Inspection on 18/08/05 for Freeland House Nursing Home

This inspection was carried out on 18th August 2005.

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

The inspector 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

Freeland House Nursing Home 20/03/08

Freeland House Nursing Home 25/05/06

Freeland House Nursing Home 12/01/06

Freeland House Nursing Home 21/03/05

Freeland House Nursing Home 30/06/04

Freeland House Nursing Home 11/03/04

Freeland House Nursing Home 10/09/03

Freeland House Nursing Home 19/09/02

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

CARE HOMES FOR OLDER PEOPLE Freeland House Nursing Home Wroslyn Road Freeland, Witney Oxfordshire OX29 8AH Lead Inspector Annette Miller Announced 18 August 2005 09:30 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. Freeland House Nursing Home H57-H08 S27150 Freeland House V232872 180805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Freeland House Nursing Home Address Wroslyn Road, Freeland, Witney, Oxfordshire, OX29 8AH 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) 01993 881258 01993 883963 Dove Care Homes Limited Frances Payne Care Home with Nursing 76 Category(ies) of Old age, not falling within any other category registration, with number (76), Physical disability (2) of places Freeland House Nursing Home H57-H08 S27150 Freeland House V232872 180805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. On admission persons should be aged 60 years and over. 2. Admittance of two named under age service users. 3. The maximum number of service users must not exceed 76. Date of last inspection 21 March 2005 Brief Description of the Service: Freeland House is set in six acres of woodland and landscaped gardens at the southern edge of Freeland village, eight miles west of the City of Oxford and approximately 3 miles from the market town of Witney. The original house was built in 1807 and owned by a former Town Clerk of Oxford. From 1984 the house has been run as a care home for older people requiring nursing care. The home was extended in 1998 to provide further bedroom accommodation. The accommodation comprises 56 single rooms and 10 shared (double) rooms, most with en-suite facilities. There are three lounges and two dining rooms on the ground floor, with an additional sitting area in the link to the new building, all with extensive views over the gardens and fields to the rear of the home. The original house is a three-storey building, with the kitchen, laundry room, administrative offices and a hairdressing room located on the basement floor. Freeland House Nursing Home H57-H08 S27150 Freeland House V232872 180805 Stage 4.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 by two inspectors from 9.30 am to 4.45 pm. The inspection focused on talking to residents and staff to find out their opinions of the home. A tour of the building and inspection of documents took place. The Registered Manager was present throughout the inspection and it was evident that she was knowledgeable about residents’ individual care needs. Members of staff said she was approachable and they felt she listened to any concern they raised and took action whenever she could. The Commission for Social Care Inspection (CSCI) sent out comment cards prior to the inspection to residents, relatives and health and social care professionals. Replies were received from seven residents, nine relatives and one GP, and the majority of responses were good. To the question: “Do you feel well cared for?” Five residents said, “Yes”; two said, “Sometimes”. To the question: “Are you satisfied with the overall care provided?” Seven relatives said, “Yes”; one said “More or less”; one said “No”. The GP responded positively to all questions. What the service does well: What has improved since the last inspection? Care plans have improved and they now provide good information about residents’ care needs and the action that needs to be taken by nurses and carers to ensure that all aspects of residents’ care needs are met. Freeland House Nursing Home H57-H08 S27150 Freeland House V232872 180805 Stage 4.doc Version 1.40 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Freeland House Nursing Home H57-H08 S27150 Freeland House V232872 180805 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Freeland House Nursing Home H57-H08 S27150 Freeland House V232872 180805 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of these standards were assessed. EVIDENCE: Freeland House Nursing Home H57-H08 S27150 Freeland House V232872 180805 Stage 4.doc Version 1.40 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 9 and 10 There is clear and consistent care planning in place that adequately provides staff with the information they need to satisfactorily meet residents’ needs. EVIDENCE: A sample of four care plans was inspected and the range of information provided about each person’s care needs was good. The action required was set out in detail and care is regularly evaluated to ensure that changing needs are addressed promptly. A range of risk assessments had