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Inspection on 24/03/09 for Foxholes Nursing Home

Also see our care home review for Foxholes Nursing Home for more information

This inspection was carried out on 24th March 2009.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The expert by experience, who talked to a large number of people living in Foxholes noted; "There was universal praise for the staff, together with recognition that they were very busy". One person said; "I would like it known that Foxholes is exemplary. Staff are excellent, domestic conditions are superior". Other positive comments included "Carers very nice, go out of their way to help you" and "The care is of a very high standard". Throughout the inspection we saw good interaction and care from care staff to people living in the home and when we spoke to care staff they told us that they felt supported by the home in the training that they are provided with so that they can maintain a high standard of care for people living in Foxholes.

What has improved since the last inspection?

The process for staff recruitment has been improved and now provides much better safeguards for people living in the home from the employment of unsuitable people to care for them. There has been an improvement in the standard of recording for the administration of medication although some weaknesses still remain. Those members of the staff team spoken to all felt that things had improved since November 2008; "Things are much better" "more training, team working much better" "Lots of informal support to one another".

What the care home could do better:

The standard of care plans still causes some concern as they are not consistently wellcompleted and in particular the details available to care staff about the life history, social interests and likes and dislikes of people living in the home are not always available and so it is hard to see how care can be effectively individualised or person centred. It is understood that work on updating and auditing care plans is already underway to address these shortcomings. The standard of medication administration, whilst better than it was, still causes concern, in particular since there have been occasions when the medication for people living in the home was not available due to problems between the home and its pharmacy. This could clearly impact adversely on people living in the home who depend on the home to obtain and administer their medication when it is required. The home`s environment is being maintained adequately, however the home themselves recognise the need for refurbishment in some parts and this is due to take place in conjunction with a planned extension to the home in the near future. Storage and tidiness were found to be less well organised and maintained than previously and this could have implications for the health and welfare of people living and working in the home.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Foxholes Nursing Home Pirton Road Hitchin Hertfordshire SG5 2EN     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jeffrey Orange     Date: 2 4 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Foxholes Nursing Home Pirton Road Hitchin Hertfordshire SG5 2EN 01462459899 01462458956 care@foxholesnh.freeserve.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Foxholes Nursing Home Limited care home 37 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: This home may accommodate 37 older people who have physical disability and require nursing care. This home may accommodate 37 older people who need post-operative and respite nursing care. 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. Date of last inspection Brief description of the care home 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 Care Homes for Older People Page 4 of 29 Over 65 37 37 0 0 0 5 1 1 2 0 0 8 Brief description of the care home 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 charges are from £450 to £550 for residential care and £550 to £650 for nursing care. Charges for hairdressing, personal toiletries and chiropody are additional. A copy of the most recent inspection report can be found in the reception area. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced key inspection took place over the course of one day, starting early in the morning, so that the routine of the home could be observed as people were getting up and ready for the day ahead. This inspection visit was carried out by one inspector accompanied by an expert by experience. Experts by experience are people whose knowledge of social care services comes directly from using services and who, because of this, some people living in a care service may feel more relaxed speaking to than to an inspector. This inspection draws on any information obtained about Foxholes since their last key inspection in November 2008. This could be from health and social care professionals associated with the home, people who live there or those who are responsible for them. We also receive notifications from the home about significant events affecting the home and people who live there. In the course of this inspection we have received a number of responses to surveys we sent to people who live in Foxholes and to care staff who work there and their views have been taken into Care Homes for Older People Page 6 of 29 account in drawing up this report. We have also made use of information previously provided to us by the home in their Annual Quality Assurance Assessment or AQAA. The AQQA is a self assessment document that focuses on how well care outcomes are being achieved for people living in Foxholes and it also includes some useful statistical information. Whilst we were at the home we had the opportunity to speak to a number of people who live there, we spoke to visitors to the home and to members of the staff team. We also had very useful discussions with the management team and were able to examine some key records including care plans, staff training records, medication records and staff recruitment files. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People considering Foxholes as a home for themselves or someone they are responsible for can be confident that they will only be admitted once an assessment has been carried out to ensure that their needs can be met appropriately and that they will be given every opportunity and assistance to visit the home beforehand to help them decide if it is a home which will meet their needs and where they could be happy. Evidence: When we asked people who live in Foxholes; Did you receive enough information about this home before you moved in so you could decide if it was the right place for you? 90 said they did.When we asked staff;Are you given up to date information about the needs of the people you support or care for (for example in the care plan)? 