CARE HOMES FOR OLDER PEOPLE
Foxmead Horsham Road South Holmwood Dorking Surrey. RH5 4JX Lead Inspector
Miss Marianne Barham Announced Inspection 29 September 2005 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. Foxmead H58 H09 s13645 Foxmead v239356 190905 Stage 4 ann.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Foxmead Address Horsham Road, South Holmwood, Dorking, Surrey. RH5 4JX 01306 888053 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) Mrs Evelyn Ramdass Mrs Aisah Talip CRH (PC) 14 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (MD(E)) 14. of places Dementia - over 65 years of age (DE(E)) 14. Foxmead H58 H09 s13645 Foxmead v239356 190905 Stage 4 ann.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The age/age range of the persons to be accommodated will be: Over 65 years of age. Date of last inspection 08 April 2005 Brief Description of the Service: Foxmead is a Victorian property situated four miles south of the town of Dorking. It overlooks a church, and used to be the vicarage. The home provides accommodation and care for up to fourteen older people who have a past or present mental illness and/or dementia. The home has been extended and has ten single and two double bedrooms on the ground and first floor. None of the bedrooms are en-suite, however, all have a washbasin and toilet and bathing facilities are located close to all bedrooms. The first floor can be reached by the main staircase which has a chair lift fitted, however there is a break in the chair lift track on the landing between the ground and first floor. There is no shaft lift fitted. There are two large lounges and a dining room which overlook the garden. The garden is large and well maintained and has wheelchair access via a ramp. There is ample parking to the front of the property and a regular bus service to Dorking which stops outside the home. Foxmead H58 H09 s13645 Foxmead v239356 190905 Stage 4 ann.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an announced inspection carried out at 10.30 am by Marianne Barham, lead inspector for the service. The inspection was carried out over a period of five hours and was the second inspection in the commission for Social Care Inspection (CSCI) year April 2005 to March 2006. The registered manager, Mrs Aisah Talip was present, and a total of four service users, five visiting relatives, two visiting healthcare professionals and the local vicar were spoken with during this inspection. Records relating to the care of service users and management of the home were also examined during this inspection. Several comment cards were received from relatives, service users and their GP prior to this inspection. All were complimentary about the care and services provided at the home. What the service does well: What has improved since the last inspection?
All service users now have a written contract with the home that states the terms and conditions of residence and the fees charged. This meets a requirement made at the last inspection on 8th April 2005.
Foxmead H58 H09 s13645 Foxmead v239356 190905 Stage 4 ann.doc Version 1.40 Page 6 All service users have an individual care plan that is designed to meet their assessed needs. These plans are detailed and reviewed monthly by the manager. Service users and their families are involved in planning their care. This meets a requirement made at the last inspection. All handwritten entries on the medication charts are now signed and dated, and shows which GP prescribed the medication. This meets a requirement made at the last inspection. The home has introduced a full programme of activities for service users. This is reviewed monthly with service users preferences being asked. Service users spoken with said that they enjoyed the activities. Visiting health professionals said that activities take place every day, morning and afternoon. This meets a requirement made at the last inspection. The home has reviewed the menus to make sure that they provide a balanced diet to service users, meeting a requirement made at the last inspection. The home has also employed a cook/housekeeper so that care staff can spend more time with the service users. Service users spoken with said the food was nice and they could choose what they ate. A number of requirements concerning the general upkeep and safety of the home were made at the last inspection. These have all been met or are in the process of being met. Please see environment section (standards 19-26) for details of how these requirements have been met. The home has reviewed staffing levels and has increased the number of staff on duty during the day, giving care staff more time to spend with each service user and better meet their needs. This meets a requirement made at the last inspection. All care staff working at the home have either completed NVQ training or are undertaking it, meeting a requirement made at the last inspection. 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.
