan includes a comprehensive risk assessment, minimising risks to service users. It does not include enough detail about the service users to facilitate person centred care. Foxholes Nursing Home DS0000019352.V358153.R01.S.doc Version 5.2 Page 11 Foxholes Nursing Home DS0000019352.V358153.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The daily life of the home is task led and residents cannot be assured that care is person centred. Visitors are welcomed to the home at all reasonable times. Regular meals are provided that is of a good standard however; residents cannot freely access snacks as they may wish. EVIDENCE: On the day of the inspection there were no organised activities in the home. Some service users were in wheelchairs in the dining room. There was nothing to stimulate service users. There were some reminiscence items in the hall that may offer comfort to service users who have little or no short term memory however there are no facilities for service user to sit in the hall and to receive
Foxholes Nursing Home DS0000019352.V358153.R01.S.doc Version 5.2 Page 13 comfort from such objects. One service user was knitting and explained to the inspector that staff had gone to great lengths to ensure that she always had wool. Visitors were welcome at all reasonable times. Staff carried out their duties with care to ensure that the dignity of the service users was protected at all times. Because care plans were not person centred it is not possible to say if all service users are assisted to maintain control over their lives. Those who could and can express themselves and their needs have their needs fully met. Food was plated up in the kitchen and delivered to the dining room on an unheated trolley. This means that staff have no means of keeping food hot and cannot serve food to up to 37 residents without the temperature of the food dropping. The staff have no idea what the temperature is of the food they are serving is. Furthermore serving food in this manner means those service users have no say in the size of the portions they receive or if they want all the food that is being served. For example gammon was being served with gravy on the day of the inspection. Foxholes Nursing Home DS0000019352.V358153.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents and their relatives can be assured that their complaints would be listened and responded to. Residents are protected from abuse by the policies in place the home however the lack of secure access could put service users at risk (see standard 19). EVIDENCE: Complaints are responded to in line with the home’s policies and procedures. All staff spoken with were aware of how to recognise abuse and what to do about it. However the lack of secure access to the home could put service users at risk. Foxholes Nursing Home DS0000019352.V358153.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Generally residents live in a homely environment that mainly meets their needs. However, some routine maintenance is required to ensure that the homely atmosphere is maintained and all service users must have a choice of sitting at a table for meals. The entrance to the building was not secure; this could endanger the service users. EVIDENCE: The home is in need of refurbishment. The carpet in the conservatory is stained and dirty. The proprietor informed the inspector that plans were in place to replace the carpet, however no evidence of this was available. The proprietor also informed the inspector that there are plans to re-furbish the
Foxholes Nursing Home DS0000019352.V358153.R01.S.doc Version 5.2 Page 16 entire home again no evidence was available to support this. Since the last inspection one room, which had been used as a communal area, was now being used as a bedroom. This reduces what was already very limited communal space. The home is registered for 37 service users, as the home was established before 31/03/0 it does not have to meet the requirement of 4.1 square meters per resident. The home now offers 117.67 square meters of communal space, 3.18 square meters per resident. The dining area only accommodates 16 service users, four tables with 4 seats. This means that the remainder of the service users do not have a choice about sitting at a table for their meals. This commission was not informed of the change of use of the room, nor was it mentioned in the Annual Quality Assurance Assessment. The entrance to the home was not secure; the inspector was in the home several minutes before encountering a staff member. During this time the inspector could have had access to service user’ s rooms. The home was clean and odour free on the day of the inspection. Foxholes Nursing Home DS0000019352.V358153.R01.S.doc Version 5.2 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 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 adequate. This judgement has been made using available evidence including a visit to this service. The staff were very caring but need more training to be enabled to fully meet residents needs. A robust recruitment policy is in place ensuring staff are recruited appropriately to protect vulnerable people. EVIDENCE: The home has a core of well-established caring staff. They were observed to be kind and caring to the service users. Mandatory training was completed for most of the staff. The home has residents who show signs of confusion and staff are not trained in the care of people who have dementia. Staff spoken with did not show they have the necessary skills to deliver good quality care to the service users with memory loss as the care provided is task led rather person centred. Three staff files were inspected and were found to contain all the necessary paperwork in relation to the staff member’s identity and security checks had been carried out including a Criminal Records Bureau check and two
Foxholes Nursing Home DS0000019352.V358153.R01.S.doc Version 5.2 Page 18 references. Foxholes Nursing Home DS0000019352.V358153.R01.S.doc Version 5.2 Page 19 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 adequate. This judgement has been made using available evidence including a visit to this service. The Registered Manager does not spend enough time dedicated to the management of the home. Residents can be assured that their health and safety will be protected. EVIDENCE: The Registered Manager works shifts as part of the day-to-day running of the home. Quoting from Annual Quality Assurance Assessment ‘The manager works with the service users all of her shift, leaving very little time to attend to office duties’. While the residents are well cared for and staff are trained the
Foxholes Nursing Home DS0000019352.V358153.R01.S.doc Version 5.2 Page 20 home had done very little to keep up with new learning on how to care for service users with dementia and memory loss. This means that the home has not fully understood personal centred care for service users particularly those with severe memory loss. This is not in the best interests of service users who live in the home The quality assurance in the home was not up to date care plans were not person centred. The Responsible Individual and the Registered Manager need to work together to establish the staffing needs of the home in order to free the Registered Manager to have more time to manage the home. They both assured the inspector that this would happen as a matter of priority. Foxholes Nursing Home DS0000019352.V358153.R01.S.doc Version 5.2 Page 21 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 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 1 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 3 X X 2 Foxholes Nursing Home DS0000019352.V358153.R01.S.doc Version 5.2 Page 22 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. OP19 Standard Regulation 13 (6) Requirement The Responsible Individual must ensure that the entrance to the home must be secure to protect service users. The Responsible Individual undertook to this as a matter of priority. The Registered manager must ensure that staff are trained to care for service users who have poor short-term memory, confusion or dementia. Timescale for action 30/11/07 2. OP30 18(1) 31/01/08 3. OP15 16 (g) 4. OP19 16(2)(k) 5. OP19 23 (2) (b) The Registered Manager must 30/11/07 ensure that there is equipment in the home to maintain the temperature of hot food prior to serving it to service users. On the day of the inspection service users who were served last got cold food. The Responsible Individual must 31/12/07 ensure that service users can sit at a dining room table to eat their meals if they so choose. The Responsible Individual must 30/11/07 ensure that carpets in the conservatory must be restored to
DS0000019352.V358153.R01.S.doc Version 5.2 Page 23 Foxholes Nursing Home an acceptable level of cleanliness, or replaced. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Foxholes Nursing Home DS0000019352.V358153.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Inspection Team Area Office CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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
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