50 said they always were and 50 said they usually were.When we asked people living in Foxholes if they received the care and support they need, 67 said they always did and 33 said they usually did.People who live in Foxholes, or those Care Homes for Older People Page 10 of 29 Evidence: responsible for them told us; Care is very good, The staff take great care of her and they are lovely and The care is a very high standard and very friendly.In their AQAA the home told us; Before each admission we always do a pre-admission assessment to make sure that we know ourselves what the need of each resident is. This is also necessary so that the care needs are up to date. We do not want a resident to come to the home if we cannot cater for their needs as this is not fair on that person, or our staff. We never admit a resident that we are not confident we can adequately care for. When we looked at care plans for some of the people who had recently moved into Foxholes we found that a pre-admission care needs assessment had been carried out in order to establish if their care needs could be met by the home. When we looked at the documentation available to people considering Foxholes as their home, including the homes statement of purpose, we found that it was quite clear and explicit and contained the kind of information they would need in order to make a reasonably well-informed decision about whether they would feel at home there.When we met some people who had been responsible for helping someone look for a residential care home, they told us that they had been able to visit Foxholes as part of that decision making process and that management and staff had been very helpful. Care Homes for Older People Page 11 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in Foxholes can be confident that their care needs will be identified and recorded so that care staff can provide the care they need appropriately. The ability of the home to offer a robust and effective medication administration for people living in the home has sometimes been compromised by the lack of availability of medication from the homes pharmacist.People living in Foxholes can be confident that they will be treated in a way that respects their dignity and is respectful to them. Evidence: When we asked people who live in Foxholes if they receive the medical support they need, 85 said they always did and 15 that they usually did. When we looked at care plans for some of the people who live in Foxholes we found evidence that they have access to health care services both in the home and community. People living in Foxholes who are unable to access local community services receive visits from community health care professionals. In their AQAA the home told us that a new care plan format has been introduced and that their documentation; Is always being revised to adapt to the changing needs of our service users. Care Homes for Older People Page 12 of 29 Evidence: When we looked at some care plans we found that the format is basically good, with the capacity to provide care staff with clear and detailed information about the care needs of people living in the home and how these are being met. The standard of the best completed care plans seen was satisfactory, however the standard was variable, in some cases reviews had not been recorded and in others there were gaps of several months in between recorded reviews. In most cases seen the social history details were very scarce, this makes it harder for care staff to provide genuinely person centred care based on the known background, interests and significant life history of people living in the home. Some records had not been completed fully and in others there was insufficient follow through from assessment of risk to how these were being managed. As indicated above, where the care plans were used to the best of their potential they were satisfactory and we were told that additional care plan training has been undertaken and will continue, to ensure that the new format is used to the best advantage of both staff and people living in the home for whom they care. When we looked at the medication records for the home, we found that these had significantly improved since the last inspection. However there were still a few gaps in records, although considerable less than previously and again a reduced number of occasions where variable doses had not been recorded appropriately. The system of recording medication carried forward from one period to another has been improved and now appears satisfactory.We found that there were some occasions when medication had not been administered due to new supplies from the homes pharmacist supplier not being available in time. On another occasion although the medication was available it had been wrongly put into a blister pack by the pharmacy, which led to a double dose being taken in the morning and none in the evening. It is the responsibility of the home to monitor medication supplies to ensure that people living in the home always have the correct medication available for them and to ensure that the correct dose of any medication is administered at the correct time. The management of the home have identified the need to improve this area of operation and have undertaken to improve staff training in medication and to work with their pharmacy to improve the service they receive. This will enable them to provide more effectively for the safe administration of medication to people living in the home. When we asked people living in Foxholes if staff listen to them and act on what they say, 98 said that they did. Very much so, encourage you to talk to them even if its bad. When the expert by experience talked to people in the home he noted that there was universal praise for the staff and observed that the staff that I observed with these residents treated them with consideration, respect and often with gentle humour. Care Homes for Older People Page 13 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in Foxholes can be confident that they will be able to take part in meaningful daytime