Inspection on 08/04/08 for Foxton Grange

This inspection was carried out on 8th April 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Foxton Grange 19/04/07

Foxton Grange 28/04/06

Foxton Grange 17/11/05

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Foxton Grange 571 Gipsy Lane Leicester Leicestershire LE5 0TA Lead Inspector Keith Charlton Unannounced Inspection 8th April 2008 09:30 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 Foxton Grange DS0000063830.V362099.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. Foxton Grange DS0000063830.V362099.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Foxton Grange Address 571 Gipsy Lane Leicester Leicestershire LE5 0TA 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) 0116 2460616 0116 2766593 linda.gazzard@mha.org.uk home.fxg@mha.org.uk Methodist Homes for the Aged Linda Gazzard Care Home 36 Category(ies) of Dementia - over 65 years of age (36), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (36) Foxton Grange DS0000063830.V362099.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. By agreement one named service user under the age of 65 years can be accommodated within Foxton Grange Nursing and Residential Care Home as detailed in application V25523. By agreement one named service user under the age of 65 years can be accommodated within Foxton Grange Nursing and Residential Care Home as detailed in application V32612. By agreement one named service user under the age of 65 years can be accommodated within Foxton Grange Nursing and Residential Care Home as detailed in application V38468. No person to be admitted into Foxton Grange in categories DE, DE(E) or MD(E) when 36 persons in total of these categories/combined categories are already accommodated in Foxton Grange Nursing and Residential Care Home. The maximum number of persons to be accommodated within Foxton Grange Nursing and Residential Care Home is 36. 19th April 2007 5. Date of last inspection Brief Description of the Service: Foxton Grange Nursing and Residential Home is a care home offering accommodation for up to thirty-six older people. The home is registered to accommodate older people with dementia and/or mental disorder. The home is divided into two separate units individually named. The home is located approximately fifteen minutes away from the centre of Leicester if travelling by car. Bus services are available near to the home. The home can be easily found just off the outer ring road. The building itself is purpose built and situated in a quiet area. There is parking available at the front of the building. All accommodation is provided on the ground floor level. All areas of the home are accessible to people who use wheelchairs. The home has a secure garden area for residents to walk. The home’s fees range from £597.00 to £690.00 per week. The Registration Certificate from the Commission of Social Care Inspection (CSCI) was displayed in the hallway. Foxton Grange DS0000063830.V362099.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The focus of the inspections undertaken by the Commission for Social Care Inspection is upon outcomes for residents and their views of the service provided… The primary method of inspection used was ‘case tracking’ which involved selecting three residents and tracking the care they received through looking at their records, discussion, where possible, with them and care staff and observation of care practices. This was an unannounced Inspection. The Registered Manager was on duty. Planning for the Inspection included reading the notifications of significant events sent to the Commission for Social Care Inspection, the Annual Quality Assurance Assessment which the service sent in and which contains information as to how the home is run, and the last Inspection Report. There have been a number of complaints made to the Commission for Social Care Inspection since the last inspection. Two were currently being investigated by the service regarding the alleged lack of care to residents. The Inspection took place between 9.30am and 5.20pm and included a selected tour of the home, inspection of records and direct and indirect observation of care practices. The Inspector spoke with one resident as communication was very limited owing to the difficulty with communicating with residents with a high level of mental frailty, four staff members, and one visitor. Seven surveys have been received from relatives as residents are unable to complete them – comments are included in relevant sections of this Inspection Report. What the service does well: It was observed that that staff were mostly friendly and helpful towards residents, the visitor said reported that staff welcome visitors and that she thought the food provided to residents was good. Care Plans contain the past life history of residents which helps staff see residents as people with a valued past and assists in talking with them. Foxton Grange DS0000063830.V362099.R01.S.doc Version 5.2 Page 6 Staff training is encouraged by the Registered Manager in order to equip staff to meet residents needs. The Registered Manager has a positive attitude in seeking to improve the care standards in the service and was receptive to ideas as how to improve the service for service users. Facilities have been improved as the wholescale refurbishment of the home was nearing its end on the day of the inspection. What has improved since the last inspection? What they could do better: To improve the quality of life and welfare needs of residents there are a number of things that need to be introduced - staff always need to encourage and prompt in a low key manner rather than being too directive at times, Care Plans need to have full details of medical checks so that the proper care is always given, and staff need to be aware of all the Care Plans. Residents needs were not always well covered regarding medical authorities being involved where necessary following an accident. Providing memory boards to lounges may assist residents with dementia. There needs to be more activities as currently there is no current input from an Activities Organiser. There needs to be an analysis of why there appears to be a high number of complaints received regarding the service. Staffing levels need to be reviewed as the Annual Quality Assurance Assessment stated that all residents need the assistance of two staff and there is not always essential supervision by staff in lounges where some residents have challenging behaviour, which then does not provide proper protection for residents and staff. Foxton Grange DS0000063830.V362099.R01.S.doc Version 5.2 Page 7 Staff always need to carry out medication procedures promptly, have full training on all essential care issues, and have a full understanding of the Vulnerable Adults procedure. Staff need to use proper Moving and Handling procedures to ensure safe practice for residents. 