Foxmead H58 H09 s13645 Foxmead v239356 190905 Stage 4 ann.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 Foxmead H58 H09 s13645 Foxmead v239356 190905 Stage 4 ann.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) 2 and 4 Each service user has a written contract with the home and they, and their representatives can be sure that the home can meet their needs. EVIDENCE: All service users have a written contract with the home that states the terms and conditions of residence and the fees charged. The contracts are in line with the guidance from the Office of Fair Trading and meet a requirement made at the last inspection on 8th April 2005. Each service user has a comprehensive assessment in place that covers all aspects of the individual’s care and social needs. These assessments are reviewed monthly with detailed records kept of any changes. This meets a requirement made at the last inspection. Foxmead H58 H09 s13645 Foxmead v239356 190905 Stage 4 ann.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 and 9 Service users’ health, personal and social care needs are set out in and individual plan of care and they are protected by the homes’ policy and procedures for dealing with medicines. EVIDENCE: Each service user has a detailed care plan, generated from their assessment. These care plans are holistic in their approach and give detailed information and instruction to the care staff on how to best meet the service user’s needs. The care plans are reviewed monthly by, the manager and detailed records are kept of any changes made. The care plans are signed by, the service user or a representative and formal review meetings are held annually with the service user, care manager (if funded by local authority), relative/representative and other involved professionals as necessary. The care plans meet a requirement made at the last inspection 8th April 2005. Members of staff receive training on the administration of medication from Boots, and this was also documented in the medication records. The home has a comprehensive medication policy in place and records are accurately maintained. The medication is stored appropriately and there are good
Foxmead H58 H09 s13645 Foxmead v239356 190905 Stage 4 ann.doc Version 1.40 Page 10 systems in place for the receipt and disposal of medication. All handwritten entries are now signed and dated, meeting a requirement made at the last inspection. Foxmead H58 H09 s13645 Foxmead v239356 190905 Stage 4 ann.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, 13, 14 and 15. Service users experience a good range of activities, both in and out of the home, they are supported to maintain contact with their family and friends and to exercise choice and control over their lives. Service users receive a balanced, nutritious diet that takes into account their individual needs and preferences. EVIDENCE: The home now has a full programme of activities in place that is updated monthly. This meets a requirement made at the last inspection on 8th April 2005. Service users can have visitors at any time, without an appointment and they may receive visitors in their own rooms or in the communal areas. Visitors spoken with during this inspection confirmed this and all said they were made to feel welcome by the home. A requirement was made at the last inspection that the produce written records detailing the reasons for restricting a named service user’s cigarettes. Having read this record and the accompanying risk assessment it is apparent that the wording of the record has led to confusion as there is no restriction
Foxmead H58 H09 s13645 Foxmead v239356 190905 Stage 4 ann.doc Version 1.40 Page 12 made on how many cigarettes the service user has, however a reference is made that the service user prefers to smoke three cigarettes a day. The initial requirement has been met, but a recommendation has been made to review the wording on the risk assessment so that it is clear that there is no restriction on the amount of cigarettes the service user has. A requirement was made at the last inspection that the menus be reviewed to ensure a varied and balanced diet was provided to the service users. This has now been done. Service users and their relatives spoken with said that the food is good and that they could choose what to eat. The home has employed a house keeper/chef, which has improved the quality of the meals and allows the care staff more time to spend with service users. Members of staff were observed to support service users during meals in a caring and sensitive manner and the food provided appeared appetising and well cooked. Foxmead H58 H09 s13645 Foxmead v239356 190905 Stage 4 ann.doc Version 1.40 Page 13 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 and 18 Service users and their representatives can be sure that their complaints will be listened to and acted upon, and that they are protected from abuse. EVIDENCE: A requirement was made at the last inspection that a record is kept of all complaints received and actions taken to resolve them. This requirement has been met. A complaints book has been introduced to the home, with no complaints having been made since the last inspection. The home has a ‘whistle blowing’ policy in place and follows the Surrey MultiAgency procedures on the protection of vulnerable adults. The manager has attended the Surrey training on adult abuse and all other staff members have received training in house by an external trainer. Refresher training is booked for 4th October 2005. Members of staff are made aware of the adult protection procedures and whistle blowing policy at induction and through supervision, however