Inspection on 28/10/08 for Freeman House

This inspection was carried out on 28th October 2008.

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

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

Other inspections for this house

Freeman House 03/11/06

Freeman House 20/02/06

Freeman House 17/08/05

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 17/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Freeman House Radburn Way Letchworth Hertfordshire SG6 2LH     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: Patricia House     Date: 2 8 1 0 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 © (2009) 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: Freeman House Radburn Way Letchworth Hertfordshire SG6 2LH 01462488000 01462488064 freeman@quantumcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Katie Heather Jane Dalton Type of registration: Number of places registered: Quantum Care Limited care home 48 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home 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. 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, Care Homes for Older People Page 4 of 26 Over 65 48 48 48 0 0 0 Brief description of the care home with visits from outside entertainers, days out and regular social events. The homes Statement of Purpose, Service Users Guide and last inspection report are displayed in the entrance hall. Fees for the home range from 420 pounds to 620 pounds per week. 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 information in this report is based on an unannounced visit to the home made by one inspector carrying out the work of the Commission. For the purposes of this report the Commission will be referred to as we. The manager was on duty during the inspection and we spoke with residents and staff. The relative of one resident also contacted us by telephone to make comments about the home. The manager has completed and returned to the Commission an annual self assessment quality review, the Annual Quality Assurance Assessment. (The AQAA). The AQAA focuses on how well the service meets the outcomes for service users and also provides us with some numerical data. Information from this document was used Care Homes for Older People Page 6 of 26 during the inspection and has been included in this report. What the care home does well: What has improved since the last inspection? What they could do better: 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. Care Homes for Older People Page 8 of 26 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. Standards 1, 3 and 4. Standard 6 does not apply to this home. People who use the service are provided with appropriate information which allows them to make an informed choice about moving into the home. Full needs assessments are completed and appropriate dementia care is provided by staff so that all parties can be sure that individual residents needs can be met. Evidence: During the inspection visit we saw a copy of a recently revised Service Users Guide and the manager confirmed she is currently updating this further as a result of some staff changes. In the AQAA the manager states that all prospective residents and their families are given an Admission Pack which includes this Guide and provides detailed information about the home. This ensures that everyone is clear about the services provided and the responsibilities of all parties concerned. Care Homes for Older People Page 10 of 26 Evidence: We checked a selection of care plans during the visit and all contained detailed written needs assessments, completed by senior staff members, as well as care summaries from referring agencies, where appropriate. From these assessments staff had completed initial care plans for each resident in order to be clear how everyones current needs could be met. In the AQAA the manager states that all new residents have a formal review completed after six weeks, or sooner. This also ensures that Freeman House is the right place for that individual. We saw details of a six week review on the care plan of a resident who was fairly new to the home. The home provides specialist care for those people with a dementia. The Admission Pack outlines the homes philosophy of dementia care and the care which can be provided. The relative of a resident who has dementia contacted the Commission and wanted to tell us how very pleased they were with the dementia care at the home. They said their relative received respectful and thoughtful care and was treated as an individual. They also said the staff have been really creative in dealing with the issues connected to their relatives dementia. The manager is a member of the specialist dementia team set up by the company, Quantum Care, known as the DART Team. The managers on this team are specially trained and come from several of the company homes and provide support and detailed assessments when specific problems around dementia arise. Each home in the company has a list of names of the people on the Team and there is always one person on call. Freeman House also has three dementia Champions who are staff members who have received specialist dementia training and they support care and ancillary staff in providing targeted and appropriate care for all the more confused people in the home. Consideration has also been given to the layout of the home and how this affects confused people and the signage on doors includes a variety of pictures as well as names to assist residents to identify their own bedroom and toilet facilities and remain as independent as possible. 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. Standards 7, 8, 9 and 10. People who use the service can be confident that detailed and written planning and monitoring ensures that all individual health needs will be met in an appropriate way. The procedures followed by staff in the home for administering medication ensure that residents are protected form the risk of harm. Evidence: We spoke with residents during the visit and then tracked a selection of their care plans. In all cases the written information was relevant to the individual concerned and gave clear guidance on how needs should be met. Detailed risk assessments had been completed and plans for assistance with moving and handling were sufficiently detailed to ensure the residents were moved safely. Risk assessments for skin care were in place and where the provision of precautionary pressure relief equipment was recommended we observed this had been provided. In the AQAA the manager confirmed that staff were now completing formal assessments of everyones nutritional Care Homes for Older People Page 12 of 26 Evidence: needs and these assessments