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Inspection on 07/09/05 for Foxholes Nursing Home

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

This inspection was carried out on 7th September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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

Feedback received from service users was very positive. Care practices observed was individualised and dignified. Service users accommodation was kept clean and offered a comfortable and homely environment. Staffing levels in the home were adequate. Staff members spoken to were very positive about the home and appeared committed to their work. They said they have opportunities to progress within their role and training and development is very much encouraged. Some of the service users spoken to said the following about their experience in the home. `Staff are nice and so is the food and I enjoy the activities provided at the home`. A service user said `wonderful place to live in` `nursing and care are wonderful` plenty of food and visitors are made welcome`. Good care plans with progress notes were kept up to date. There was a weekly activity chart on display in the main hall and it was noted that alternatives to the menu were provided. There is an ongoing quality assurance system in place and the home has received the blue cross mark of excellence. The provider has responded positively to the report of the last inspection and has implemented all the requirements and recommendations except for one, which is repeated in this inspection.

What has improved since the last inspection?

Assessment of needs were fully completed and signed by the person carrying out the assessments. The administration and management of medicines were kept in good order. Doors were not wedged open but are fitted with `door guards`. Formal supervision has been devised and implemented. Relevant risk assessments have been carried out. Care plans have been agreed and signed by service users and/or their relatives. General maintenance works have been carried out as required by the last inspection report.

What the care home could do better:

CARE HOMES FOR OLDER PEOPLE Foxholes Nursing Home Pirton Road Hitchin Hertfordshire SG5 2EW Lead Inspector Bijayraj Ramkhelawon Unannounced 7 September 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. Foxholes Nursing Home I52 s19352 foxholes v248011 070905 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Foxholes Nursing Home Address Pirton Road Hitchin Hertfordshire SG5 2EW 01462 459899 01462 458956 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) Foxholes Nursing Home Limited Mrs Susan Barton Care Home with Nursing 37 Category(ies) of OP Old Age - 37 registration, with number PD(E) Physical Disability (over 65) - 37 of places Foxholes Nursing Home I52 s19352 foxholes v248011 070905 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: This home may accommodate This home may accommodate require personal care. This home may accommodate require nursing care. This home may accommodate respite nursing care. 7 older people who require personal care. 7 older people with physical disability who 37 older people who have physical disability and 37 older people who need post-operative and Date of last inspection 18 April 2005 Brief Description of the Service: Foxholes is a care home providing nursing care and accommodation for 37 older people. It is privately owned and managed by a registered manager. 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 home’s bedrooms are single accommodation and 6 are with ensuite facilities. There is a passenger lift provided and the home has well maintained gardens, which are accessible to all service users. Foxholes Nursing Home I52 s19352 foxholes v248011 070905 stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a positive unannounced inspection and feedback received from service users was excellent. The standard of care and practices observed were good. The majority of time was spent talking to service users and staff. Some time was spent in the office scrutinising care plans, staff files and other records. Discussions were held with the manager to whom the feedback of the inspection was given. The experience of service users was that there was a pleasant and relaxed atmosphere in the home and they were complimentary of the staff, the food, activities and their rooms. What the service does well: What has improved since the last inspection? Assessment of needs were fully completed and signed by the person carrying out the assessments. The administration and management of medicines were kept in good order. Doors were not wedged open but are fitted with ‘door guards’. Formal supervision has been devised and implemented. Relevant risk assessments have been carried out. Care plans have been agreed and signed by service users and/or their relatives. General maintenance works have been carried out as required by the last inspection report. Foxholes Nursing Home I52 s19352 foxholes v248011 070905 stage 4.doc Version 1.40 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. Foxholes Nursing Home I52 s19352 foxholes v248011 070905 stage 4.doc Version 1.40 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 Foxholes Nursing Home I52 s19352 foxholes v248011 070905 stage 4.doc Version 1.40 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) 1-5 Adequate information was available to prospective service users and their relatives to assist them in their decision making process when chosing the home. Each service user has an assessment of needs carried out by the provider prior to an offer of placement being made. Good observations were made of staff’s approaches and attitudes to service users and to the appropriateness of their delivery of care. EVIDENCE: The home has a written ‘Statement of Purpose and a ‘Service User Guide’ and both documents were available to prospective and current service users and their relatives. Service users and relatives spoken to confirmed that they were encouraged to visit the home prior to admission. There was evidence in the care plans scrutinised that a pre-admission assessment of needs of the service users were carried out either in their homes or places of residence. Foxholes Nursing Home I52 s19352 foxholes v248011 070905 stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7-11 Service users observed appeared to be well cared for, were comfortable and received care and attention in a timely manner. Good care practices and interactions were observed. Feedback from service users was generally positive. They said they were well cared for and were happy with the service provision. Care plans were comprehensive and reviewed regularly to reflect the changing needs for health, personal and social care needs of the service users. However, a separate weight records for each individual should be kept as part of their care plans to ensure that confidentiality is maintained. Records of medicines including the receipt, storage and disposal were kept in good order. EVIDENCE: Care plans inspected had all the information required by this Standard including assessment of needs, risk assessments except for manual handling and how the needs of the service users were being met. The care plans were reviewed regularly but should be signed by the service users or their relatives. At the time of the inspection there was no service users who had pressure sore. Each service user has a nutritional assessment carried out on admission, which was reviewed, if needed, based upon monthly weight gain or loss. Foxholes Nursing Home I52 s19352 foxholes v248011 070905 stage 4.doc Version 1.40 Page 10 However, a separate weight records for each individual should be kept as part of their care plans to ensure that confidentiality is maintained rather than the present weight book used for all service users. All service users are registered with a GP, who refers service users to all other health care agencies as and when required. Records of medicines including the receipt, storage and disposal were kept in good order but there were gaps in the MAR sheets with no explanation. All service users were appropriately dressed and were correctly addressed by staff. A “knock and wait” policy is in place when entering service users’ bedrooms, toilets and bathrooms. Staff members on duty were observed to deliver care and to attend to service users’ needs in a manner that is conducive to respect for their privacy, dignity, choice and wishes whilst actively promoting independence where possible. All personal and intimate care practices are carried out behind closed doors. Doctors also see service users in the privacy of their own rooms. A policy and procedures were in place for care of the dying. Staff members spoken to were aware of the needs of this particular service user and the action they should take in similar situation. Involvement of the family and friends were noted to be actively encouraged once a service user has been identified as a terminally ill. Feedback from service users was generally positive except for one service user who had experienced slight disturbance at night when she was trying to sleep. This was reported to the manager who had reassured the service user that she will look into this concern and bring to the attention of the night manager Foxholes Nursing Home I52 s19352 foxholes v248011 070905 stage 4.doc Version 1.40 Page 11 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) 12-15 Autonomy and choice is promoted within the home. Visitors are welcomed and the manager promotes integration with the local community in accordance with service users preferences. EVIDENCE: An activity