CARE HOMES FOR OLDER PEOPLE
Freshfields Agaton Road St Budeaux Plymouth Devon PL5 2EW Lead Inspector
Fiona Cartlidge Unannounced Inspection 13th July 2006 10:45 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 Freshfields DS0000003586.V292742.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. Freshfields DS0000003586.V292742.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Freshfields Address Agaton Road St Budeaux Plymouth Devon PL5 2EW 01752 360000 01752 361584 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) Freshfields Management Company Limited vacancy Care Home 39 Category(ies) of Physical disability over 65 years of age (39), registration, with number Terminally ill over 65 years of age (39) of places Freshfields DS0000003586.V292742.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. Physically disabled (over 50 years) One Service User named elsewhere under 65 years may reside at the home. TI(E) Maximum registered 39 service users (both) PD(E) Maximum registered 39 service users (both) Date of last inspection 02/03/06 Brief Description of the Service: Freshfields is a purpose built facility in the St Budeaux area of Plymouth. It provides nursing care to a maximum of 39 Service Users, male or female, over the age of 65. The home is on two floors with lift access. The majority of rooms have en-suite bathrooms. There is a lounge and a separate dining room. There is a patio to the rear leading to a garden area accessible via ramps. The home is owned by Freshfields Management Company Ltd and is currently being managed by one of the directors of the company Mrs Angela Teasdale. Freshfields DS0000003586.V292742.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over 6 hours and 15 minutes and was unannounced. A partial tour of the home took place when some bedrooms and all communal living rooms were viewed. Personal records of care held in the home on behalf of 4 clients and personnel records of 3 members of staff were inspected. The inspector spoke with 12 residents, 5 staff members as well as the acting manager and her deputy. Written feedback was received from 4 clients and 3 staff. The homes senior staff had also submitted answers to a pre-inspection questionnaire supplied to them by the Commission. What the service does well:
The information about this service provided to prospective service users and or their representatives is of a good standard and in sufficient detail to allow an informed decision to be made about admission. The admissions process is safe; a good level of information about people’s conditions and needs is received to enable the nurses in the home to make a professional judgement about if/how each person’s needs will be met. When possible i.e. if the person being admitted is geographically accessible, the acting manager and her deputy visit the person in their existing setting to perform a full needs assessment in addition to receiving documentation from other social and health care professionals. Resident’s needs are set out in an individual plan of care, the plans provide sufficient information for care staff to be able to meet the individuals’ health, social and psychological needs. The registered person promotes and maintains residents’ health and ensures access to health care services to meet assessed needs. The Commission received written feedback from 2 General Practitioners who visit this home regularly both rated the homes management of health and personal care as good. Residents are able to maintain contact with family and friends and exercise choice and control over their lives. Residents receive a wholesome appealing diet; Menu choices are advertised, all the residents spoken to said the food provided in the home is of a good standard one commented ‘The food is excellent’. Written feedback from 2 residents was received 1 indicated they ‘always’ like the food and commented ‘the food is absolutely excellent’ the other indicated they ‘usually’ like the meals at the home, their comment was ‘the food has improved recently’. One resident told the inspector it would be nice if the menus changed occasionally perhaps seasonally. The home is pleasantly decorated and furnished and clean, bright and hygienic. Freshfields DS0000003586.V292742.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. Freshfields DS0000003586.V292742.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 Freshfields DS0000003586.V292742.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): 1,3,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The information about this service provided to prospective service users and or their representatives is of a good standard and in sufficient detail to allow an informed decision to be made about admission. The admissions process is safe. This home does not provide intermediate care. EVIDENCE: The inspector read 2 recently reviewed documents containing a good level of information to enable people to make decisions about the suitability of the home in meeting their needs. The documents are entitled ‘Service Users Guide’ and a ‘statement of purpose’. Two residents provided written feedback to the commission about this home both confirmed they had received enough information about the home before they moved in and had received a contract. The inspector examined the personal records held on behalf of 4 residents and the information obtained for a prospective resident due to be admitted the day
Freshfields DS0000003586.V292742.R01.S.doc Version 5.2 Page 9 of the visit. These documents provided evidence that a good level of information about people’s conditions and needs is received to enable the nurses in the home to make a professional judgement about if/how each person’s needs will be met. When possible i.e. if the person being admitted is geographically accessible, the acting manager and her deputy visits the person in their existing setting to perform a full needs assessment in addition to receiving documentation from other social and health care professionals. Freshfields DS0000003586.V292742.R01.S.doc Version 5.2 Page 10 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): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s needs are set out in an individual plan of care. The registered person promotes and maintains residents’ health and ensures access to health care services to meet assessed needs. The homes medication storage system does not fully protect the medical welfare of residents. Residents are treated with respect and their right to privacy is upheld. EVIDENCE: The personal records examined which are held on behalf of residents contained assessments in relation to nursing needs, skin condition, moving and handling, nutrition, continence and pain, this information was of a good standard and provided detail on which the care plans were based. There was evidence that the care planning process had been reviewed with the resident and their representatives where possible. The care plans provided sufficient information for care staff to be able to meet the individuals’ health, social and psychological needs. The documents held on behalf of the residents showed