were seen on the records checked. Regular weight checks were recorded and food and fluid charts had been completed where the plans indicated this was needed to ensure an individual received sufficient nutrition. Care staff were recording appropriate information about the resident concerned after each shift had finished and most records had been signed by residents or families to show their involvement in the planning. We saw the Book of Memories competed in some plans and staff said that this information was used to plan appropriate activities and aid communication for the residents concerned. In the AQAA the manager also states that monthly reviews and audits of care plans now take place to ensure these documents are up to date and being used in practice. The staff we spoke with confirmed that every resident has a key worker whose tasks involve one-to one support for the resident as well as looking after their room and checking routines for personal care and supplies of toiletries. Care staff said they record information in care plans and are involved in the monthly reviews. They also said they pass appropriate information to the unit managers when necessary. Staff confirmed that at each unit meeting one care plan is chosen, on a rota basis, and all aspects of the residents care is reviewed in depth to ensure the most appropriate care is being provided. We observed one medication round, where a senior member of staff was training another in this administration. These care workers confirmed that only staff who had completed the full training procedure were able to give medication. In the AQAA the manager states that annual reviews take place of everyone administering medication and that competency is confirmed in writing in staff records. The manager also states that medication is monitored twice each day and that there are plans to fully audit supplies of controlled drugs on a weekly basis. We checked the storage and recording systems for medication administration and the system was thorough. We just recommended that all totals of non-blistered medication is carried forward on all record sheets to ensure accurate audits can take place easily. The relative of one resident who contacted the Commission told us that, since entering the home, the resident had had their medication reviewed and that their medication had been reduced as a result. The relative said that staff at the home were managing the residents behaviour with a planned response, rather that by using sedative type drugs. The residents we spoke with confirmed that all staff treat them with respect and promote their independence and allow them to make decisions about their daily life. They also confirmed that they saw Health professionals where appropriate and always saw them in private. Care Homes for Older People Page 13 of 26 Care Homes for Older People Page 14 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. Standards 12, 13, 14 and 15. Staff at the home provide a range of activities and outings for the residents and welcome visitors to the home so that people who use the service feel positive about their daily lives and continue to feel part of the community. Residents enjoy the meals provided and these are varied and well balanced and help to maintain the good health of people in the home. Evidence: In the AQAA the manager states that an additional activity co-ordinator had been appointed and that more residents outings had taken place since the last inspection. By the time of this inspection a second new co-ordinator had also been appointed. The manager also states in the AQAA that there are plans to increase the provision of activities at weekends. Care staff told us that the home has access to a large vehicle and that residents are taken out in this at least fortnightly. One care worker is also undertaking a certificated course for activity provision. The residents we spoke with said that they are taken out to the shops and to garden centres and that they enjoy the coffee mornings held in the home. We saw a range of activities advertised on Care Homes for Older People Page 15 of 26 Evidence: notice boards in the home and these included cooking and quizzes. We saw people reading newspapers around the home and they told us that these are regularly delivered. Care staff confirmed the home has a shop which is a trolley and this is taken round so that residents can purchase their own goods. Residents also confirmed that they were involved in choosing new pictures and furniture for the home and that their visitors were welcomed into the home at all times. In the AQAA the manager states that residents in the home are able to use an Age Concern advocate if they wish to. We observed the lunch provided for residents. This is now a light meal as the home now provides the main cooked meal in the evening. The manager confirmed that this change was discussed and agreed at a residents meeting. Residents now have the choice of a full cooked breakfast and about a quarter of the residents have this regularly. The manager said that, since changing the main meal provision to the evening, residents are sleeping better and the number of falls has reduced. One resident has chosen to have their main meal at mid-day still and this choice is being accommodated. Residents confirmed they are offered snacks and drinks between meals and in the evening and that snack trays are taken round by staff. We saw fresh fruit offered in all areas of the home during the inspection. Care staff also said that the chef provides monthly catering themes for residents and we heard details of the October theme which was Exotic Fruit Tasting. Care Homes for Older People Page 16 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. Standards 16 and 18. People who use the service can be sure that procedures followed by staff in the home mean that their views will be listened to and acted on and that staff will help to safeguard them from abuse. Evidence: The home has written policies covering complaints and adult safeguarding, which the staff we spoke with were aware of. Residents we spoke with said they would not hesitate to tell staff if they had a concern and the homes complaints procedure is displayed on the notice board. No complaints about the home have been received by the Commission since the last inspection. Care staff confirmed they have all received training in Adult Safeguarding and the manager demonstrated a clear understanding of the Hertfordshire County Council Adult Care Sevices multi-agency Safeguarding Procedures. Care staff also confirmed they were aware of the homes Whistle Blowing policy and its implications. Care Homes for Older People Page 17 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. Standards 