Inspection on 12/08/08 for Freegrove

This inspection was carried out on 12th August 2008.

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

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

Other inspections for this house

Freegrove 01/09/06

Freegrove 05/12/05

Freegrove 09/08/05

Freegrove 12/10/04

Freegrove 21/04/04

Freegrove 14/05/03

Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Freegrove 60 Milford Road Pennington Lymington Hampshire SO41 8DU     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Ian Craig     Date: 1 2 0 8 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Freegrove 60 Milford Road Pennington Lymington Hampshire SO41 8DU 01590 673168 01590 679120 charlotteduffin@btopenworld.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable): Type of registration: Number of places registered: Ms Charlotte Duffin Mrs Angela Andrews care home 17 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: 0 0 Over 65 17 17 Date of last inspection Brief description of the care home Freegrove is set in a residential area close to local amenities on the outskirts of the town of Lymington. It provides residential care for up to 17 elderly residents, some of whom have mild dementia. The home is on ground and first floors and there is a stairlift between these. There are a variety of aids and adaptations to allow residents to move about more independently. Thirteen of the bedrooms are single and two are doubles, although the doubles are only normally used as singles. Four of the single rooms and both double rooms have en suite toilets. There is a communal bathroom and separate toilet on the ground floor and a communal bathroom and separate toilet on the first floor. There is a large garden with several car parking spaces to the front of the property, and a large enclosed garden to the rear. The homes weekly fees range from 415.03 to 600.00 pounds. Care Homes for Older People Page 4 of 26 Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection was unannounced. Discussions took place with the manager, Mrs. Andrews, and the owner, Mrs. Duffin. Two staff were interviewed about their work at the home. Care records were looked at for 4 residents. Three residents were interviewed. Records, document, policies and procedures were also looked at during the visit. Care services are required to complete an Annual Quality Assurance Assessment (AQAA). This was completed by the home and sent to the Commission. Information contained in the AQAA has been used for the purposes of this report. Care Homes for Older People Page 6 of 26 What the care home does well: What has improved since the last inspection? What they could do better: The homes written assessment and care plan process needs to include mental health, behaviour and dementia needs where applicable. The home also needs to involve residents, or their representatives in devising the care plans. Care Homes for Older People Page 7 of 26 A photograph of each resident needs to be held with care records. Two written references need to be obtained prior to staff starting work. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line – 0870 240 7535. Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensures that it accommdates only those whose needs it can meet. Information and the opportunity to look around the home ensures potential residents can make an informed choice about moving in. Evidence: A document called, Philosophy of Care was seen. This includes details of the homes fees, contractual obligations, visiting times, the complaints procedure, the residents rights and how cultural needs will be met. The home also has a Service Users Guide, which gives details of the facilities avialble to the residents. A resident described how his/her son looked around the home on his/her behalf to Care Homes for Older People Page 10 of 26 check that it will meet his/her needs. The home has a process for assessing the needs of those referred for possible admission. Records show that the home completes its assessment of need before the person moves in. The assessment covers communication, mobility, sight, cultural needs and care requirments. Where residents are referred for admission from social services, the home obtains copies of the social services care management assessment and care plan. For one person, the home had comprehensive details from social services as well as multi agency assessment and care plans for those with mental health needs. The homes own pro forma for assessing the needs of those referred for possible admission needs to be expanded to include mental health needs relating to dementia. Contracts are held with residents records. These are signed by the interested parties. Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements are needed so that care plans detail the mental health needs of residents, especially regarding dementia so that staff have guidance on how to deal with these needs. Residents health, medication and personal care needs are met. The home ensures that residents are treated with dignity and their privacy promoted. Evidence: Care records were looked at for 4 residents. Care plans are structured under the following headings: dressing/undressing, washing/bathing/drying, using the toilet, dining/drinking and snack preparation, gross and fine mobility/recreation and leisure. Risk assessments are completed and recorded for any areas where there is a risk to the resident and how staff minimise the risk. Care Homes for Older People Page 12 of 26 The care plan pro forma needs to be expanded to include mental health needs, especially regarding dementia. Care plans do not have sufficient details about the dementia needs of residents and how staff support the person with these