been completed, e.g. to check on residents’ nutritional intake and manual handling needs. The manager is advised to consider using the ‘MUST’ (Malnutrition Universal Screening Tool) that is advocated by Oxfordshire community nutrition and dietetic service, in place of the nutritional tool currently in use. This is because it is expected that, eventually, all patients discharged from hospital will have been assessed using ‘MUST’ and it is preferable that re-assessment is carried out using a tool that care home staff are familiar with. Recommendation. Medicines are stored in medicine trolleys and cupboards that are kept locked when not in use. Controlled drugs are stored appropriately in a metal drug cabinet situated within a room that is locked, and administration of these drugs Freeland House Nursing Home H57-H08 S27150 Freeland House V232872 180805 Stage 4.doc Version 1.40 Page 10 was appropriately recorded in the home’s controlled drug register. The records for three residents were checked and found to be correct. There is a drug fridge for medicines that must be stored in a cool environment. Daily temperature checks are carried out and records showed that the fridge temperature was within the recommended temperature range. A number of residents are prescribed Lactulose (a laxative) that is supplied in half litre bottles; each bottle is named for a specific resident. The home’s medicine trolleys are not large enough to carry all the bottles needed, and to overcome this problem one bottle is carried in each trolley and is used to supply all residents taking the medicine. The CSCI pharmacist was contacted for advice and confirmed that this practice was not strictly legal, and suggested the manager discussed with the doctors the possibility of prescribing a bulk prescription, with either the name of the home on the label, or the names of those residents requiring the medicine shown. The pharmacist said, “The legal limitations are that the home must have at least 10 residents cared for by the GP; and of these 2 must be prescribed the product”. Recommendation. Every resident has a medication record chart listing the medicines that doctors have prescribed and on which nurses record when medicines are administered. On completion of these charts, a registered nurse prepares a new chart by writing out the list of medicines from the old chart, and signs that this has been done. A second nurse should check and countersign each entry. Alternatively, a doctor could be asked to check and sign the medication chart before it is used, or the pharmacist supplying the home’s medications could be asked to provide computer generated instructions to attach to a blank medication chart. Recommendation. Freeland House Nursing Home H57-H08 S27150 Freeland House V232872 180805 Stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 and 15. Activities are well planned and good opportunities are provided for residents to maintain their interests and socialise with other residents. The menus showed that the diet is varied and well balanced, and choices are available. The lunchtime meal was well organised and the Hotel Services Manager and her team are commended for promoting an unhurried and relaxed mealtime for residents. EVIDENCE: From discussions with a number of residents, and observations made during the inspection, there are opportunities available for residents to participate in a variety of activities in group and one-to-one sessions. Residents’ interests are documented and a programme of activities and events is displayed. Recreational activities are provided Monday to Saturday each week. One resident said, “We have speakers coming from the museums – it gets my brain going”. Also, “I went to Blenheim Palace on Sunday – six of us went in wheelchairs. It was a marvellous afternoon”. Another person said, “I enjoy the activities – the activity girls are very energetic. We do quizzes; I do crosswords and bingo”. Freeland House Nursing Home H57-H08 S27150 Freeland House V232872 180805 Stage 4.doc Version 1.40 Page 12 A popular event is the ‘Happy Hour’ from 6 – 7 pm every Thursday when a variety of activities are arranged, e.g. films, live music and dancing. The two dining rooms are most attractive and the layout allows for ease of access and social interaction to take place. Sherry and wine are served at lunchtime, and soft drinks are also available. A hotel service is provided in the Bladon dining room for the more independent residents, and in the Eynsham dining room carers serve meals and help those residents who require more assistance. The menus are produced to cover a four-week cycle and seasonal food is provided. There is a choice of two main courses and two desserts at lunchtime, and hot and cold menu choices at supper. Supper is served at about 5 pm and residents are free to choose where they want to eat. Seven comment cards returned by residents to CSCI contained the following responses: To the question: “Does the home provide suitable activities?” replied, “Yes”. All 7 residents To the question: “Do you like the food?” 6 residents replied “Yes” and one replied “Sometimes”. Freeland House Nursing Home H57-H08 S27150 Freeland House V232872 180805 Stage 4.