19 and 26. People who use the service live in a home which is well maintained and furnished for their comfort and have their health protected by staff who follow procedures which ensure good infection control. Evidence: We visited all areas of the home briefly and saw that it was being well maintained and kept very clean. There is a new bathroom on the ground floor and two new bathrooms on the top floor. Some new carpets have been provided and the bedrooms we visited were bright and homely, with lots of residents personal posessions around. In the AQAA the manager states that there are plans to provide new furniture for the ground floor lounge. At the time of the inspection staff at the home were dealing with an outbreak of sickness and diarrhoea and were clearly following good hygiene practices and using the guidelines for Universal Precautions for infection control. All communal bathrooms and toilets contained liquid soap and soft paper towels and anti-bacterial hand gel is provided in the entrance to the building for the use of visitors to the home. The staff we spoke with were aware of the recommended procedures for good infection control Care Homes for Older People Page 18 of 26 Evidence: and the manager said that members of the senior staff team have attended a certificated training course on Good Infection Control. Staff at the home therefore have up to date information about safe procedures and can ensure that residents are not put at unnecessary risk of harm. Care Homes for Older People Page 19 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 27, 28, 29 and 30. People who use the service are supported by staff who are well trained and employed in sufficient numbers to meet all the residents needs. Recruitment procedures followed in the home are thorough and help to protect residents form the risk of abuse. Evidence: Because of the sickness outbreak in the home, affecting staff and residents, staff numbers were slightly lower than usual. However all normal routines were being followed and the residents we spoke with said that their care and activities were still being provided in the normal way. The relative who spoke with the inspector confirmed that thre were usually enough staff on duty in the home. The manager has appointed two new activity co-ordinators and this is in addition to an existing part-time coordinator. Staff also confirmed they link with co-ordinators and provide activities to ensure that all units in the home have activities offered as well as one to one discussions. The records we checked showed that staff were provided with good levels of training. We were told that the previous week care staff had attended training in Quality Assurance, linked to care planning and recording. This training is on-going so that all Care Homes for Older People Page 20 of 26 Evidence: members of staff will eventually be trained in this area and so that all care planning in the home will be consistant and relevant to current requirements. The manager said that courses in Person Centred Planning have also been booked for care staff. In the AQAA the manager states that recent staff training has included the Mental Capacity Act and that three levels of Dementia training are offered, providing care staff with skills that range from basic to specialist. Over 50 of care staff have either completed or are just finishing NVQ 2 training and staff confirmed they are encouraged to undertake this training. The home has two qualified NVQ Assessors on the staff which enables care staff to undertake this training in-house. In the AQAA the manager also confirmed that all training and procedures in the home are based on promoting equal opportunities and diversity. We checked a selection of staff recruitment records for those employed more recently. In all cases evidence of apppropriate checks were in place before the candidate started work at the home. We just reminded the manager that full employment histories were needed with written details explaining any gaps, for all prospective employees. This is to ensure that all staff in the home are suitable to work with vulnerable people. Care Homes for Older People Page 21 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. Standards 31, 33, 35 and 38. People who use the service can be confident that the home is well run and that their views are always listened to. Procedures followed by staff at the home help to protect residents from unnecessary accidents and promote the health safety and welfare of staff and residents. Evidence: The manager is registered with the Commission and demonstrated an up to date knowledge of current regulations and guidelines for providing care. The manager is also an NVQ Assessor and a dementia Mapper. Staff and residents we spoke with confirmed that the manager is always approachable and listens to all views about the running of the home. The manager confirmed she completes monthly audits of accidents, incidents, Care Homes for Older People Page 22 of 26 Evidence: complaints and other significant issues. A report is then sent to Head Office and is used to affect any changes that might be needed. The home implements the company Quality Assurance programme and all residents, families and stakeholders are sent surveys to enable their views to be understood. Residents and staff confirmed that they have regular meetings where they can voice their opinions. Minutes of these meetings were available during the inspection. Reports of the monthly monitoring visits made by a senior manager from outside the home, were also available. We checked the homes system for handling residents money. Only small amounts are held for residents and we tracked details for one named resident. All amounts were correct and receipts were in place for all transactions. The company auditors also check all financial procedures in operation at the home, at regular intervals. We saw no hazardous substances left accessible in any areas of the home and staff we spoke with were clear about the health and safety procedures needed to ensure residents safety in the home. Care staff and residents confirmed that the fire alarms are tested regularly in the home and staff were clear about fire procedures. Records of fire safety checkes were all up to date. Care Homes for Older People Page 23 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 24 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 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards 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 © (2009) 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. Care Homes for Older People Page 26 of 26 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!