activities either individually or with other people who live in the home, depending upon their personal choice. They can be confident that they will be encouraged to maintain important social and family relationships, that they will be offered some choice as to the food they eat and that there will be alternatives available to them if they specifically request them. Evidence: When we asked people who live in Foxholes; Are there activities arranged by the home that you can take part in? 20 said always, 60 said usually, 20 sometimes and 20 never. When the expert by experience talked to people in the home who were predominantly in their rooms, they seemed to suggest that this was a matter of their own choice and not necessarily a reflection on the activities on offer. I go down if I want to, I like it on my own, I dont want to watch rubbish on the television, I dont want to participate one resident indicated by non-verbal communication that they wanted to be in their own room and did not want to join others and another said I am not a joiner. When we spoke to the activities organiser we found that there was an activities Care Homes for Older People Page 14 of 29 Evidence: programme covering five days a week with at least one communal activity and two one to one sessions with people living in the home. The activities organiser keeps records of activities and who participates and they are gradually becoming integrated into the care planning process. The activities are publicised on a 14 day sheet and in addition there is a daily activities board in the main lounge. The activities organiser is beginning to enhance the social history part of the care plans to show specific interests, background and needs of people who live in the home. This will help her and other care staff to tailor care more to the individual on an informed basis. The activities organiser is also being supported by the home to attend an external course to develop her skills and to keep abreast of current good practice, this will not only benefit her but importantly the people in the home.The expert by experience discussed with the homes management the possibility of care staff taking an enhanced role in providing activities outside of the core hours of the activities organiser. This would benefit people who live in the home and it was indicated by the homes management that this would be considered as a possibility, staff and other resources permitting. When we spoke to visitors to the home they confirmed that they were always welcome; always make us welcome, Staff here are so lovely, so friendly and kind, I come here twice a week were some of the comments made. When we asked people in surveys Do you like the meals in the home? 33 said they always did, 59 that they usually did and 8 that they never did. When we spoke to people on the day of the inspection their comments and assessment of the food in the home varied widely from; It is diabolical, very repetitious, all vegetables are frozen to others who felt it was good or not too bad and sometimes better than others. When the expert by experience observed lunch he noted that; There were at any time 4 to 6 staff helping out, the tables were nicely set out and a choice of juice offered. He noted that residents were encouraged to eat by themselves where possible and that plenty of time was allowed for them to complete their meals at their own pace. Three visitors to the home were helping their relatives and he notes that; staff helping where necessary in a caring and considerate manner.In their AQAA the home told us that; As we have so many service users, our mealtimes are at specific times and our meals are the same for everyone. We observed at lunch that meals are served already plated and without much in the way of explanation. Comments made to us by people that live in the home suggest that some choice is offered, and we saw this happening on occasions. Other people told us that they were only sometimes offered choice and others that choices were not offered before mealtimes. One relative told us that they felt the home used reheated cooking oil too often and that there were too few fresh vegetables. When we discussed this with the proprietor we were told that there had been a temporary problem with their supplier and that recently more frozen vegetables had been used than would normally be the case, but that they Care Homes for Older People Page 15 of 29 Evidence: intended to provide more fresh vegetables in the future. Where people living in Foxholes have very specific cultural food requirements, relatives have sometimes preferred to provide their own food, although wherever possible the home have tried to cater at least in part for their needs as far as they are able. When we asked the proprietor of they had obtained and read a copy of the commissions report Highlight of the Day in line with a recommendation made following the last inspection in November 2008 they indicated that they had not. Care Homes for Older People Page 16 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in Foxholes can be confident that care staff have the training they require to enable them to recognise abuse if it seen and that care staff know what action to take in order to protect them. Whilst the home has a complaints policy and people living in the home should be aware of how to make a complaint, not all complaints are always fully recorded which may mean that trends and patterns in complaints may not be effectively identified and dealt with. Evidence: When we asked people who live in the home if they knew how to make a complaint, 84 said that they did, with only 16 saying that they did not.When we looked in the homes service user guide, we saw that it includes details of hiow to make a complaint and the complaints policy and procedure is on display in the home which should mean that anyone who wants to make a complaint is able to do so. We have been made aware by relatives of people who live in the home of complaints they have made, and although they were not always satisfied with the outcome, they were able to make a complaint and to have it considered under a formal complaints process. In their AQAA the home informed us that they had received 2 complaints in the previous 12 months, that they had all been resolved within 28 days and that none of them had been upheld. When we looked at complaints records we found that whilst formal complaints are usually recorded appropriately, the tendency is for less formally