Inspection on 14/09/05 for Freshfields Nursing Home

This inspection was carried out on 14th September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Freshfields Nursing Home 27/10/08

Freshfields Nursing Home 15/11/07

Freshfields Nursing Home 24/01/07

Freshfields Nursing Home 13/07/06

Freshfields Nursing Home 02/03/06

Freshfields Nursing Home 01/02/05

Freshfields Nursing Home 28/09/04

Freshfields Nursing Home 11/02/04

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

CARE HOMES FOR OLDER PEOPLE Freshfields Agaton Road St Budeaux Plymouth PL5 2EW Lead Inspector Fiona Cartlidge Unannounced 14 September 2005 th 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. Freshfields D52-D07 S3586 Freshfields V235162 140905 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Freshfields Address Agaton Road St Budeaux Plymouth PL5 2EW 01752 360000 01752 361584 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) Freshfields Management Company Limited Marjorie Anne Hoyle Care home with nursing 39 Category(ies) of TI (E) - 39 registration, with number PD (E) - 39 of places Freshfields D52-D07 S3586 Freshfields V235162 140905 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: 1. Physically disabled (over 50 years) 2. One Service User named elsewhere under 65 years may reside at the home 3. Manager to complete Registered Managers Award by December 2005 4. TI (E) Maximum registered 39 service users (both) 5. PD (E) Maximum registered 39 service users (both) Date of last inspection 01/02/05 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. All rooms have ensuite bathrooms. There is a lounge, smoking 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 managed by Mrs Marjorie Hoyle. Freshfields D52-D07 S3586 Freshfields V235162 140905 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over 5 and a half hours and was unannounced. A tour of the home took place and personal records of 3 residents and 3 staff were inspected. The inspector spoke to 15 of the residents, 5 visitors, 2 members of staff as well as the registered Manager and administrator. Two of the company’s directors were in the home when the inspection commenced but were happy to let the registered manager assist the inspector. The staff on duty were professional and helpful in their approach to the inspection. What the service does well: A proper assessment is performed on people considering admission to this home this provides information to the homes staff so they can be sure they can meet the individuals needs. Residents are referred to community and hospital health care professionals when specialist needs are identified to ensure their medical needs are met. Social activities are organised and provide stimulation and interest for residents on most days. Meals are nutritious and balanced offering a healthy and varied diet for residents. People feel safe living in this home and know who to speak to if they are dissatisfied. The home is well decorated and furnished and clean, pleasant and hygienic. The procedures for the recruitment of staff are robust and offer protection to people living in the home. The deployment and number of staff on duty during the inspection met the needs of the residents. The home is being managed properly and there is evidence of clear leadership, guidance and direction to staff. Systems for holding money in the home on behalf of service users are safe. Quotes received from residents include ‘ I couldn’t be looked after better, the staff are kind gentle and polite’. ‘can’t fault it’. Freshfields D52-D07 S3586 Freshfields V235162 140905 Stage 4.doc Version 1.20 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 full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Freshfields D52-D07 S3586 Freshfields V235162 140905 Stage 4.doc Version 1.20 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 Freshfields D52-D07 S3586 Freshfields V235162 140905 Stage 4.doc Version 1.20 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) 1,3,5 The information provided in the homes guide is out of date and this poses a risk that prospective service users will not have an accurate picture on which to place their judgement of admission or not. The information the staff receive about perspective service users is adequate to ensure the admissions process is safe for those considering admission to this home. EVIDENCE: Freshfields D52-D07 S3586 Freshfields V235162 140905 Stage 4.doc Version 1.20 Page 9 The inspector examined the written information guide, found in the patient’s bedrooms; the information about the management of the home was found to be out of date and there were gaps in the information for instance - the cost of hairdressing. The guide is written in plain English and can be produced in large print if required The inspector examined personal records held on behalf of 3 recently admitted residents; all included pre-admission information supplied from care management and/or hospital settings. The Manager confirmed that staff from the home make every effort to perform the homes own pre- admission assessments on all prospective service users except those admitted via the early hospital discharge scheme or in an emergency where time does not allow, in these cases the home obtains detailed relevant information to enable them to make a clear decision about the homes ability to meet the needs of individuals. The inspector spoke to a number of patients about how they had made the decision to be admitted to the home, the inspector was told that some had been given a list of homes by the placing authority and had visited several before deciding that Freshfields was the one for them, others had heard about the home through word of mouth, all told the inspector that they (or their representatives) had been able to visit the home before making a decision. Freshfields D52-D07 S3586 Freshfields V235162 140905 Stage 4.doc Version 1.20 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 standard(s) 7,8,910 Care plans were not in place for a patient who had been admitted 10 days before this inspection and one other plan of care had not been updated to reflect a change in the care being given - this poor documentation poses a risk that patients may not have all their care need met in a consistent manner. The health care needs of residents are monitored and medical and specialist nursing advice is sought when needed. Patients are treated with respect and their right to privacy is upheld. EVIDENCE: The inspector viewed 3 care plans; The records seen provided