Freshfields DS0000003586.V292742.R01.S.doc Version 5.2 Page 11 that the staff refer residents to the general practitioner appropriately. The Commission received written feedback from 2 General Practitioners who visit this home regularly both rated the homes management of health and personal care as good. Letters regarding hospital appointments were seen providing evidence that residents are enabled to access specialist services according to need. 2 residents provided written feedback, 1 confirmed they always receive the medical support they need the other indicated they usually received the medical support they need and commented ‘matron will always call doctor if asked’. An inspector examined the system for storing. Administering and recording of medication held in the home. The records of medication entering and leaving the home were of a good standard. The storage of medication was found to be safe, with the exception of medication required to be stored in a fridge at temperatures between 2-8 degrees centigrade - the fridge temperatures had not been checked or recorded and the inspector found some ice on one of the shelves. Residents told the inspector that the staff respect their privacy and dignity, the inspector observed that when personal care was being provided this was done behind closed doors, the staff spoke to residents in a polite manner and were witnessed to knock on the doors to private accommodation before entering. Freshfields DS0000003586.V292742.R01.S.doc Version 5.2 Page 12 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): 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some effort is made by the home to provide an activities programme and social interaction/stimulation for residents. Residents are able to maintain contact with family and friends and exercise choice and control over their lives. Residents receive a wholesome appealing diet but sometimes the menu is monotonous. EVIDENCE: The inspector found that limited social activities are currently being offered in the home residents said that musical entertainment is arranged approximately every 2 weeks but little else. Two residents provided written feedback about activities; when asked ‘Are there activities arranged by the home that you can take part in?’ one indicated sometimes and commented ‘we are hoping new management will arrange some entertainment’ and the other ‘there used to be activities but I’m not sure if there is now’. Residents spoken to during the visit told the inspector that they would like more organised activities one said they used to enjoy the bingo that was put on but it doesn’t happen any more. Some residents were
Freshfields DS0000003586.V292742.R01.S.doc Version 5.2 Page 13 observed in the lounge some receiving visitors, some watching telly but most just sitting, others were seen to spend time in their rooms again some were receiving visitors others were reading, watching television – one resident had had their own digital viewing dish put up for them, or listening to radios and one resident said the staff would post their letters for them. Records confirmed that musical entertainment is arranged once a fortnight. Residents said they were able to make choices about how and where they spent their time, one confirmed they stayed in their room but that was their choice. Menu choices are advertised – all the residents spoken to said the food provided in the home is of a good standard one commented ‘The food is excellent’. Written feedback from 2 residents was received 1 indicated they ‘always’ like the food and commented ‘the food is absolutely excellent’ the other indicated they ‘usually’ like the meals at the home, their comment was ‘the food has improved recently’. One resident told the inspector it would be nice if the menus changed occasionally perhaps seasonally. During a tour of the premises the kitchen was found to be clean. Feedback from relatives/visitors at the time of the inspection indicates that they all feel welcomed into the home at any time. Freshfields DS0000003586.V292742.R01.S.doc Version 5.2 Page 14 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): 16,18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents and their relatives/friends know how to make a complaint. People are safe living in this home. EVIDENCE: Residents spoken with at the time of the inspection told the inspector they knew who to speak to if they were dissatisfied with the care or services provided. Complaints procedures were found in residents’ rooms in the Service Users Guide. Two residents who provided written feedback indicated that they ‘usually’ know how to make a complaint. It has not been practise in this home for verbal complaints to have been documented and handled under the homes written complaints procedure this was discussed with the acting manager and her deputies at the time of the inspection and all agreed a more formal approach to documenting and responding to complaints would be beneficial. Information seen in individual staff training records indicates that most staff have received recent training on the Protection of Vulnerable Adults (POVA). The inspectors was told by the acting manager that the homes policy and procedure relating to responding to allegations or incidence of abuse or neglect was currently under review. Freshfields DS0000003586.V292742.R01.S.doc Version 5.2 Page 15 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): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is pleasantly decorated and furnished and clean, bright and hygienic. EVIDENCE: A tour of the home showed that resident’s rooms contain personal items of furniture and ornaments and pictures. All of those spoken to said they liked their rooms, some particularly commented positively about the fact they have there own en suite bathroom. The home appeared well equipped to meet the needs of those residents identified with moving and handling risks and disabilities that affect their capability to bathe. Specialist mattresses were seen in place for those residents requiring them, as were height adjustable beds. The communal area of the home was fresh and clean; Hand washing facilities are available throughout the home as were protective gloves.