there is no record to support this. A recommendation has been made that staff members sign to show that they have read the policies and procedures in the home. Foxmead H58 H09 s13645 Foxmead v239356 190905 Stage 4 ann.doc Version 1.40 Page 14 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, 21, 24, 25 and 26 Service users live in a safe, well-maintained home, which is clean, pleasant and hygienic. Service users rooms are comfortable and they have their own possessions around them. EVIDENCE: The home is clean and tidy with no unpleasant odour. Visiting relatives spoken with during this inspection commented positively on the cleanliness of the home and the fact that it always smells fresh and clean. A number of requirements were made at the last inspection concerning the environment of the home, all of which have been met or are in the process of being met. The home has implemented and ongoing programme of redecoration and refurbishment of the home, with several areas already having been redecorated. Foxmead H58 H09 s13645 Foxmead v239356 190905 Stage 4 ann.doc Version 1.40 Page 15 All trip hazards have now been removed from the hallways and walkways in the home. The manager has obtained quotes for the refurbishment of both bathrooms following re-assessment of the bathing needs of the service users. It is proposed to begin works within the next six months. The home now has a programme of routine maintenance and renewal in place and records are kept of all servicing and repairs undertaken in the home. There is adequate bedding available for al service users and the tumble dryer has been replaced. Radiator covers have been fitted to nearly all radiators in communal areas, with the remainder awaiting delivery of the covers prior to fitting. Foxmead H58 H09 s13645 Foxmead v239356 190905 Stage 4 ann.doc Version 1.40 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 and 29. The service users’ needs are met by, the numbers and skill mix of the staff team, and they are in safe hands and are supported and protected by the homes recruitment policy and practices. EVIDENCE: A requirement was made at the last inspection on 8th April 2005 that the staffing numbers in the home must be reviewed to ensure there are sufficient numbers on duty to meet the needs of the service users. This has been done. Staff duty rotas were examined. These showed that there is three staff on duty during the day as well as the cook/housekeeper. The manager works a 95 shift Monday to Friday and the owner who is also a registered nurse is currently living on site and also carries out care duties. Any shortfall in staffing numbers is met through the use of regular agency staff. The manager has nearly completed the NVQ level 4 in care qualification and three members of staff are working towards NVQ level 3 and a further three are working towards NVQ level 2. All staff members are enrolled with The Surrey and Hampshire Borders Trust training department for the NVQ training. This meets a requirement made at the last inspection. Recruitment files were examined for several members of staff. These were found to be in good order with all necessary checks and documentation in place for each member of staff. Foxmead H58 H09 s13645 Foxmead v239356 190905 Stage 4 ann.doc Version 1.40 Page 17 Four members of staff were spoken with during this inspection. All were happy working at the home, said they receive supervision from the manager and felt that the training and support provided was good. Foxmead H58 H09 s13645 Foxmead v239356 190905 Stage 4 ann.doc Version 1.40 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 and 35 The home is run in the best interests of the service users and their financial interests are safeguarded. EVIDENCE: The home sends out questionnaires to service users and their relatives every three months to obtain feedback on the service provided. A number of these questionnaires, completed by relatives were viewed and seen to be complimentary about the care and services provided at the home. Responses from the questionnaires are collated and a report is made, detailing any actions that need to be taken. Visiting relatives, friends and healthcare professionals spoken with were aware that this inspection was taking place and confirmed that their views are sought by the home. The home is not involved with service users finances at any stage. Any purchases required extra to the fees are invoiced directly to the service user or a representative.
Foxmead H58 H09 s13645 Foxmead v239356 190905 Stage 4 ann.doc Version 1.40 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 x 4 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 x 3 x x 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x 3 x 3 x x x Foxmead H58 H09 s13645 Foxmead v239356 190905 Stage 4 ann.doc Version 1.40 Page 20 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard Regulation Requirement Timescale for action 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 14 Good Practice Recommendations It is recommended that the risk assessment concerning the smoking habit of a named service user, be reviewed to make it clear that there is no restriction on the number of cigarettes the service user may smoke. It is recommended that the registered person introduces a system for staff to sign to show they have read and understood the policy and prodecures for the protection of vulnerable adults. 2. 18 Foxmead H58 H09 s13645 Foxmead v239356 190905 Stage 4 ann.doc Version 1.40 Page 21 Commission for Social Care Inspection The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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