evidence that patients have had their needs assessed with regard to risks of pressure sores, continence, moving and handling and nutrition however only one had been reviewed as recommended on a monthly basis they also lacked detail about the social history and the record of social therapies to provide a plan to meet social needs. There was documentary evidence that patients and or their representatives had been involved in the planning process, one patient who’s care the inspector case tracked confirmed he had been involved in the plan to meet needs. Records are maintained for all visits to the home by social or health care professionals, all residents are registered with a GP who visits the home on a Freshfields D52-D07 S3586 Freshfields V235162 140905 Stage 4.doc Version 1.20 Page 11 weekly basis. Records provided evidence that as well as visits from General Practitioners, specialist nurses, a chiropodist and dentists visit. Records of outpatient appointments show that visits to community and hospital health resources are enabled. 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 knocked on the doors to private accommodation before entering. Freshfields D52-D07 S3586 Freshfields V235162 140905 Stage 4.doc Version 1.20 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 standard(s) 12,13,14,15 The lifestyle experienced in the home meets the expectations of most people who are resident. Contact with family and friends is actively encouraged and supported. People receive a nutritious and varied diet. EVIDENCE: There was no organised group social activity on the day of inspection. Patients and staff told the inspector that the care staff organise and provide activities on a Tuesday and Thursday afternoon these are held in the dining room and include board games and dominoes. In addition movement to music classes are held on a Monday and periodically various entertainers visit the home. During the inspection patients were spending time socially in the lounge or were in their rooms or in the lounge, receiving visitors, watching television, reading or listening to music, one patient said they were disappointed there had been no trips away from the home. The inspector spoke with 5 visitors all said they feel welcomed into the home and 2 commented particularly about how beneficial it was for them to be able to purchase meals whilst visiting and appreciated free beverages being served during their visits. Everyone said how much they enjoy the food served and praised the cook for the quality of the meals and the standard of cooking. Some people chose to eat in the dining room, those people requiring assistance from staff are given this whilst sitting in their chairs in the lounge detracting from the usual dining Freshfields D52-D07 S3586 Freshfields V235162 140905 Stage 4.doc Version 1.20 Page 13 experience however 2 patients said they preferred it that way because it was more comfortable for them. Lunch provided was ‘bangers and mash’ or steak and kidney pudding served with vegetables and potatoes the only adverse comment was that there was too much. Dessert followed and was peaches and cream or fruit sponge and custard. The patients and visitors said they were very happy with the choices available for all meals. The manager told the inspector that menus have recently been reviewed to take in to consideration meals that had not been very popular and those that patients had said they would like to see included. Residents said they had recently enjoyed some trips out despite the weather. Freshfields D52-D07 S3586 Freshfields V235162 140905 Stage 4.doc Version 1.20 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 standard(s) 16,18 People know who to talk to if they are unhappy. Lack of a specific procedure for responding to allegations of abuse may pose a risk that incidents may not be dealt with effectively in a timely fashion. EVIDENCE: The home has a complaints procedure, which is included in the information pack. The procedure needs to be updated to include the correct details of the Commission for Social Care Inspection (CSCI) to enable people to make a complaint to them at any time. There have been no complaints recorded in this inspection year. The home has a copy of the local councils alerter guidance and a whistle blowing policy but lacks a robust procedural document including specific details of local agencies which must be contacted if an allegation or incidence of abuse occurs. A large number of staff have received training on preventing, recognising and reporting elder abuse. All of the patients spoken to confirmed they feel safe living in the home. Freshfields D52-D07 S3586 Freshfields V235162 140905 Stage 4.doc Version 1.20 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 standard(s) 19,20,21,22,23,24,25,26 The environment is safe and meets the needs of those living at the home comfortably. EVIDENCE: A tour of the home provided evidence that the providers maintain an attractively presented environment for patients and staff that is well maintained. Patient’s rooms contained 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 their own en suite bathroom. All doors into patient’s bedrooms have locks accessible by staff in emergencies. Cordless nurse call alarms are in use these activate bleepers carried by the staff. This nursing home appeared well equipped to meet the needs of those patients identified with moving and handling risks and disabilities that affect their capability to bathe. One person was being transferred in a wheelchair without foot plates – to prevent their feet dragging on the floor the carer tilted the Freshfields D52-D07 S3586 Freshfields V235162 140905 Stage 4.doc Version 1.20 Page 16 chair back when moving it – this poor practise was discussed with the manager at the time of the inspection to prevent a re-occurrence. Specialist mattresses were seen in place for those requiring them as were height adjustable beds. All areas of the home were fresh and clean in their appearance; Hand washing facilities are available throughout the home, as were protective gloves. Freshfields D52-D07 S3586 Freshfields V235162 140905 Stage 4.doc Version 1.20 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 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) 27,29,30 The skill mix and numbers of staff are sufficient to meet the needs of those living in the home. The recruitment procedure is robust and provides safeguards for those living and working in the home. EVIDENCE: Patients spoke of the kindness and helpfulness of