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. Foxton Grange DS0000063830.V362099.R01.S.doc Version 5.2 Page 8 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 Foxton Grange DS0000063830.V362099.R01.S.doc Version 5.2 Page 9 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. The admission process means that residents get a detailed assessment, thereby ensuring that their main health and welfare needs are being met. EVIDENCE: The Annual Quality Assurance Assessment stated that the first eight weeks after admission is regarded as a trial period to ensure that the services are fully adequate and satisfactory to all parties concerned. An assessment was inspected and whilst it contained good detail of relevant information as to residents needs it did not include all aspects of medical checks – dental, optical, hearing etc as per the National Minimum Standard. The Registered Manager said the form would be reviewed to cover all care issues in the future. Foxton Grange DS0000063830.V362099.R01.S.doc Version 5.2 Page 10 However, comments from a relative in a survey said that she did not receive enough information about the home before she moved in. Management need to review this issue. The home does not offer intermediate treatment facilities. Foxton Grange DS0000063830.V362099.R01.S.doc Version 5.2 Page 11 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 adequate. This judgement has been made using available evidence including a visit to this service. Residents are not always well looked after regarding their personal care, or health. EVIDENCE: Residents care plans were inspected and included records of their care needs. There was written evidence that residents /their representatives were given the choice to be involved in the setting up and reviewing of the Care Plan. Care Plans contain the past life history of residents. This helps staff see residents as people with a valued past and assists in talking with them. However staff said they had not read all the Care Plans so could not have been aware of all the care needs of residents. It does not help that Care Plans are long forms. The Registered Manager was asked if a summary of plans could be introduced so that there can be easy reference to them as needed by staff. Foxton Grange DS0000063830.V362099.R01.S.doc Version 5.2 Page 12 Risk assessments were found to be a part of the plans so that staff know how to keep residents safe. Care Plans did not clearly set out medical checks as it did not include all aspects of medical checks – dental, optical, hearing etc or whether the residents needed a chiropodist, and there was no information regarding daily living wishes. There was little information regarding the cultural needs of residents, e.g. if a resident wanted a fuller kosher/Afro Caribbean diet, whether a resident wanted to go to a synagogue or see a rabbi in the home etc though there was good information regarding death and mourning practices for one resident. Daily care recording was in place though the system looks lengthy, as staff have to complete a large number of sections. It would save time if this were carried out by date rather than subject, as it would only need one entry. It was also noted in a meeting that staff took a long time to do the notes – this detracts from staff being away from residents. There was clear writing for some records but also some that were illegible. This needs to be changed. The inspector observed Moving and Handling practices whereby a resident appeared to being inappropriately lifted, and because a handling belt was not available it took over five minutes to assist the resident who had to be left on the floor. The Registered Manager said that she would follow this up with staff and organise refresher training if needed and review Care Plans to see if hoisting was needed in some cases. There was comment made to the inspector that there are not enough pressure cushion or working wheelchairs with footplates. The Registered Manager doubted this was the case but said it would be followed up. She later reported that there are pressure cushions available but one resident shreds them if she finds one. Accident records were viewed which showed that medical services were not always contacted if there had been injuries, e.g. a head injury to a resident. The Registered Manager said this procedure would be changed so that this is done in the future. She later commented that now even minor bumps will be discussed with Medical Services. The inspector observed that in general staff were friendly and gave residents choices – e.g. to walk or use a wheelchair, what they wanted for breakfast etc, and explained what they were going to do before doing it so as not to alarm the resident, so were explaining and encouraging in a friendly manner at the residents pace. Comments from a relative in a survey said that staff ‘’..are wonderful, very caring and pleasant’’ though another one said, ‘’staff’ don’t always take notice of what you say.’’ Foxton Grange DS0000063830.V362099.R01.S.doc Version 5.2 Page 13 There were also instances where staff members were too directive in trying to get residents to do things, rather than explaining and encouraging in a respectful way. The Registered Manager said she would take this up further. One relative stated ‘’There is room for improvement on effectiveness of nursing and attitude’’. The visitor the inspector spoke with said she thought the staff were caring and friendly and did a good job. The Deputy Manager confirmed that only senior staff issue medication and had recently undertaken medication training. The Registered Manager confirmed this and supplied medication training records which showed that this had happened. Some gaps in medication record sheets were noted. The Registered Manager said she would take this matter further with staff and set up a system so that the next staff member doing medication checks and takes forward the issue if there is a gap for the previous medication round. 10.00am medication was still being given out to residents at 11.40am – an indication that staff had a lot to do. The Registered Manager must ensure medication is supplied in a timely manner. Foxton Grange DS0000063830.V362099.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents do not always have the opportunity to lead full and active lifestyle though can exercise choice. The food supply needs to be reviewed to give more choice and be based on residents known food preferences. EVIDENCE: Comments from a relative in a survey said that there were ‘’sometimes’’ activities that her mother could take part in. Another said, ‘’There needs to be a therapy coordinator and an activity coordinator. Funding must be found. There needs to be much more stimulating activity for patients. Where are the volunteers. There should be trips out occasionally’’. Staff said that they tried to do activities when they had time. Though the inspector did not see residents having any activities it was later reported that staff had done hand massage and sat down to talk to residents when they had time. Foxton Grange DS0000063830.V362099.R01.S.doc Version 5.2 Page 15 Hobbies were recorded in Care Plans but then there was no evidence they had been followed up – e.g./. how often a resident wanted to be taken for walks, that arrangements were in place to provide music (there was no music on in lounges even though two residents case tracked liked music). Currently there is no Activities Organiser so that activities have reduced though the Registered Manager pointed out that staff are designated on a daily basis to coordinate activities. This needs to be tackled and the Registered Manager was asked to set up an Activities Programme, as it has been emphasised in the Annual Quality Assurance Assessment. It is also recommended that a staff member receive specific training so as to be able to plan to provide relevant activities for residents with dementia. The Registered Manager said that individual memory boxes are to be set up to help residents with reminiscence – this will offer a good stimulating activity to residents. The relative spoken to said she was able to bring in an alcoholic drink for her husband to enjoy before his lunch as he always had this when he was at home. This is a good example of respecting residents lifestyles. The Registered Manager said there are relatives meetings though they occurred about every year. The Registered Manager was recommended to increase the frequency of these to increase relevant input to increase the quality of life for residents. A relative stated that visitors are always welcomed to the home by staff and there were no restrictions. Staff said that there were no rules for residents – they said they could rise and retire when they wanted and if they did not want a shower then this would be worked round so they did not have to have one at that time. The resident and visitor thought that the standard of food was good though comments from a relative in a survey said ‘’sometimes meat and vegetables are too chunky and hard’’, and another said ‘’Mum finds some of the food too spicy and she has no teeth so soft foods are best’’. There were some comments that the food could be more traditional so that there were more stews, casseroles and home made soup on the menu. The residents who were ‘case tracked’ did not have sufficient information indicating how their food preferences are to be met regarding meals for their culture being provided. Menus were inspected and found to have choice for the main meal though only a choice of one desert which needs extending to provided more variety (the Registered Manager said that a second option is available on request), and also Foxton Grange DS0000063830.V362099.R01.S.doc Version 5.2 Page 16 having a choice of cooked breakfast on the menu seven days a week instead of the current one day a week. It was recommended that the cook has residents food preferences is displayed in the kitchen area to act as a reminder as to what foods individual residents like. Food records need to be more detailed to include the vegetables and sandwiches served so this variety can be monitored. It is recommended that the cook attend relatives meetings to receive direct feedback from relatives and answer any questions. The inspector tasted the food. It was broadly satisfactory though the beefburger alternative was a basic processed food. Foxton Grange DS0000063830.V362099.