needs. For instance, one persons daily records includes details of how staff dealt with an incident involving the persons behaviour. The approach used by staff, or any other agreed intervention, was not recorded in the care plans. This is needed in order that staff have guidance to follow in the future. Suggestion was also made that Life Story Books could be devised and recorded for those with dementia. The home should develop a method for involving residents, and/or their relatives in the recording of their agreement to the care plans There was evidence that the home liaises with health care professionals such as general practitioners when residents physical health and mental health requires medical attention. Running records show appointments for residents with the district nursing service, opticians and other specialist healthcare services. The home has working relationships with a local community mental health team who provide advice and information. This was confirmed from conversations with the staff and manager. Three residents stated that their health and personal care needs are met. Two staff also expressed the view that the residents health and personal care needs are met and described how their work involves liaison with general practitioners and district nursing sevices. Medication procedures were looked at. Staff receive training in medication procedures. This was confirmed from records, the staff and the manager. Medication records and stocks of medication, show that medication is administered as prescribed. Medication is stored apprporiately. Residents described the staff as helpful, kind and patient. One person stated that he/she is able to spend time as he/she wishes and prefers to spend time in his/her room. The homes Service Users Guide refers to the home promoting the cultutal and religious needs of the residents. Each bedroom door has a lock which residents can use for privacy and security. The Service Users Guide states that residents have a lock to their bedroom door which they can and that residents can have their own telephone line. It was noted that several residents have their own telephone in their bedrooms. One resident has a computer which he/she uses. Care Homes for Older People Page 13 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a range of activities and stimulation. The food is of a good quality, nutritious and home made. Evidence: Discussions took place with 3 residents. Each person confirmed that the home provides a variety of activities and stimulation. These include activities provided by an outside agency such as arts, crafts, quizzes and exercise. Two musicians visit on diffrent occassions once a month to entertain the residents with guitar and piano playing. There are occassional outings but one person stated that he/she would like these to take place more often as he/she had only been on one outing in the preceeding 11 months. This was discussed with the owner and the manager. Residents state that they are able to spend their time as they wish. One person prefers to spend time in his/her room where he/she completes his/her own craft items. Care Homes for Older People Page 14 of 26 Religious communion is provided by a visiting preacher one a month. This was confirmed by the manager, the owner and the a resident. The rear garden has been relandscaped. The manager and the owner described how the residents were consulted about this and that the views of the residents were incorporated into the design. The residents confirmed how much they enjoy sitting in the garden. Residents confirmed that visitors, such as family members are always made to feel welcome by the home and are often given a meal. The home has a 4 week menu plan showing a varied, nutritious and balanced diet. There is a choice of food at each meal time and special diets are catered for. This was evidenced from records and discussions with the residents and the manager. Residents described the food as being very good and good home cooking. One person said, The food is the equivalent of a 3 star hotel. The menu plan shows that fresh fruit and vegatables are provided and this was also confirmed by a resident. The midday meal on the day of the visit was: roast turkey, with roast potatoes and vegetables. The dessert was home made apple sponge with custard. The food looked and smelt apetising. Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are provided with a clear and concise complaints procedure. The home has procedures to ensure residents are protected from possible harm. Evidence: The home has a complaints procedure which is provided to the residents in the Service Users Guide. The home has not received any complaints. There is a logbook to record any complaints and how they are dealt with. The home has copies of Department of Health literature on protecting residents from possible abuse as well as a copy of the local authority procedure for dealing with any suspected abuse. Staff confirmed that training is provided in dealing with suspected abuse although it was noted that the 2 staff spoken to should have additional support and training on terminology used by local authorities when dealing with suspected abuse. This was discussed with the manager. Care Homes for Older People Page 16 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes environment is of a very good standard being well maintained, bright, clean and well decorated. Evidence: A tour of the home was undertaken where several residents bedrooms and the communal areas were seen. The home has 15 bedrroms, six of which have an en suite toilet with a wash basin. All bedrooms are singley occupied with the exception of a married couple who share two rooms. Rooms contain numerous personal possessions