Inspection on 17/08/05 for Freeman House

This inspection was carried out on 17th 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

Freeman House 28/10/08

Freeman House 03/11/06

Freeman House 20/02/06

Freeman House 10/02/05

Freeman House 10/08/04

Freeman House 03/02/04

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

CARE HOMES FOR OLDER PEOPLE Freeman House Radburn Way Letchworth Herts SG6 2LH Lead Inspector Tom Cooper Unannounced 17 August 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Freeman House I52 s19390 Freeman House v242326 170805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Freeman House Address Radburn Way, Letchworth, Herts, SG6 2LH 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) 01462 488000 01462 488064 Quantum Care Limited Not yet registered CRH Care Home 48 Category(ies) of DE(E)-48, OP-48, PD(E)-48 registration, with number of places Freeman House I52 s19390 Freeman House v242326 170805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: The home may accommodate a maximum of 48 service users over 65 years of age , including individuals with dementia and/or physical disabilities. Date of last inspection 10 February 2005 Brief Description of the Service: Built circa 1965, Freeman House is a large three storey building located in a residential neighbourhood of Letchworth close to local shops and amenities. The home is furnished to a good standard and provides a comfortable and reasonably homely environment that belies the rather stark external appearance. Accommodation is provided on three floors served by a lift. There are communal lounges and a kitchenette/dining room on each floor as well as a functions room on the ground floor. All bedrooms are singles, although provision can be made for couples who wish to share. There are three shower facilities but no en-suite facilities in bedrooms. Additional rooms comprise a hairdressing room, staff room and various offices. Accommodation can be provided for visitors if required. There is a car park to the front of the building and a pleasant garden to the rear. The home provides a growing range of weekly activities, with visits from outside entertainers, days out and regular social events. Freeman House I52 s19390 Freeman House v242326 170805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on a weekday afternoon and early evening. The home was full with 48 residents, although one was away in hospital. Service users were seen relaxing in their bedrooms and the communal areas of the home. Discussions were held with service users, members of care staff, the manager and deputy manager and a volunteer worker. Documentation was checked, including several service users’ care plans, medication records (and storage), accident records and complaints records. A dementia care training course took place at the home during the inspection. The atmosphere in the home was businesslike yet relaxed on a hot summer’s day, with staff going about their duties quietly and confidently and interacting positively with service users. What the service does well: What has improved since the last inspection? Following recommendations made in the last inspection report, medication handling and storage practice had been improved, although some lapses in the recording of the administration of medication were found. The new manager has taken steps to improve the range and consistency of activities provided and has recruited a new activities coordinator and a Freeman House I52 s19390 Freeman House v242326 170805 Stage 4.doc Version 1.40 Page 6 volunteer who provides beauty treatments and was planning to start running a trolley shop the week after the inspection. This emphasis on promoting a better quality of life for service users was most positive. 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. Freeman House I52 s19390 Freeman House v242326 170805 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 Freeman House I52 s19390 Freeman House v242326 170805 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) 1, 2, 3 Prospective and current service users have access to the home’s statement of purpose and service user’s guide, which contain the required information about the establishment’s aims and objectives and the services and facilities to be provided. The terms and conditions of occupancy are laid out in a document issued to all service users upon admission. All admissions are made on the basis of a full assessment of needs undertaken by a competent person. EVIDENCE: All the relevant documents are available in the home for inspection. Pre-admission assessment information was in personal files. This information is used to develop service users’ care plans. Freeman House I52 s19390 Freeman House v242326 170805 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. 8, 9, 10 Care plans covering the full range of health, personal, social and emotional needs are in place for each service user. Staff monitor individual service users’ physical condition and take action to maintain or restore it as necessary. A well managed and safe medication system is in place, although more effective monitoring is required by the management to ensure staff always accurately record administration on the medication administration record (MAR) sheets. Service users are treated with respect and can make their own decisions. Staff actively promote their dignity and privacy. EVIDENCE: Seven care plans in the standard Quantum Care format were examined. All contained comprehensive information on individual care needs, coupled with clear instructions to staff on how best to meet them. The particular circumstances of each person were fully noted, for example the cultural requirements of a West Indian service