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Arrangements for receiving and responding to complaints are in place though the Complaints Procedure needs to be altered to make it easier to make a complaint, and refresher staff training on the Adult Protection procedure is needed to result in the full protection for residents. EVIDENCE: The relative spoken with thought that if there was a problem then the Management would sort it out. In a survey a relative stated, ‘’There needs to be efficiency so issues can be resolved and concerns and worries acted upon’’. A Complaints Book is kept. There have been a number of complaints in the past year. An analysis of why this is so needs to happen. If there are complaints in the future these need to be reported to the Commission for Social Care Inspection if it affects residents welfare. There was evidence of detailed investigations of complaints on file. The Complaints Procedure is generally satisfactory but does not give the complainant the opportunity to go to the lead Agency, the local Social Service Department, as per the National Minimum Standard. It also states that all Foxton Grange DS0000063830.V362099.R01.S.doc Version 5.2 Page 18 complaints need to be made to the home first – the National Minimum Standard states complainants can choose to go to the lead agency first. The Registered Manager said these issues would be followed up. Care staff spoken with were not fully aware of the procedure regarding of which Agencies to contact if the in house arrangement failed. The Registered Manager said these issues would be followed up and a short procedural statement drawn up and displayed to help staff to follow the correct procedure. Foxton Grange DS0000063830.V362099.R01.S.doc Version 5.2 Page 19 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 good. This judgement has been made using available evidence including a visit to this service. Facilities are comfortable and are currently undergoing improvement. Odour control is generally good. EVIDENCE: The visitor said she was satisfied with the current refurbishment work. The Registered Manager said that residents bedrooms were due to be personalised again following this work, with personal items of residents furniture, pictures, photographs etc as chosen by the residents to be replaced. The secure courtyard garden area looked attractive and user friendly. . Foxton Grange DS0000063830.V362099.R01.S.doc Version 5.2 Page 20 Comments from a relative in a survey said that a bathroom has been taken out, there are slippery floors in the dining areas, the new chairs are hard and they have wooden arms which are not comfortable for residents and if they fall to the side then they ‘’hang over the side for a long time’’. These issues need to be tackled by management. There is signing to the environment to assist with residents with dementia, e.g. same colour doors for bathrooms etc to make them more recognisable. There were two bathrooms without functioning locks. The Registered Manager said these would be followed up. There were some radiators without the protection of having covers on them. The Registered Manager said that they were temperature regulated so there were not hot surfaces. Odour control was of a good standard though one relative in a survey stated that although the home was fresh and clean this was not the case in her relative’s room – ‘’ the last three weeks the room smells’’ ‘something other than carpet needs to be laid and his slippers are always missing’. The Registered Manager was asked to look at covering all times of the day for domestic assistance as currently this in only covered until lunch time. This will help with care staff not being called upon to carry out domestic duties so they can concentrate on residents needs. Foxton Grange DS0000063830.V362099.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels need to be reviewed to ensure they fully meet residents needs. Recruitment procedures are in place to properly protect residents welfare. Staff training systems are in place to plan to equip staff to meet residents needs though more training needs now to be carried out. EVIDENCE: The staffing rota demonstrated that usually there is four care staff on duty in each wing with a qualified nurse from 8am to 8pm then three night care workers and a qualified nurse at night. One wing was a staff member short on the day of the inspection due to sickness. The Registered Manager said that they try to replace staff who cannot work but this is sometimes not possible. Agency use needs to be reviewed so that it can be ascertained who can quickly respond to fill gaps. Comments have been received that there were not enough staff to cover residents needs and ensure they can deal with the challenging behaviour presented. A relative stated in a survey, ‘’There is undoubtedly not enough support for patients and care staff’’. Foxton Grange DS0000063830.V362099.R01.S.doc Version 5.2 Page 22 There were instances where the inspector noted that there were not enough staff on duty - that lounges where residents were did not have any staff with them at times, the morning medication round was late, and residents had to wait for their lunch as they needed the assistance of staff who were busy with other residents. Staffing needs to be reviewed and increased as needed to ensure that residents are properly protected and their needs are met. This is especially important, as the Annual Quality Assurance Assessment stated that all residents needs the assistance of two staff for personal care and there are a number of residents with challenging behaviour, which demonstrates the need for ongoing supervision. The Registered Manager has since pointed out that staff are sought if there are shortages and generally there is a high staff ratio. However if this staffing ratio does not meet residents needs it needs to be increased. Staff said there had been training in the last twelve months. Records seen by the inspector showed this. There was also evidence of induction training for new staff. The Registered Manager was asked to follow up whether the recognised Skills for Care induction pack was being used. The Registered Manager has devised a Training Matrix to identify key issues that staff need training which quickly shows who needs training in relevant issues. There were a number of staff without training in important areas – e.g. first aid, challenging behaviour, accident reporting, health and safety, dementia (which the Registered Manager said was currently happening though there this was not shown on the Training Matrix), and specific training on residents conditions – stroke care, diabetes, parkinsons disease etc, is also needed. Staff said they were encouraged to undertake National Vocational Qualification level training and the Annual Quality Assurance Assessment stated that the National