co-ordinator is employed within the home, she organises a variety of activities and entertainment. Service users spoken said that there were always lots of activities provided for them and these include art and crafts, chair exercises, bingo, quizzes, reminiscence afternoons, sewing and trips outside of the home. Holy Communion is held weekly and representatives of the local Baptist church also visit the home on the second Wednesday of each month. Service users manage their own financial affairs with the help of their relatives. Personal belongings were evident in service users bedrooms. Confidential and private information was locked away and care plans were securely stored in an office. The lunch was unhurried with assistance and encouragement given by staff sitting down next to service users. Service users spoken to were complimentary of the food provided. Foxholes Nursing Home I52 s19352 foxholes v248011 070905 stage 4.doc Version 1.40 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16-18 A complaints procedure is in place of which all service users spoken to were aware. The manager has a presence within the home thus safeguarding service users. EVIDENCE: A copy of the complaints procedure was available to prospective and current service users. Those spoken to said that they were aware of the complaints procedure but would prefer to speak to a member of staff or the manager if they had any concerns. No complaints had been received since the last inspection except on the day of the inspection, one of the service users raised concerns about the level of noise made by staff during the night. This was reported to the manager by the service user in the presence of the inspector. The manager had reassured the service user that she will look into her concern by talking to the night manager and will monitor this situation. Staff confirmed they had received training on adult abuse and were aware of the ‘Whistle Blowing Policy’. Foxholes Nursing Home I52 s19352 foxholes v248011 070905 stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19-26 The home and its surroundings offer a pleasant, comfortable and safe environment to its service users. The home was kept clean and well maintained and bedrooms are personalised offering a homely, lived in feel. However, the floorings in the kitchen area were old and badly stained and must be replaced. The large hole in the bathroom wall must be repaired. EVIDENCE: The redecorating programme has started and it was noted that some of the bedrooms were freshly done. The bedrooms that were inspected were clean and contained service user’s personal furniture and belongings. Adjustable beds and pressure-relieving aids were provided for service users following an assessment of need carried out by the nursing staff. The floorings in the storerooms in the kitchen area were old, dirty, badly stained and must be replaced. The large hole in the bathroom wall must be repaired. Staff spoken to were aware of infection control and it was noted that alcohol gel was provided in bedrooms and sluice rooms. Foxholes Nursing Home I52 s19352 foxholes v248011 070905 stage 4.doc Version 1.40 Page 14 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) 27-30 The skills and experience of staff was varied. There was an enthusiastic, dedicated and caring staff team who took great pride in the service provision. However, it was required that the Pin number for registered nurses must be checked with NMC to ensure that it is valid. EVIDENCE: There was adequate numbers of care staff rostered on duty per shift during the day and night. Service users were complimentary about the staff and management of the home. Stating ‘ the carers are good, they look after us and are very kind’. Staff files were inspected and found to have all the required documents including the references, CRB and POVA checks. However, it was noted that the Pin number of a registered nurse was not up to date. Staff spoken to confirmed that they have received appropriate training, this included NVQ, moving and handling, food hygiene, first aid, dementia, adult abuse and other mandatory training. Foxholes Nursing Home I52 s19352 foxholes v248011 070905 stage 4.doc Version 1.40 Page 15 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) 31-38 The home is well managed and is achieving its aims and objectives. The manager and staff who have direct involvement, appear to be dedicated to providing a good quality service. The Registered Provider must visit the home at least once a month and prepare a written report and supply a copy to the Commission. EVIDENCE: The manager has an open-door policy where staff could see her at any time with any issues or concerns they may have. Pride and dedication is taken in every aspect. Service users have commented positively on the good practices and quality of service provision. All statutory records were available for inspection and maintained in accordance with legislation. Records inspected were up-to-date and accurate and were held securely. Staff spoken to were aware that service users can access their records and information held about them in accordance with the Data Protection Act 1998. Foxholes Nursing Home I52 s19352 foxholes v248011 070905 stage 4.doc Version 1.40 Page 16 Policies and procedures are in place to ensure that the health, safety and welfare of service users and staff are promoted and protected. These records are accessible to all staff. All accidents and injuries are recorded in the accident book and RIDDOR forms have been completed where applicable. The CSCI has been kept informed of all accidents and admissions to hospital. Regular checks on hot water temperatures and moving and handling equipment are recorded. A valid insurance certificate was displayed in the reception area and this offered cover of no less than £5 million. The Commission has not been receiving the Regulation 26, Registered Provider’s written report following the monthly visit. Foxholes Nursing Home I52 s19352 foxholes v248011 070905 stage 4.doc Version 1.40 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 CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 1 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 3 3 3 3 3 2 3 Foxholes Nursing Home I52 s19352 foxholes v248011 070905 stage 4.doc Version 1.40 Page 18 yes 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 OP 19 Regulation 23 (2) (d) Requirement All parts of the home must be kept clean and reasonably decorated including the kitchen (This remains outstanding from the last inspection) The large hole on the ground floor bathroom wall must be repaired. Pin number for registered nurses must be checked to ensure that it is valid. The Registered Provider must visit the home at least once a month and prepare a written report and supply a copy to the Commission. Timescale for action 28/10/05 2. 3. 4. OP 19 OP 29 OP 37 23 (2) (b) 19 (1) (b) (i) 26 (3) & (5) (a) 28/10/05 28/10/05 21/10/05 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 OP 8 Good Practice Recommendations A separate weight records should be kept for individuals as part of their care plans and not in the homes weighing book for all service user. Foxholes Nursing Home I52 s19352 foxholes v248011 070905 stage 4.doc Version 1.40 Page 19 Commission for Social Care Inspection Mercury House 1 Broadwater Road Welwyn Garden City AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Foxholes Nursing Home I52 s19352 foxholes v248011 070905 stage 4.doc Version 1.40 Page 20 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!