user, personal preferences, dietary needs, psychological and emotional health and so on. Regular weight records were made where considered relevant. Details of GPs visits were well recorded. Risk assessments had been made of essential topics such as moving and Freeman House I52 s19390 Freeman House v242326 170805 Stage 4.doc Version 1.40 Page 10 handling, falls, pressure sores and physical activities e.g. making tea. Each care plan sampled had been regularly updated with any agreed changes duly recorded. A considerable amount of time and effort had been put into the documents with the result that they provided valuable working tools for staff and demonstrated the ability of the home to care for the individuals concerned. Service users spoken with said that staff were kind and considerate and generally treated them in the way they preferred. They felt that staff respected their privacy, for example by knocking and waiting at their bedroom doors to be invited in and by ensuring that personal care tasks and medical consultations took place in private. Service users looked well cared for and were physically well presented, dressed in their own clothes suitable for a hot summer’s day. Although all the other service users consulted said that staff were respectful and took care to promote their privacy, one person complained that a member of staff had on one occasion used inappropriate language when speaking to her. This was passed on to the manager to deal with. Staff were observed dealing with residents in a calm and relaxed manner, even under quite stressful conditions in the dementia unit. The Nomad system of weekly dosette containers was being used for the administration of medication. Only trained staff deal with medication. Storage and records were checked in one unit. Storage was well organised, with incoming medication, the dates of opening of bottles and packets not in the Nomad containers and remaining tablet balances clearly recorded on the MAR sheets. However six signature gaps were found on the current MAR sheets, indicating a lack of discipline amongst staff. Although the home’s policy is for the relevant care team manager to monitor staff recording practice daily, evidently this had not been carried out effectively. Therefore a requirement has been made in this report that accurate medication records must be kept. Freeman House I52 s19390 Freeman House v242326 170805 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, 13, 14, 15 Service users are able to follow the lifestyles they choose and can take part in a range of recreational and social activities. The home’s policies facilitate contact with relatives and friends with staff support as appropriate. Varied and nutritious menus are provided, with special dietary requirements catered for. Service users can choose where to eat. Extra food and drinks are available at any time on request outside the formal mealtimes. EVIDENCE: The manager was keen to expand the range and quality of activities available. To that end a new activities coordinator recently has been employed for 16 hours per week, supported by an identified care assistant. In addition, a volunteer had been recruited to provide beauty treatments and run a trolley shop for residents. The volunteer explained her plans for introducing other initiatives in consultation with service users. These were most positive developments. In addition to games and singalongs, a fashion show was being planned. Outside entertainers, mainly musicians, are regularly hired for performances. Details of activities occurring are displayed at various points around the home and are also described on the individual daily records. Occasional outings are organised for which the Heritage Foundation bus can be borrowed. All service users asked said they were content with the activities on offer and were able to choose whether to join in or not. Freeman House I52 s19390 Freeman House v242326 170805 Stage 4.doc Version 1.40 Page 12 The home’s policy is to place no restrictions on visiting times and service users stated that their relatives and friends were always made to feel welcome. Service users spoken with said that they were able to make their own decisions about how and where to spend time, rising and retiring times, food, activities and so on. Obviously this is less possible for residents with dementia nevertheless staff were observed offering guidance and support in a gentle and sympathetic way in the dementia unit. Most service users spoken with said the food provided was satisfactory, two said it was always excellent and one said it was usually poor. The menu was varied and nutritious and staff said that service users were always offered an alternative meal if the menu was not to their liking. The early evening food supplied during the inspection looked tasty and well presented and was well received by service users. Staff provided assistance as necessary. Some residents choose to eat in their rooms. Freeman House I52 s19390 Freeman House v242326 170805 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) 16, 18 The home has an effective complaints procedure that service users and their relatives and friends can have confidence in. However the manager should reemphasise to staff the importance of taking all complaints seriously as one service user expressed doubts. Service users are protected from abuse through training in abuse awareness and the protection of vulnerable adults, reinforced by the company’s policies and procedures. EVIDENCE: The Quantum Care complaint procedure is comprehensive, specifying how complaints may be made and who will deal with them, as well as a response within 28 days. Only one complaint had been filed in the complaints file since