Minimum Standard regarding of 50 of care staff with National Vocational Qualification level 2 will be met when staff currently undertaking the training complete it. Recruitment records were inspected with Criminal Records Bureau /Protection of Vulnerable Adults checks in place, and written references in place. There was no reference from one staff member’s previous employer, which is strongly recommended so as to have a more up to date check of competency etc. Foxton Grange DS0000063830.V362099.R01.S.doc Version 5.2 Page 23 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. Management systems are largely in place though fire systems do not fully protect the health and safety of residents. EVIDENCE: The visitor spoken with thought the home was well run. The Registered Manager has a National Vocational Qualification level 4 and is a Registered Nurse. Foxton Grange DS0000063830.V362099.R01.S.doc Version 5.2 Page 24 Comments from a relative in a survey said that care staff are available when needed, but ‘’management not so good.’’ This needs to be reviewed by management to see if there is any substance to this comment. The inspector observed that the staff room was open with no one in when there were residents records on open display. This compromises confidentiality. The Registered Manager said this issue would be put in tackled with staff. There was evidence on records that staff are regularly supervised and supported. Staff Meetings have been held and were well recorded though these were not frequent for care staff. The Registered Manager agreed to follow up the need to have more meetings, which will provide more support for staff and ensure practice issues are regularly discussed. There were some comments that staff are not always listened to – e.g. when it has been pointed out there is a shortage of pressure relieving cushions. There is a Health and Safety folder with Risk Assessments for safe working practices so residents are properly protected from any potential dangers in the home. A Quality Assurance system manual was in place and the Registered Manager said surveys had been carried out for 2007, though completed forms were not available. The Registered Manager said that forms had been supplied to relatives though not other interested parties - e.g. GPs, Social Workers, District Nurses etc. The Registered Manager said she would follow this up. Residents monies records were found to be properly kept with running balances, and though two signatures had not often been recorded to show that transactions are witnessed. The Registered Manager said that would be followed up. Fire Precautions: staff members were asked the fire procedure and they were fully aware of the whole procedure. System testing was on not on the required monthly schedules for emergency lighting as records showed it had not been tested since 15/5/07 – the Registered Manager agreed to follow this up. Weekly fire bell testing records were not available though the Registered Manager later confirmed they had been found. They need to be available to prove testing has been done. Fire drills are carried out on a six monthly basis. The inspector advised the Registered Manager to check with the Fire Officer, as this should normally occur on a three monthly basis. Records did not include the names of staff taking part in drills so it could not be ascertained that the policy of the home, of each staff member having one drill a year, was being followed. Foxton Grange DS0000063830.V362099.R01.S.doc Version 5.2 Page 25 There was also a fire risk assessment on file, which needs to be reviewed as the refurbishment work may have altered risk in different areas of the home. The hot water temperature was checked in a bathroom and found to be 39c, which met the National Minimum Standard of 43c. The Registered Manager said that regular hot water temperature checks are carried out and there are fitted valves to protect residents from hot water. Foxton Grange DS0000063830.V362099.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 1 28 3 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 1 Foxton Grange DS0000063830.V362099.R01.S.doc Version 5.2 Page 27 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 OP8 Regulation 12 Requirement Residents health needs in respect of injuries and Moving and Handling must be met at all times. An Activities Programme based on residents needs should be drawn up and supplied. Staffing levels need to be reviewed and increased as needed to ensure that residents needs are met and there is protection of residents and staff from health and safety concerns and challenging behaviour. Staff training on all relevant issues needs to be supplied. The fire safety systems in the home must protect residents from harm. Timescale for action 08/05/08 2. OP12 16 08/06/08 3. OP23 18 08/06/08 4. 5. OP30 OP38 18 13 08/10/08 08/06/08 Foxton Grange DS0000063830.V362099.R01.S.doc Version 5.2 Page 28 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 OP7 Good Practice Recommendations Care Plans need to be more thorough regarding medical checks and cultural issues and including the daily living wishes of residents. Staff need to read all Care Plans so that appropriate care is always delivered. There should be no medication gaps on records and medication needs to be delivered at prescribed times. That the Registered Provider ensures that residents are always spoken to in a respectful manner by staff. The food supply is in need of review to ensure there is always proper choice, it is based on residents preferences and it is always of good quality. There needs to be a clear Complaints Procedure and an analysis of the high number of Complaints. Staff need to be aware of the full Vulnerable Adults procedure. 2. 3. 4. OP9 OP10 OP15 5. 6. OP16 OP18 Foxton Grange DS0000063830.V362099.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 Foxton Grange DS0000063830.V362099.R01.S.doc Version 5.2 Page 30 - 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. 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