CARE HOMES FOR OLDER PEOPLE
Freeland House Nursing Home Wroslyn Road Freeland, Witney Oxfordshire OX29 8AH Lead Inspector
Kate Harrison Unannounced Inspection 25th May 2006 09:40 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 Freeland House Nursing Home DS0000027150.V294262.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. Freeland House Nursing Home DS0000027150.V294262.R01.S.doc Version 5.2 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 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) 01993 881258 01993 883963 Dove Care Homes Limited Frances Payne Care Home 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 DS0000027150.V294262.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. On admission persons should be aged 60 years and over. Admittance of two named under age service users The maximum number of service users must not exceed 76. Date of last inspection 12th January 2006 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 on two floors. 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 corridor 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. The current scale of charges is from £567 to £850 per week. Freeland House Nursing Home DS0000027150.V294262.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the service was an unannounced ‘Key Inspection’. The inspector arrived at the service at 09.40 hours and was in the service for 9.5 hours. This inspection was a thorough look at how well the service is doing. It took into account detailed information provided by the service’s manager, and any information that CSCI has received about the home since the last inspection. The inspector saw all areas of the home and looked at records and documents relating to the care of the residents. Although the Commission sent out comment cards, none were received from residents or from relatives, and one was received from a health care professional. There were 58 residents living at the home on the day of inspection and the inspector had conversations with eight residents and one visitor, but several residents were not able to communicate meaningfully with the inspector and it was not possible to get their views of the home. The inspector spoke to other professionals in the home on the day, and all said that the home was well managed. From the evidence seen by the inspector and comments received, the inspector considers that this service would be able to provide a service to meet the needs of individuals of various religious, racial or cultural needs. What the service does well:
The home’s manager is competent and approachable and provides good leadership for the staff. The home is set in attractive surroundings and has a homely, welcoming atmosphere. Residents praised the staff and one said that the best thing about the home was the helpful staff. Residents are encouraged to express their views through regular meetings, and their views are listened to. Residents have a choice of activities each morning and afternoon, in different areas of the home, and include group and individual activities. The dining rooms are attractively set out in small groups and well managed by the hotel services manager. Relatives can use the facilities at the home for special family occasions. Several residents praised the quality of the food. Day to day maintenance issues are quickly addressed. Freeland House Nursing Home DS0000027150.V294262.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Freeland House Nursing Home DS0000027150.V294262.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Freeland House Nursing Home DS0000027150.V294262.R01.S.doc Version 5.2 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 the following standard(s): 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The assessment process is good, so that the needs of residents are known and met. Standard 6 does not apply. EVIDENCE: The registered manager or another registered nurse conducts the preadmission assessments by visiting the prospective resident, discussing his/her health and welfare needs, and completing the home’s Client Assessment Form. Other information from social workers or health care professionals is taken into account to decide if the home can meet the needs of the individual. The assessments seen contained all the necessary information, and the home was meeting the needs of the individuals admitted. Freeland House Nursing Home DS0000027150.V294262.R01.S.doc Version 5.2 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 the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements for health and welfare are good, and residents’ health and welfare are monitored and promoted. EVIDENCE: The care plans of three individuals were assessed. Named nurses are responsible for specific aspects of care and this helps to improve the continuity of care. Risk assessments are in place, for instance regarding falls and nutrition, but not all are evidence based, so their accuracy is not guaranteed. Risk assessments regarding health and welfare should be evidence based. A representative from the vision impairment unit of Oxfordshire County Council was visiting a resident in the home to assess his/her needs, and several individuals with stroke and Parkinson’s disease could benefit from the input of the organisations concerned with these conditions. The registered manager should consider using the expertise of expert organisations to improve the lives of residents. Freeland House Nursing Home DS0000027150.V294262.R01.S.doc Version 5.2 Page 10 The social interests of residents are recorded after admission, but the information is not always used to the benefit of the individual, and the registered manager should consider how best to apply this information to improve the social and emotional lives of the residents. Arrangements to access the local NHS services, such as the community dietetics and speech therapy service, are good. The inspector spoke to two health care professionals who were in the home on the day, and both said that they had no concerns about health and welfare provision in the home. Medication is kept on each of the floors, and policies are available for staff. The receipt and administration of medication is recorded, and there is a system for appropriately returning medication. Controlled drugs are well managed. Several residents said that staff treated them with respect, and one said that the best thing about the home was the staff, and that they ‘put you at your ease’. Residents have access to a telephone and are always called by their preferred name. Freeland House Nursing Home DS0000027150.V294262.R01.S.doc Version 5.2 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 the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management of daily life and social activities is good, and residents are able to exercise choice whenever possible. EVIDENCE: The residents hold meetings twice a month to discuss life at the home, and are able to discuss choices such as food and activities. The minutes of the meetings show that the meetings have improved life for the residents and their views are valued and acted on. A wide range of activities is provided each morning and afternoon, including Saturdays, in different areas of the home. The home’s policy is to welcome visitors and visitors were at the home on the day of inspection. Residents said that their visitors come when they want to, and one of the social rooms can be booked for family events. Residents said that the food was good, and that they could choose from the menu. The hotel services manager is responsible for the dining rooms, and the tables were well prepared and attractively set out. Staff have improved how they attend to residents who need assistance with eating, and attention is paid to the numbers of staff necessary to meet the needs of the diners.