the last inspection, which had been thoroughly investigated and all details recorded including the outcome and future action proposed. Most service users spoken with had no knowledge of the formal complaints procedure but said they would feel able to approach a senior member of staff with any problem if need be. Several were keen to point out that they had no wish to complain. However one service user said that she had made various complaints about the performance of the staff in her unit that had been ignored. These issues had not been recorded in the complaints file. The inspector passed on the details to the manager to deal with. A recommendation has been made in this report to adopt a more rigorous approach to service users’ complaints raised to demonstrate that they are always taken seriously. Freeman House I52 s19390 Freeman House v242326 170805 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, 26 The building is safe, well equipped, furnished and decorated, comfortable and well maintained. The home is clean, pleasant and hygienic. EVIDENCE: All areas of the building inspected were in a good state of repair, clean and free from unpleasant smells. Furniture provided was of domestic type and suitable for the use of elderly people with restricted mobility. Décor was adequate throughout. The building is somewhat institutional looking from the outside but the accommodation and communal areas is comfortable and homely. Corridors are wide and various aids to mobility are provided including the passenger lift, handrails etc. A hard-wired fire detection and alarm system is fitted, with fire doors in place as required. The statement of the procedure to be followed in the event of fire is positioned at strategic points throughout the building. The garden was in good order, providing an attractive facility for residents to use in fair weather. Freeman House I52 s19390 Freeman House v242326 170805 Stage 4.doc Version 1.40 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 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 Adequate numbers of competent staff are provided at all times. EVIDENCE: On the day of the inspection there were seven careworkers plus a care team manager and the deputy manager available to provide care as well as three housekeepers, cook, kitchen assistant and the administrator on duty. The manager (regarded as supernumerary) and the volunteer worker were also present. Staff confirmed that this was the typical staffing situation. Observation of the care staff at work, the condition of the premises, the quality of care plans sampled and the comments made by service users supported the conclusion that the day to day level of staffing was adequate to meet the needs of the 48 service users. Freeman House I52 s19390 Freeman House v242326 170805 Stage 4.doc Version 1.40 Page 16 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, 38 The manager is well qualified and very experienced in the care of the elderly. The health, safety and welfare of service users and staff are promoted and protected by means of safe working practices and policies followed by staff. EVIDENCE: The manager has been working in the care of the elderly for many years and has achieved the CSS and NVQ4 qualifications. She has previously managed five other Quantum Care homes and is therefore very well qualified to manage Freeman House. She had been in post only a short time but had already made a positive impact, for example in strengthening the activities staff team and abolishing the use of tabards by staff, which were regarded as unhygienic and institutional. She has therefore demonstrated her commitment to raising standards in the home. Freeman House I52 s19390 Freeman House v242326 170805 Stage 4.doc Version 1.40 Page 17 The health, safety and welfare of all persons on the premises is safeguarded as far as possible via a system of checks, risk assessments and compliance with the requirements of the relevant legislation. For example, mandatory staff training in disciplines such as health and safety, moving and handling, food hygiene, first aid and fire safety awareness is kept up to date on an ongoing basis. The staff induction and foundation training programme was TOPPS accredited. Weekly fire alarm tests are made and regular drills are carried out, with staff present recorded. Lifting equipment, assisted baths, fire extinguishers etc. are regularly serviced with the dates recorded. Freeman House I52 s19390 Freeman House v242326 170805 Stage 4.doc Version 1.40 Page 18 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 3 3 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 x x x x x x 3 Freeman House I52 s19390 Freeman House v242326 170805 Stage 4.doc Version 1.40 Page 19 Non-applicable 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 OP9 Regulation 17(1)(a) Schedule 3(3)(i) Requirement Accurate records must be kept of the administration of medication to service users. Timescale for action Immediate from 17th August 2005 and henceforth 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 OP16 Good Practice Recommendations The manager should emphasise to staff the importance of taking any complaint made by a service user seriously and investigating it thoroughly and recording the details. Freeman House I52 s19390 Freeman House v242326 170805 Stage 4.doc Version 1.40 Page 20 Commission for Social Care Inspection Mercury House 1 Broadwater Road Welwyn Garden City, Herts AL7 3BQ National Enquiry Line: 0845 015 0120 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 Freeman House I52 s19390 Freeman House v242326 170805 Stage 4.doc Version 1.40 Page 21 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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