the staff, all those spoken to said the staff had to work very hard and felt that there was usually enough staff on duty. Despite 2 members of staff being absent through sickness on the day of the inspection the care staff spoken to said they had managed to meet the needs of the patients through good team work. The staff on duty during the inspection were seen to be polite and attentive. Nurse call bells were answered in a timely fashion. Staff training records indicated that no training had taken place this year but discussion and viewing of attendance certificates showed some training has taken place but has not been recorded and therefore the inspector is unable to confirm that all staff receive 3 paid days training/year. Despite being contracted to provide palliative care – no one in the home has undertaken a specialist-training course in palliative care or recent relevant training in symptom control or communication with the dying and their family records indicate that specialist nurses including Macmillan and stoma care nurses visit and advise if requested. There is no infection control link nurse despite the health protection agency offering this support to nursing homes in the area. Freshfields D52-D07 S3586 Freshfields V235162 140905 Stage 4.doc Version 1.20 Page 18 The inspector examined the personnel files of 3 recently employed members of staff these contained all of the information and documents required to safeguard the welfare of residents and in addition showed a fair and equitable interview process is completed. Freshfields D52-D07 S3586 Freshfields V235162 140905 Stage 4.doc Version 1.20 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 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) 31,33,35,38 The registered manager has the qualifications, skills and experience to effectively manage the home and is well supported by team who work well together in the best interests of those living and receiving care in this home. EVIDENCE: The registered manager has the qualifications, skills and experience to manage this service effectively. Patients and staff confirmed the manager is approachable and takes appropriate action to meet needs. Safety notices were displayed throughout the home and written information viewed by the inspector indicates that fire equipment is regularly maintained and tested. The inspector viewed the personal records held on behalf of 3 residents these included individual assessments of risks connected to: use of bed rails, falls, climbing out of windows and for risk of scalds. The inspector examined the records and storage of personal money held in the home on behalf of residents. The actual balances were checked against the Freshfields D52-D07 S3586 Freshfields V235162 140905 Stage 4.doc Version 1.20 Page 20 documentation and found to be correct, all receipts are stored for auditing purposes and the money is securely stored. Internal auditing processes are in place, the Inspector viewed satisfaction survey results from patients and discussed the actions taken by the manager to correct the issue raised which had resulted in additional staff starting at midday to meet the needs of the high number of patients needing assistance to eat their lunch time meal. It is hoped that satisfaction surveys will be used more widely for instance with staff and visiting professionals to affect the way in which this service runs. The company directors visit the home on an at least weekly basis but do not prepare a report and have no formal systems of auditing the services provided in this home. Freshfields D52-D07 S3586 Freshfields V235162 140905 Stage 4.doc Version 1.20 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. Where there is no score against a standard it has not been looked at during this inspection. 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 2 x 3 x 3 x 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 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 x 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 2 3 x 3 x 3 x x 3 Freshfields D52-D07 S3586 Freshfields V235162 140905 Stage 4.doc Version 1.20 Page 22 yes 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 7 Regulation 15(2) Requirement Service users plans of care must be kept under review and updated to reflect changes in care. The responsible individual or one of the partners must visit the home at least once a month unannounced, interview with consent and in private service users and or their representatives, persons working at the care home in order to form an opinion of the standard of care provided in the home. Inspect the records of incidents and accidents and complaints and prepare a written report a copy of this report as required under regulation 26 must be supplied to the Commission and the registered Manager. Timescale for action 01/11/05 2. 33 26(2) extended from 01/03/05 to 01/11/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Freshfields Refer to Standard Good Practice Recommendations D52-D07 S3586 Freshfields V235162 140905 Stage 4.doc Version 1.20 Page 23 1. 2. 1 9 3. 4. 12 16 5. 18 6. 30 The Statement of Purpose and Service users guide should be reviewed to ensure the information provided is inclusive and current. When insulin is prescribed on a titrating scale according to blood sugar readings, the actual amount of insulin administered must be recorded clearly to ensure that an audit trail of correct administration is maintained. The social history and interests of patients should be recorded and a plan to meet social needs must be documented, followed and regularly reviewed. The complaints procedure should be updated to include the correct the details of the commission so that people are able to contact it at any time if they wish to make a complaint. A robust procdure should be put in place and communicated to all staff to ensure that the correct process is followed should an allegation or incident of abuse occur. Staff training records need to be improved/kept up to date, analysis of training needs should be performed at least annually to ensure the staff have up to date knowledge and skills to meet the needs of patients in the home. Freshfields D52-D07 S3586 Freshfields V235162 140905 Stage 4.doc Version 1.20 Page 24 Commission for Social Care Inspection 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 © 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 Freshfields D52-D07 S3586 Freshfields V235162 140905 Stage 4.doc Version 1.20 Page 25 - 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!