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) None of these standards were inspected. EVIDENCE: Freeland House Nursing Home H57-H08 S27150 Freeland House V232872 180805 Stage 4.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, 20, 21, 24 and 26 The standard of the environment within this home is good providing residents with an attractive and homely place to live. EVIDENCE: The communal facilities are spacious, attractive and allow for a variety of social and cultural activities to take place. There are shared (double) rooms in the existing house over three floors, some with en-suite facilities. In the extension (completed in 1998) the bedrooms are single and all have en-suite facilities of toilet and washbasin. A resident in the extension said she was very happy with her room and liked having her own possessions with her, as this made her room feel ‘homely’. Her armchair was positioned near to a window overlooking the rear garden. She said she enjoyed watching the birds visit the bird feeder near to her window, as well as the wild life, e.g. foxes and squirrels, that regularly visited the garden. Freeland House Nursing Home H57-H08 S27150 Freeland House V232872 180805 Stage 4.doc Version 1.40 Page 15 Cleanliness was good throughout and it was apparent that the domestic team is committed to maintaining good standards of cleanliness and hygiene. Most areas of the home were fresh smelling, although one bedroom had a strong smell of urine and two bedrooms had a slight smell of urine. Prompt action was taken to deal with this at the time of inspection. The corridor carpet on the ground floor in the existing house (adjacent to the Club Room) was stained and would benefit from deep cleaning. Recommendation. The grounds are well maintained and there are shady spots where residents and visitors can sit. There is an area of garden with garden furniture leading directly off the lounge on the new wing, where a number of residents and visitors were enjoying the fine weather sitting under a gazebo. Plant containers and hanging baskets provided a colourful display of flowers. Staff regularly provided people in the garden with hot and cold drinks. The communal rooms in the existing part of the home have lovely views across the gardens and open countryside beyond, but the steps leading down to the garden from these rooms are only suitable for residents who are able to walk independently. Level access to the gardens is only available from the new wing. The grounds are extremely pleasant and provide good opportunities for physically able residents and visitors to enjoy the outdoor facilities, but there is a shortage of suitable paths for wheelchairs. A relative commented on this, saying she wished she could push her wheelchair-bound relative around the garden. Recommendation. Freeland House Nursing Home H57-H08 S27150 Freeland House V232872 180805 Stage 4.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 and 29. On the day of inspection staffing levels and skill mix were good for the morning period and exceeded the minimum number required by two carers. However, although the skill mix was also good during the evening, the number of staff on duty was one carer below the minimum required and this could potentially leave residents at risk. EVIDENCE: The number of staff on duty on the day of inspection for 59 residents was: 8am – 3pm 3pm – 8pm 8pm - 8am Five registered nurses and 8 carers Six registered nurses and 4 carers. Two registered nurses and 4 carers. This level of staffing exceeded minimum staffing levels by two carers for the morning period, but was below the minimum required in the evening by one carer. Minimum staffing levels, below which staffing must not fall, are referred to in the home’s staffing statement issued by the previous registration authority. The manager and the matron were also on duty throughout the day and were extra to the numbers shown. The duty rota for the period 8th to 21st August 2005 showed that on five evenings there were eleven members of staff on duty, on seven evenings ten staff and on two evenings 9 staff. According to the home’s staffing statement Freeland House Nursing Home H57-H08 S27150 Freeland House V232872 180805 Stage 4.doc Version 1.40 Page 17 for 58 – 63 residents there should be a minimum of 11 staff on duty. Requirement. The home does not employ agency staff, using instead its own permanent nurses and carers to work extra hours. The manager said she monitors the number of hours worked by staff to ensure they do not work excessively long hours. Four staff files were inspected and these were found to contain the required recruitment documents and checks, except that one file did not contain proof of identify. The manager said this would be obtained at the earliest opportunity and placed on file. Criminal Records Bureau (CRB) checks had been done for staff, but there was no evidence that a check had been carried out against the Protection of Vulnerable Adults (POVA) List, as the company retains the section of the CRB form that shows this. The manager confirmed verbally that POVA checks are done. Nine relatives returned comment cards to CSCI. To the question: “In your opinion are there always sufficient numbers of staff on duty”, five relatives replied “Yes”; three replied “No”. One relative said they did not think there was enough staff at weekends, particularly on Sundays. Residents’ comment cards do not ask about staffing levels and no comments were received during the inspection to indicate that residents thought staffing levels were low. Freeland House Nursing Home H57-H08 S27150 Freeland House V232872 180805 Stage 4.