expressed complaints and concerns to be dealt with as they arise, informally, and not always recorded. Care Homes for Older People Page 17 of 29 Evidence: There have been recent referrals made about individuals living in Foxholes to Hertfordshire County Council Adult Care Services under their safeguarding adults process. These are ongoing, the home have co-operated fully in these processes and continue to do so.When we spoke to care staff, they told us that they had received training in the protection of vulnerable adults and this was supported by copies of the homes training records seen. Care Homes for Older People Page 18 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in Foxholes can be confident that the home will be kept reasonably clean, tidy and free from unpleasant smells and that it will be maintained adequately so as to provide a warm and comfortable environment for them. There are however some instances where risks to the health and safety of people living in the home have not been identified and rectified as quickly as they should, which could compromise the safety of some people living in the home. Evidence: When we asked people if the home is fresh and clean, 40 said always and 60 usually. Comments received included; Sometimes the home smells of urine, but it is not always the case and Yes the home is clean, but it can be better, especially the bedroom windows. When we walked around the home at the start of our visit we saw two cases where the automatic fire closing devices in bedrooms were being rendered ineffective as the doors were wedged open by stools. This would prevent the door closing automatically in the event of a fire. The proprietor agreed to address this on the day of the inspection. The home is planning a major refurbishment at the same time as work on a planned extension is carried out. In their AQAA the home recognised that some areas of the home need updating. In particular there is pressure on storage within the home and we saw hoists badly positioned blocking corridors and residents access to their Care Homes for Older People Page 19 of 29 Evidence: bedrooms, there were some wall lights not working and others not on which meant that a staircase was poorly illuminated which could be a problem for anyone using it. One sluice room door was open, despite there being a notice on it saying it should be kept locked shut and there was a raised toilet seat on the floor. One cupboard seen outside room 11 was very untidy, with pads, slings, stocking, used gloves and other items, including catheter bags and dressings being haphazardly stored. During our visit we saw domestic staff actively working throughout the home, and with minor exceptions the home was clean and free from unpleasant smells. In the past the home have responded promptly to requirements made about the environment and the last report noted improvements to the dining and garden areas and the the provision of new profiling beds. Those bedrooms seen were reasonably clean and tidy and showed evidence that people living in the home are able to personalise their rooms to their taste, with ornaments, pictures and items of their own furniture. There are a number of communal areas available to people living in Foxholes, which should enable them to find a suitable place where they can be with other people if they choose to, or to sit in a quiet area if they prefer. Care Homes for Older People Page 20 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in Foxholes can be confident that care staff will be given the training they need to ensure that they have the skills and knowledge they require to enable them to meet their care needs effectively and appropriately. People living in Foxholes can be reassured that they are now effectively protected by the way that the home recruits staff to care for them. Evidence: When we asked people living in Foxholes do you receive the care and support you need? 64 said that they always did and 36 that they usually did. When we asked them if staff were available when they needed them, 57 said they usually were, 33 that they always were and 10 that they never were. People living in Foxholes told us; The care is a very high standard, Yes the staff take great care of her and they are lovely ,The care is very good and I would like it to be known that Foxholes is exemplary,staff are excellent, domestic conditions are superior. The expert by experience found that there was universal praise for the staff, together with recognition that they were very busy. This is confirmed in comments received from people living in the home; Sometimes they take 10-15 minutes to see you, maybe they are busy, On the whole carers work very hard, but not enough of them and There have been times when they have been a bit thin on the ground. When we asked care staff if there were enough of them on duty, 70 said that there usually Care Homes for Older People Page 21 of 29 Evidence: were and 30 that there always were. Staff told us that they received a good level of training and that they kept up to date with care developments, they were positive about the quality of their induction training when they started work in the home and they all said that they either often or regularly had meetings with their manager to discuss their performance and to offer them support. When we spoke to care staff they told us that they felt that things had improved since the last inspection, that teamwork was better, that they received more support and that training was better. They told us of recent training received, including dementia care and safeguarding. When we looked at training records we found that there is a system of recording training undertaken and due that should mean that staff are kept up to date with training that needs to be periodically renewed. Several staff told us they were about to start NVQ level 3 training, having completed their level 2 qualification. In their AQAA the home provided information that a high percentage of care staff have already achieved level 2 NVQ in care or its equivalent. All of this suggests that staff are being provided with the skills and knowledge that they need in order to provide a good level of care to people living in foxholes and that assessment would seem to be borne out by the above comments of people living in the home about the care outcomes for them. When we looked at staff recruitment files and spoke to the homes administrator about the recruitment process we found that there is