CARE HOMES FOR OLDER PEOPLE
Foxholes Nursing Home Pirton Road Hitchin Hertfordshire SG5 2EW Lead Inspector
Alison Jessop Key Unannounced Inspection 27th October 2006 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.V317598.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.V317598.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Foxholes Nursing Home Address Pirton Road Hitchin Hertfordshire SG5 2EW 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 Foxholes Nursing Home Limited Mrs Susan Barton Care Home with Nursing 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.V317598.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. 7th September 2005 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.V317598.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, visitors 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. The outcome was very positive however some requirements remain outstanding from the previous inspection report. What the service does well: What has improved since the last inspection? What they could do better:
Some areas within the home require redecoration. The carpets on the first floor hallway are loose and require replacing in order to prevent risks to service users, staff and visitors.
Foxholes Nursing Home DS0000019352.V317598.R01.S.doc Version 5.2 Page 6 Not all staff spoken to were aware of the protection of vulnerable adults procedure or whistle blowing procedure, therefore further training is required. Malodours were detected in one service users bedroom, this room must be thoroughly cleaned in order to eradicate the odour. 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.V317598.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.V317598.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&6 Quality in this outcome area is good. 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. Prospective service users can visit the home prior to moving in and a meeting is held after six weeks to review suitability. This home does not provide intermediate care. Foxholes Nursing Home DS0000019352.V317598.R01.S.doc Version 5.2 Page 9 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 excellent. 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. EVIDENCE: Care plans contain comprehensive information and are regularly reviewed. Nutritional assessments are carried out on admission and are reviewed on a monthly basis with weights being closely monitored. Service users look comfortable and well cared for. Care practice observed was dignified and sensitive and feedback from service users was very positive. One service user said ‘I am happy with everything here, I am well looked after.’ Procedures relating to medication were satisfactory and no requirements or recommendations in relation to this have been made.
Foxholes Nursing Home DS0000019352.V317598.R01.S.doc Version 5.2 Page 10 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 excellent. This judgement has been made using available evidence including a visit to this service. A varied activity programme is available offering meaningful stimulation to service users. Systems enable the service to be flexible and changed to meet individual wishes. Residents enjoy the flexibility of meal arrangements and enjoyed being able to eat in a room of choice. EVIDENCE: On the day of the inspection activities were taking place. In the morning there was singing in the lounge. One service user said that she loves to listen to the music and often plays the piano to the other service users. The activity coordinator was enthusiastic about her work and ensures that activities are appropriate to individual service users. One service user who cannot speak or understand the English language has notices in Cantonese on her bedroom wall so that staff can to some extent communicate with her. The staff team liase with the service users family and have looked at ways in which communication can be more effective. The
Foxholes Nursing Home DS0000019352.V317598.R01.S.doc Version 5.2 Page 11 service users family said ‘she is very happy and settled and the staff are doing a good job.’ During lunch service users were able to make a choice about where they would like to sit, some sat at the dining room tables, others chose to stay in their arm chair and one group of ladies ate together in a small private dining room. This provided a nice, relaxed atmosphere where service users appeared to enjoy their nutritious meal. Foxholes Nursing Home DS0000019352.V317598.R01.S.doc Version 5.2 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and others associated with the service state that they are very satisfied with the service provision, feel very safe and well supported by an organisation that has their protection and safety as a priority. EVIDENCE: A copy of the complaints procedure is available to service users who confirmed that they knew how to make a complaint. No complaints have been received since the previous inspection. Staff spoken to did not appear to be aware of the Whistle blowing procedure and had not received training on the protection of vulnerable adults procedure. Foxholes Nursing Home DS0000019352.V317598.R01.S.doc Version 5.2 Page 13 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. Although the home offers a comfortable, homely environment to service users, some areas require refurbishment to enhance the environment. There may be one or two areas that pose a potential risk to service users and staff, for example areas of carpet are loose. EVIDENCE: Bedrooms are homely and offer comfort and privacy to service users. Malodours were detected in one bedroom and action must be taken to eradicate this. Communal areas are spacious and also offer a comfortable, clean environment to service users however some areas require refurbishment. The carpet on the first floor hallway is loose and is a risk to service users, staff and visitors. The
Foxholes Nursing Home DS0000019352.V317598.R01.S.doc Version 5.2 Page 14 wallpaper on the ground floor bathroom is lifting, this room requires redecoration. Foxholes Nursing Home DS0000019352.V317598.R01.S.doc Version 5.2 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The skills and experience of staff was varied. There was an enthusiastic, dedicated and caring staff team who took pride in the service provision. EVIDENCE: There are adequate numbers of staff on duty and many of the staff have a long employment history at the home. Records pertaining to recruitment were satisfactory and PIN numbers for nurses are now reviewed and updated. Staff receive regular training and a high number of staff are completing or have completed NVQ. Foxholes Nursing Home DS0000019352.V317598.R01.S.doc Version 5.2 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager has the required qualification/s and experience and is competent to run the home. She works to continuously improve services and provide an increased quality of life for residents. The manager is resident focused and leads and supports a strong staff team who have been recruited and trained to a high standard. EVIDENCE: A quality audit is carried out annually and the home has the Blue Cross mark of excellence. All statutory records were available for inspection and had been maintained in accordance with legislation.
Foxholes Nursing Home DS0000019352.V317598.R01.S.doc Version 5.2 Page 17 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 Foxholes Nursing Home DS0000019352.V317598.R01.S.doc Version 5.2 Page 18 CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Foxholes Nursing Home DS0000019352.V317598.R01.S.doc Version 5.2 Page 19 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP18 Regulation 13 (6) Requirement All staff working in the home must be aware of the whistle blowing procedure and the protection of Vulnerable Adults procedure. Carpets on the first floor hallway must be made safe and/or replaced. The bathroom on the ground floor requires redecoration. Malodours identified must be eradicated. Timescale for action 31/01/07 2 OP19 23(2)(b)& (d) 23(2)(b)& (d) 16(2)(k) 15/12/06 3 4 OP19 OP26 28/02/07 15/12/06 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.V317598.R01.S.doc Version 5.2 Page 20 Commission for Social Care Inspection Hertfordshire Area Office CPC1 Capital Park Fulbourn Cambridgeshire 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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