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) 31 and 38 The manager is supported well by her senior staff in providing clear leadership throughout the home with all staff demonstrating an awareness of their roles and responsibilities. EVIDENCE: From the discussions held with a number of staff and observations made by the inspectors, it was apparent that the manager communicates a clear sense of direction and leadership and is thought highly of by her staff. She has several years’ experience in the management of care homes and was appointed manager at Freeland House in March 2004. She is a registered nurse and successfully completed the Registered Manager’s Award in October 2003. The staff spoken to considered that the manager listened to their views, and her ‘open-door’ approach was appreciated. Comments from residents included: • “Issues get sorted – the manager sees to things straight away.” H57-H08 S27150 Freeland House V232872 180805 Stage 4.doc Version 1.40 Page 19 Freeland House Nursing Home • • “The care home is being run well. I can’t see how to make improvements.” “I feel confident the home is running as it should.” An inspector was informed by a resident that he did not like his door closed because he could not see what was going on outside. He said, normally, it was propped open. If bedroom doors need to be kept open to meet residents’ wishes, or for the convenience of staff, they should be fitted with acoustically operated devices that release automatically if the fire alarm sounds. Recommendation. (Approval must be obtained from Oxfordshire Fire Authority before any such device is fitted). Good procedures are in place regarding arrangements for carrying out safety checks on appliances. For example, an approved engineer carried out a quarterly check on the home’s lift on 23.7.05, the gas installation and central heating was checked on 7.4.05, and the fire equipment was checked on 14.7.05. The last fire training session was on 18.7.05, and the manager said that more sessions are planned to ensure that staff receive two periods of fire training annually. One of the inspectors observed two members of staff using the ‘under-arm’ lift to move a resident. This lift is not recommended and handling and moving training should be arranged to ensure that all staff are aware of correct lifting procedures. It was established on the day that this has been arranged. Freeland House Nursing Home H57-H08 S27150 Freeland House V232872 180805 Stage 4.doc Version 1.40 Page 20 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 x x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 3 3 3 x x 3 x 3 STAFFING Standard No Score 27 2 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 3 x x x x x x 3 Freeland House Nursing Home H57-H08 S27150 Freeland House V232872 180805 Stage 4.doc Version 1.40 Page 21 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 27 Regulation 18 Requirement The manager must ensure that the number of staff on duty does not fall below the minimum number shown on the homes staffing statement. Timescale for action With immediate effect. 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. 2. Refer to Standard 7 9 Good Practice Recommendations Implement the MUST nutritional assessment tool. Only administer medication to residents from containers specifically named for each person, or discuss with GPs the possibility of a bulk prescription for medicines dispensed in large quantities. Nurses who transcribe medication instructions must ensure transcriptions are checked and countersigned by a second nurse, or discuss with GPs how to stop the necessity for transcriptions to be made. Improve access to, and around the grounds, for residents who use wheelchairs. Deep clean the corridor carpet adjacent to the Club room. Bedroom doors that need to be kept open to meet residents wishes, should be fitted with devices (approved by the Fire Authority) that close automatically, should the fire alarm sound. H57-H08 S27150 Freeland House V232872 180805 Stage 4.doc Version 1.40 Page 22 3. 9 4. 5. 6. 19 26 38 Freeland House Nursing Home 7. None. Freeland House Nursing Home H57-H08 S27150 Freeland House V232872 180805 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection Burgner House, 4630 Kingsgate, Cascade Way, Oxford Business Park South, Cowley, Oxford. 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