a commitment to maintain a high standard of recruitment practice, including obtaining two written references and criminal records bureau clearances at enhanced level. This is to ensure that people living in the home are protected from the employment of unsuitable people to care for them. Care Homes for Older People Page 22 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in Foxholes can be confident that the management team will provide an essentially safe and comfortable care environment for them. However they will benefit from greater clarity and clear responsibility for areas like health and safety and staff supervision where weaknesses have been identified. Evidence: The home does not currently have a registered manager and at the time of this report no application has been finalised to the commission for registration of a manager. The Clinical Manager, Managing Director and the Executive Director all take a prominent role in the management and supervision of the homes activities and each have been referred to as manager during the course of this inspection visit by either staff or people living in the home. The potential for confusion or lack of clarity that this brings has been discussed with the directors of the home and it is still not clear if a final candidate for registration as manager has yet been identified. In many ways, from what staff and people living in the home tell us, the home appears overall to be managed quite effectively, however it is not satisfactory that there is no registered Care Homes for Older People Page 23 of 29 Evidence: manager in place who has been assessed as a fit person to manage a residential home by the Care Quality Commission. When we talked to care staff about supervision and looked at formal supervision records, we found that whilst staff tell us that they receive regular supervision, this is largely informal and is not routinely recorded. This has been discussed with the management of the home and they have indicated that as from April, a pattern of formal supervision, at least six times a year will be in place. This will ensure that formal records of the support provided to staff are kept. When we visited the home we found that there were some incidents or practices that could compromise the health and safety of staff or people living in the home. This includes the use of footstools to keep bedroom doors open, which could prevent them closing properly in the event of a fire. We found instances of poor storage conditions and practice that could pose a risk through cross-contamination and infection and which needs to be audited and improved to fully protect people living and working in the home.We also found instances where trip hazards had been created by the poor positioning of hoists whilst they were not in use. We have seen brief minutes of residents meetings, one of which was held on the 10th March and we have seen copies of the Foxholes newsletter and details of the homes website where comments can be made. In their AQAA the home told us that they hold regular residents meetings, and that feedback is requested from residents and relatives both formally by questionnaires and also informally. When we talked to relatives about Foxholes, there were no specific concerns raised about their ability to discuss issues with the management team and when we asked people who live in the home, they told us that they knew what to do if they had a concern or wanted to talk to someone about it. The level of personal information that we found in care plans relating to the history, likes and dislikes and hobbies of people who live in the home was poor in many cases, although it is acknowledged that this has been recognised and that it is the intention of the home and the activities staff to ensure that care plans contain the level and kind of information that will enable all areas of the homes operation to be run, wherever possible, in a way that reflects the individual background, tastes and preferences of the people who live there and will mean that the home is effectively and consistently run in the best interests of people living there. Care Homes for Older People Page 24 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 The registered provider 01/04/2009 must carry out a review and audit of all care plans to ensure that they are fully recorded and up to date and that all the information required to provide individualised care is in place. Care plans should be comprehensive and fully completed including details about the life history, interests and preferences of the people to whom they refer so that care can be appropriately and effectively given. 2 9 13 The registered provider must make sure that the medication for people who live in the home is always available to administer by monitoring stock levels and ensuring orders for the next period are placed and 01/04/2009 Care Homes for Older People Page 26 of 29 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action received in time to ensure continuity of supply. This is because the health and safety of people living in the home could be compromised if their medication is allowed to run out. 3 19 23 Doors fitted with automatic closing devices must not be prevented from operating correctly by the use of wedges or any obstacle that would stop them closing effectively in the event of a fire. If a door does not close properly in the event of a fire there is a significant risk to any person in the room and to the integrity of the building as a whole. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 31/03/2009 1 15 The home should consider obtaining, reading and making use of the CSCI report Highlight of the Day as this may help them consider ways to enhance and improve the mealtime experience for people living in the home. The home should ensure that all complaints, however minor and how quickly dealt with are recorded so that any trends or patterns can be identified and addressed appropriately, which will improve the care experience of Page 27 of 29 2 16 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations people living in the home. 3 19 An audit of the homes storage facilities should be carried out to make sure good standards of cleanliness, tidiness and hygiene are being observed and that poor storage does not have a detrimental effect on the care, health and welfare of people living in the home. Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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