Freeland House Nursing Home DS0000027150.V294262.R01.S.doc Version 5.2 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s arrangements regarding complaints and protection are good, so that the rights of residents are protected. EVIDENCE: The home’s complaints procedure has recently been amended and now includes current information. Residents said that they knew whom to complain to. The Commission has received information concerning two complaints made against the service since the last inspection and judges that the provider appropriately managed one complaint and the second complaint has not yet been resolved. Staff have received training on how to protect vulnerable adults from abuse, and the manager is clear on how to work in accordance with the local code of practice regarding the protection of vulnerable adults. Freeland House Nursing Home DS0000027150.V294262.R01.S.doc Version 5.2 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management of the environment is adequate, and recommendations have been made to improve the service. EVIDENCE: The home is set in mature gardens, and a gardener is responsible for the upkeep. Residents have access to the grounds, and further developments for the benefit of the residents are planned. The home has a full time member of staff responsible for maintenance, and has a system for staff to report maintenance issues to him for action. The heating arrangements in the original part of the building are causing problems, making it too hot in some individual’s rooms. Major alterations are planned to address the issue soon, and in the meantime all possible action is taken to make the residents comfortable.
Freeland House Nursing Home DS0000027150.V294262.R01.S.doc Version 5.2 Page 14 The ground floor corridor carpet mentioned in the previous report has not yet been replaced, but a decision has been made to replace all of the ground floor carpeting and arrangements are in place for this to be done. A pane of glass in the basement fire door is broken and should be replaced. The home’s laundry is in the basement and is managed by the housekeeping staff. One broken laundry bin was in use, and dirty laundry being transported was falling out and trailing on the floor, and spilling out from the top of the bin. The housekeeping staff should attend update training regarding infection control. The home’s policies and procedures regarding infection control are currently being reviewed. Freeland House Nursing Home DS0000027150.V294262.R01.S.doc Version 5.2 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s arrangements regarding staff recruitment, staffing numbers and training are good, and the registered manager is addressing issues remaining from the previous management’s procedures. EVIDENCE: The staff rota was examined for the week of the inspection visit, and for the week prior to the visit. The registered manager has a system in place to meet the minimum staffing levels when the number of residents increases to 58, when there should be three nurses and eight carers on duty morning and evening as well as the manager, so that the needs of the residents are met. One resident said that staff ‘know what they are doing’, and others said that the staff are ‘good’. There are 20 care staff excluding registered nurses working at the home. Some are nurses registered in other countries choosing to work as care staff at the home, and are recognised as having NVQ Level 3 training. Altogether 12 care staff have NVQ Level 2 or above or equivalent qualifications, and therefore the home meets the minimum level of 50 trained carers. NVQ training is encouraged at the home, and the registered manager is an NVQ assessor. Freeland House Nursing Home DS0000027150.V294262.R01.S.doc Version 5.2 Page 16 Three staff recruitment files were assessed, but in two instances, under the previous management, references were not appropriately requested or received. The registered manager has started a full review of the recruitment information regarding staff recruited under the previous management with reference to the amended regulations, and currently operates the home’s recruitment procedures according to regulations. Induction at the home is based on the Skills for Care standards and the home operates a staff-training programme based on the needs of the residents. Freeland House Nursing Home DS0000027150.V294262.R01.S.doc Version 5.2 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management and administration of the home is good, based on openness with effective quality assurance systems, and has a qualified competent manager in charge. EVIDENCE: The registered manager is qualified, experienced and skilled in managing the home. Since the last inspection she has organised training for staff on the health and safety issues identified, and in April 2006 implemented the quality assurance survey for all relatives. The results of the survey are not yet available, but will be given to relatives as soon as possible. Residents meetings are held regularly, as are staff meetings, and the registered manager has an ‘open door’ policy for residents and relatives. The housekeeping team
Freeland House Nursing Home DS0000027150.V294262.R01.S.doc Version 5.2 Page 18 conduct daily audits on health and safety topics, and a medication review was conducted in February 2006. The registered manager is not involved with residents’ personal allowances, as a recharging system is used, and secure facilities are provided for the safekeeping of residents’ valuables, and records are kept. The home has a health and safety policy statement, and provides training for staff on relevant topics, such as moving and handling residents. The registered manager and the maintenance manager have attended health and safety courses, and the home has a named member of staff responsible for health and safety. All the fire safety checks and training are appropriately carried out. Freeland House Nursing Home DS0000027150.V294262.R01.S.doc Version 5.2 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Freeland House Nursing Home DS0000027150.V294262.R01.S.doc Version 5.2 Page 20 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 OP29 Regulation 19 (4) Schedule 2 (amended 2004) Schedule 2 (amended 2004) Schedule 2 (amended 2004) Requirement The registered manager must obtain written confirmation as to the authenticity of references for individuals employed through an agency. A reference from the last employer must be available for new staff, when that employment was with vulnerable adults and was of not less than three months duration. When employing new staff that previously worked with vulnerable adults or children, written verification must be obtained of the reason why an individual ceased that employment. Timescale for action 30/06/06 2 OP29 30/06/06 3 OP29 30/06/06 Freeland House Nursing Home DS0000027150.V294262.R01.S.doc Version 5.2 Page 21 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 OP19 Good Practice Recommendations Replace the ground floor corridor carpet that is heavily stained, to include the section that is ripped. This recommendation remains from the previous report, and plans are in hand to change all the carpets. Risk assessments regarding health and welfare should be evidence based, so that the results can be relied on as accurate. The registered manager should consider using the skills of expert voluntary organisations to improve the lives of residents. The registered manager should consider how best to apply information regarding residents’ life stories to improve the social and emotional lives of the residents. A pane of glass in the basement fire door is broken and should be replaced. The broken laundry bin should not be used, and should be replaced. Housekeeping staff responsible for laundry should receive relevant training on the prevention of infection. 2 3 4 5 OP7 OP8 OP8 OP19 6 OP26 Freeland House Nursing Home DS0000027150.V294262.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Oxford Area Office Burgner House 4630 Kingsgate, Cascade Way Oxford Business Park South, Cowley Oxford OX4 2SU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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