such as items related to hobbies, arts and crafts, books, furniture and ornaments. The homes Service Users Guide outlines how residents are free to bring their own furniture to the home. Bedrooms are decorated in a variety of colour schemes. Communal lounges and dining areas were seen. Residents were observed using these areas to relax or to watch a wide screen television. Areas of the home have been recarpetted and the home has a maintenance plan. The exterior of the home has lanscaped gardens with shrubs,trees and flower beds. Residents described how they enjoy sitting in the garden during the summer. The front of the home has car parking spaces. Care Homes for Older People Page 17 of 26 There are bathrooms on the ground and first floors both of which have specialist bath facilities. The home was found to be clean and free from any odours. Care Homes for Older People Page 18 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Well trained staff are provided in sufficient numbers to meet residents needs. The homes recruitment procedures do not protect the residents. Evidence: The staffing levels were discussed with the manager, the owner and two of the staff. The home aims to provide at least 3 care staff from 8am to 2pm each day including weekends. From 2pm to 8pm 2 care staff are on duty plus the managers working hours. Observation, the staff rota and discussions with the staff and management show that these staffing levels are being maintained. At night time there are two waking staff on duty. The home does not employ staff for the purposes of only cleaning and cooking. These duties are completed by the care staff. The staff expressed the view that the home has suffcient staff to meet residents needs and that the staff work effectively as a team. Staff meetings are held every 3 months. Staff confirm that they receive regular formal supervision. Care Homes for Older People Page 19 of 26 Residents described the staff as kind, helpful and very patient. Newly appointed staff receive an induction which is recorded. Three of the 10 care staff have a National Vocational Qualification (NVQ) level 2 in care. A further staff member is due to start the course. Staff also receive training in various other subjects, including the following: basic and appointed first aid, moving and handling, food hygiene, safe handling of medicines, infection control, fire safety and demnetia awareness. This was conformed from training records and discussions with the staff on duty as well as with the manager and owner. Recruitment procedures were checked for 3 staff who have started work at the home recently. Each person has completed an application form. Criminal record bureau (CRB) and Protection of vulnerable adults checks are carried out before the person starts work. Two written references are normally obtained as part of the recruitment process. It was noted that one person has been employed without any references being obtained. The managr explained that the references had been requested twice but not returned. The home had not maintained a record of the references being requested and a telephone enquiry had not been made by the home to the referees number as given on the application form. The recruitment process involves a formal interview and completion of an interview assessment form. Care Homes for Older People Page 20 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and run in the best interests of the residents. The health and safety of residents and straff is promoted. Evidence: The manager has completed the Registered Managers Award. She has managed the service for several years and attended other training courses and is due to complete an equality and diversity course. The home asks for the views of the residents and the staff about the home. the Care Homes for Older People Page 21 of 26 manager and owner explained that these have been useful in reviewing the service, leading to the provision of additional activities and changes to the food menu. The home uses the Commission Annual Quality Assurance Assesment to audit its service. The home has a maintenance plan. The home does not hold any residents money for safekeeeping. Staff receive regular supervision. This was confirmed from discussion with the two staff, the manager and the owner. Records are maintained as set out in the regulations with the exception that for the 4 residents whose care records were looked at only one included a photograph. Staff are trained in health and safety and in fire safety. The homes appliances are serviced by suitably qualified persons. The fire logbook shows that the fire safety equipment is tested and that fire drills take place. Temperature controls are installed on hot water outlets to protect residents from possible scalds. Restrictors prevent possible falls from first floor windows. Care Homes for Older People Page 22 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Residents care plans must detail mental health needs such as behaviour and dementia. So that staff have guidance in providing care regarding mental health and dementia. 12/10/2008 2 29 19 The home must obtain two written references before a newly appointed staff member starts work. In order that residents are adequately protected. 12/10/2008 3 37 17 A photograph of each resident must be held with care records. So that staff are able to identify residents for the purposes of medication administration and should the resident go missing. 12/10/2008 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards Care Homes for Older People Page 24 of 26 and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 25 of 26 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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