Freshfields DS0000003586.V292742.R01.S.doc Version 5.2 Page 16 Freshfields DS0000003586.V292742.R01.S.doc Version 5.2 Page 17 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): 27,28,29,30, Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are usually sufficient numbers of staff with appropriate skills and knowledge to meet the needs of residents in this home. The homes recruitment practise protects residents from being placed at risk of harm or abuse. EVIDENCE: The home has recently changed ownership and there has been a reasonably high turnover of staff, residents and visitors told the inspector that this had worried them but also said that they were pleased because new staff had now been taken on. Comments received during the inspection included ‘the staff couldn’t be better’ ‘the staff don’t have time to talk’, ‘the nurses are kind and very hard working’, ‘the staff are very busy, but are always polite and respectful’. The staff spoken to on the day of the inspection told the inspector they like working at Freshfields and have access to training and all the equipment they need to carry out their roles effectively. The individual training records seen show that staff do have access and are actively encouraged to attend mandatory training on fire safety, protection of Vulnerable adults and safe moving and handling. The records did not provide evidence that each member of staff has received a minimum of 3 days training per year. Staff records did show that the staff have a wide range of qualifications and experience to enable them to care for current residents needs. Less than 50 of Care staff
Freshfields DS0000003586.V292742.R01.S.doc Version 5.2 Page 18 have obtained a National Vocational Qualification however the deputy manager told the inspector that further training is a priority. The inspector examined the personnel files of 3 recently employed members of staff the records showed a commitment to extremely safe recruitment practises files contained detailed application forms, at least 2 written references, Criminal Record Bureaux checks, induction records, job description, code of practise forms, health and safety responsibilities, health assessments and interview notes and evidence that two people are involved in interviewing applicants. Staff grievance, discipline and whistle blowing policies were seen displayed as notices in the nursing office. Two residents provided written feedback, when asked are the staff available when you need them? One indicated usually and commented ‘they are very very busy, but given time they get things done’ the other indicated that in their opinion the staff are available when they are needed ‘sometimes’ and commented ‘having changed hands recently staff seem unsettled and at weekends in particular it is hard to find a member of staff’. Freshfields DS0000003586.V292742.R01.S.doc Version 5.2 Page 19 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): 31,33,35,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well run, but the current person managing the home is not registered as manager under the Care Standards Act 2000. However, she has had nine years experience as a registered manager at two other homes. Client’s views underpin self- monitoring, review and development in this home. The health, Safety and welfare of service users is protected. EVIDENCE: Comments received from residents and staff during the field trip confirmed that the previous manager who has now left was well respected and is now missed, however they confirmed the acting manager and deputy manager
Freshfields DS0000003586.V292742.R01.S.doc Version 5.2 Page 20 have filled the void well in her absence. The inspector witnessed meaningful interaction by the acting and deputy manager with staff and residents. The inspector examined the records and storage of personal money held in the home on behalf of residents. A random selection of actual balances were checked against the documentation and found to be correct. Best practise systems are in place for the protection of both residents and staff. A bank account is being opened for resident’s funds. Internal auditing processes are in place, an external health and social care consultant has assisted the directors of the company in performing an analysis of the homes strengths and weaknesses to enable them to develop the service further. Accident and incident analysis has commenced on a monthly basis and a quality assurance questionnaire was supplied in April, 17 responses were received and correlation of this information performed to inform future changes and improvements. The inspector examined the recorded minutes of recent meetings between the management team and staff these provided evidence of clear direction from management along with a willingness to listen to the views of others in consideration of finding the best way forward to reach required outcomes. The provider generally demonstrates a responsible attitude towards health and safety pre-inspection information given to the Commission by the provider indicates that services and equipment are routinely maintained and serviced by people trained to do so, many fire doors that were open were being held by ‘safe’ hold open devices and notices were displayed throughout the home. Risks to residents are individually assessed and documented with an agreed plan in place to minimise risk where possible. Requirements and recommendations communicated from previous inspections are acted upon. Freshfields DS0000003586.V292742.R01.S.doc Version 5.2 Page 21 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 Freshfields DS0000003586.V292742.R01.S.doc Version 5.2 Page 22 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 OP31 Regulation 8 Requirement The registered provider must appoint an individual to manage the care home and the person must apply to register with the Commission. Timescale for action 30/01/07 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 OP7 Good Practice Recommendations Service Users plans of care should be reviewed by care staff in the home at least once a month, updated to reflect changing needs and current objectives for health and personal care and actioned. When there is an instruction for medicines to be stored between 2-8 degrees centigrade this instruction should be adhered to this requires fridge temperatures to be regularly monitored. Service users should be given opportunities for stimulation through leisure and recreational activities in and outside
DS0000003586.V292742.R01.S.doc Version 5.2 Page 23 2 OP9 3 OP12 Freshfields 4 OP30 the home, which suit their needs, preferences and capacities. The registered person should ensure that the staff training programme ensures all staff receive a minimum of 3 paid days training/year to enable staff to fulfil the aims of the home and the changing needs of service users. Freshfields DS0000003586.V292742.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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