CARE HOMES FOR OLDER PEOPLE
Freshfields Agaton Road St Budeaux Plymouth Devon PL5 2EW Lead Inspector
Fiona Cartlidge Unannounced Inspection 11:30 2 March 2006
nd 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.V264027.R01.S.doc Version 5.1 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.V264027.R01.S.doc Version 5.1 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 Marjorie Anne Hoyle 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.V264027.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. Physically disabled (over 50 years) One Service User named elsewhere under 65 years may reside at the home. Manager to complete Registered Managers Award by December 2005 TI(E) Maximum registered 39 service users (both) PD(E) Maximum registered 39 service users (both) Date of last inspection 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, 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 DS0000003586.V264027.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over 3 hours and 45 minutes and was unannounced. This was the homes second statutory inspection of the year 2005-2006 readers may wish to consider the content of both reports to gain a full picture of the homes achievements in relation to key National Minimum Standards. A partial tour of the home took place when some bedrooms and all communal areas were viewed. Individual records of care held on behalf of 3 residents were inspected. The inspector spent the majority of the time talking with 5 residents and 1 visitor and took time observing actual practise. What the service does well: What has improved since the last inspection?
It is disappointing that few of the requirements or recommendations made at the time of the last inspection in 2005 have been acted upon.
Freshfields DS0000003586.V264027.R01.S.doc Version 5.1 Page 6 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.V264027.R01.S.doc Version 5.1 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.V264027.R01.S.doc Version 5.1 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): 1,2,3,5, People are provided with sufficient information about the services and facilities to make an informed decision about their admission to this home. The admissions procedure enables the staff to make a professional judgement about how the needs of individuals will be met. People are invited to visit the home before making a decision about admission. EVIDENCE: Each resident’s room had a copy of a useful information guide. The guide is informative and contains a copy of the contract/terms and conditions of residency. The inspector examined the personal records held within the home on behalf of 3 of the residents (10 ) the inspector found that information about the individuals’ health, personal and social care had been sought and residents are visited in their current settings to enable the registered nurses to make a professional judgement about how needs will be met before offering the individual the opportunity of admission. Residents told the inspector that the home had been recommended to them through word of mouth or on a list of homes given to them by their care manager all had either visited the home them selves or a relative had done so
Freshfields DS0000003586.V264027.R01.S.doc Version 5.1 Page 9 on their behalf. Only one resident admitted as an emergency from the local community said they had not visited before their admission. Freshfields DS0000003586.V264027.R01.S.doc Version 5.1 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): 7,8,10 Two Care plans seen had not been reviewed by staff in the home on a monthly basis, this may pose a risk to residents, as staff may not formally recognise changes and be consistent in their approach to meeting needs. The health care needs of residents are regularly reviewed and action is taken to meet those needs EVIDENCE: The 3 documented assessments seen, provided information about skin integrity, moving and handling, safety - including risk of falls, and nutritional assessment, none included social care needs assessment. This information had been obtained from pre-admission assessments performed by staff from the home which includes gaining information about peoples medical needs, social history and ability to perform all activities of daily living. Further information is provided at the time of admission from the patient’s current setting as well as from the social services department if they have arranged the admission. All of the information obtained generates the plans of care, which provides a basis for the care to be delivered. Freshfields DS0000003586.V264027.R01.S.doc Version 5.1 Page 11 The inspector viewed 3 residents’ care plans; two had not been reviewed as recommended by staff in the home on a monthly basis. Daily records of the actual care provided are maintained. Records are maintained for all visits to the home by social or health care professionals, all residents are registered with a GP. Records provided evidence that as well as visits from General Practitioners, chiropodists, physiotherapists and dentists also 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 were witnessed to knock on the doors to private accommodation before entering. The inspector observed a resident being assisted to their own room when a doctor visited to examine them. Freshfields DS0000003586.V264027.R01.S.doc Version 5.1 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): 13,15 Meals are nutritious and balanced offering a healthy and varied diet for residents. The arrangements for residents to receive visitors are good. EVIDENCE: The feedback about food was positive all of the residents spoken to said how good it was; on the day of inspection lunch was served, residents were offered Roast beef or chicken with all the usual trimmings followed by rice pudding, fruit pie or chocolate sponge with custard. Most residents ate their meal in the dining room, some needing assistance were seen to have their meals served in the lounge at individual tables; those requiring assistance were given this in an appropriate supportive manner. All other residents ate their lunch in their own accommodation. The people living in the home told the inspector they were happy with the visiting arrangements, visitors said they feel welcomed into the home and are able to visit their relative/friend in private. Freshfields DS0000003586.V264027.R01.S.doc Version 5.1 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 People know who to speak to if they are dissatisfied. EVIDENCE: The home has a complaints procedure, which is included in the service user guide the information is inclusive of details on how to contact the Commission for Social Care. Those residents spoken to told the inspector they would speak to matron if they had any concerns about their care or the services provided in the home. Freshfields DS0000003586.V264027.R01.S.doc Version 5.1 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 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 areas of the home were fresh and clean in their appearance; Hand washing facilities are available throughout the home as were protective gloves. Freshfields DS0000003586.V264027.R01.S.doc Version 5.1 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,30 The number and skills of staff available in the home meets the needs of those living in the home. EVIDENCE: The home employs 9 Registered Nurses these trained nurses are assisted by Care Assistants, 9 care staff have achieved a National Vocational Qualification (NVQ) in care or equivalent and 1 more is currently working towards a NVQ. The staff records provide evidence that the staff have a wide range of qualifications, skills and experiences. All of the residents spoke of the kindness and helpfulness of the staff, One said they are ‘polite and cheerful’, another ‘they couldn’t do more’. All residents spoken to said they felt there was always enough staff on duty. Training records did not provide evidence that all staff receive 3 days training/year. The records did provide evidence of recent training on moving and handling and some staff are to attend infection control training in the near future. Freshfields DS0000003586.V264027.R01.S.doc Version 5.1 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 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): 31,38 The home is being managed effectively and in the best interests of its residents. Failures to ensure that bedroom doors are held open with ‘safe’ devices pose a fire risk to residents. EVIDENCE: This Registered Manager of the home is an experienced registered nurse and has completed the units required to obtain the Registered Managers Award. An administration manager supports the registered manager. The inspector witnessed a good level of communication between the manager and the staff, residents, visitors/relatives and visiting professionals. All residents have an individual assessment of risks posed to them from the environment. The inspector found during the tour of the building that a number of bedroom doors were being held open with wooden wedges. The inspector discussed the
Freshfields DS0000003586.V264027.R01.S.doc Version 5.1 Page 17 need for safe approved (by the fire safety department) hold open devices to be used. Freshfields DS0000003586.V264027.R01.S.doc Version 5.1 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 4 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 x 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x x x x x x 1 Freshfields DS0000003586.V264027.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? yes 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 OP7 Regulation 15(2) Requirement Service users plans of care must be kept under review and updated to reflect changes in care. Extended from 01/11/05 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. Extended from 01/11/05 The registered person must consult with the fire authority to ensure safe hold open devices are fitted to doors where residents wish to have the doors to their accommodation open
DS0000003586.V264027.R01.S.doc Timescale for action 01/04/06 2. OP33 26(2) 01/04/06 3 OP38 13(4) 23(4) 01/04/06 Freshfields Version 5.1 Page 20 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 30 Good Practice Recommendations Staff training records should be maintained in enough detail to evidence the actual amount of and subject of the training for each individual. Freshfields DS0000003586.V264027.R01.S.doc Version 5.1 Page 21 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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