CARE HOMES FOR OLDER PEOPLE
Freshfields Agaton Road St Budeaux Plymouth Devon PL5 2EW Lead Inspector
Fiona Cartlidge Unannounced Inspection 24th January 2007 11:30 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.V328401.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.V328401.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 care@onetel.com 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 Angela Teasdale Care Home 39 Category(ies) of Physical disability over 65 years of age (39) registration, with number of places Freshfields DS0000003586.V328401.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 13th July 2006 Brief Description of the Service: Freshfields is a purpose built facility in the St Budeaux area of Plymouth. It provides nursing and personal 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. Information about the home was found in the entrance hall and in residents bedrooms, people can request a copy of the latest inspection reports from the administration office. Information given to the Commission by the provider indicates the current range of fees is from £438 - £520/week. Freshfields DS0000003586.V328401.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The site visit took place over 5 hours 30 minutes and was unannounced. A partial tour of the home took place when some bedrooms and all communal areas were viewed. Three residents had their care case tracked this means their records were examined in detail and all three residents were spoken to in depth about the care and services they receive. Five other residents were spoken with during the visit, as were 3 visitors/relatives one Social services professional and 3 members of staff and the registered manager/provider. Personnel records of 3 members of staff and policies and procedures were also inspected. What the service does well:
People are provided with sufficient information about the service to enable them to make a decision about admission to the home. Each resident is given a guide, which sets out the aims and objectives of the home and provides comprehensive information about the service. People can be sure their needs will be met following their admission to the home because an assessment of care needs of prospective service users takes place prior to admission to the home. The registered person promotes and maintains residents’ health and ensures access to health care services to meet assessed needs. All residents are registered with a GP. Records provided evidence that as well as visits from General Practitioners, district and specialist nurses, chiropodists, physiotherapists and dentist’s also visit. Records of outpatient appointments show that visits to community and hospital health resources are enabled. The feedback about food was positive all of the residents spoken to said how good it was; Menus were seen and residents chose their meal options on a weekly basis. The people living in the home said they were happy with the visiting arrangements, visitors said they feel welcomed into the home visiting was seen to take place in the lounge and privately in residents own rooms. 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. Freshfields DS0000003586.V328401.R01.S.doc Version 5.2 Page 6 The home is well equipped to meet the needs of those residents identified with moving and handling risks and disabilities that affect their capability to mobilise and or to bathe. There are sufficient numbers of staff with appropriate skills and knowledge to meet the needs of residents in this home. The residents were complimentary about the staff team confirming their needs were met 24 hours a day. Comments received from clients included: ‘I am really impressed with the care and support that I am given here’, ‘the staff are kind and attentive. Management arrangements are meeting the needs of the service, and the quality of the service is continually assessed. The registered provider shows a responsible attitude toward promoting and protecting the health, safety and welfare of residents and staff. 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.
Freshfields DS0000003586.V328401.R01.S.doc Version 5.2 Page 7 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Freshfields DS0000003586.V328401.R01.S.doc Version 5.2 Page 8 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.V328401.R01.S.doc Version 5.2 Page 9 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. 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. People are provided with sufficient information about the service to enable them to make a decision about admission to the home. The admissions process is safe. This home does not provide intermediate care. EVIDENCE: The home has a service users guide this document sets out the aims and objectives of the home and provides comprehensive information about the service. This booklet was available in the entrance of the home and each resident’s room. Three residents were spoken with about how they chose this home; one commented that they chose the home because they had always lived in the area, one visitor had recommended the home because they had
Freshfields DS0000003586.V328401.R01.S.doc Version 5.2 Page 10 known another resident, another residents relative said they had chosen the home because of its close proximity to their own home to enable them to visit regularly. All of those spoken to said they felt they had received enough information. An assessment of care needs of a prospective service user takes place prior to admission to the home. Records seen included copies of assessments carried out through care management arrangements and hospital/community health care teams where applicable. A full assessment of need is performed by staff employed by the home following the residents’ admission and this information and that from the preadmission care management/health assessments informs the homes care planning process. Freshfields DS0000003586.V328401.R01.S.doc Version 5.2 Page 11 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. 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 system protects the medical welfare of residents. Residents are treated with respect and their right to privacy is upheld. EVIDENCE: Personal records held on behalf of 3 residents were examined; in all of those seen there were documented assessments which provided information about skin integrity, moving and handling, safety - including risk of falls, nutritional screening and social needs. The information generates the plans of care, which
Freshfields DS0000003586.V328401.R01.S.doc Version 5.2 Page 12 provide the basis for the care to be delivered. The care plans were clear and easy to understand and had been regularly reviewed with input from the residents and/or their representatives. These care records are held in the residents rooms and all were aware they contained personal information about them. 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, district and specialist nurses, chiropodists, physiotherapists and dentist’s visit. Records of outpatient appointments show that visits to community and hospital health resources are enabled. The medication system is well managed; the inspector looked at storage and recording – controlled drug stock was checked against records and found to be correct The home uses a monitored dosage system, which is well organised and easily audited and administered from purpose built trolleys directly to the residents on a 1:1 basis. Disposal of unused medication is safe, well recorded and removed by a licensed contractor. Staff were seen and heard knocking on doors before entering rooms and were carrying out personal tasks in private. Staff observed in 1:1 conversation with residents were heard to be courteous and respectful. Freshfields DS0000003586.V328401.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This home provides 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 a choice of meals is well advertised. EVIDENCE: During the site visit, some residents were seen sitting in the lounge; in one part of the lounge a television was on, but none of the residents seemed to be aware of or interested in the programme. Other residents were seen spending time in their rooms, reading, listening to music, and watching television. In the afternoon a group of 7 residents were seen participating with staff making handy crafts such as cards and items of jewellery. Considerable effort is made by the home to find out resident’s life histories these are documented; other
Freshfields DS0000003586.V328401.R01.S.doc Version 5.2 Page 14 records seen included activities assessments, comments sheets and activity records. The feedback about food was positive all of the residents spoken to said how good it was; Menus were seen and residents chose their meal options on a weekly basis. The people living in the home said they were happy with the visiting arrangements, visitors said they feel welcomed into the home visiting was seen to take place in the lounge and privately in residents own rooms. Freshfields DS0000003586.V328401.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. 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: The complaints procedure was found to be included in the document ‘service users guide’, which was situated in the entrance hall and in resident’s rooms. Three people who had their care case tracked said they were aware of how to make a complaint and know who to speak to if they are not happy they said they would talk to ‘matron or sister’. All confirmed they had nothing to complain about. Residents said they feel safe living in the home. There have been no complaints referred to the Commission about this service. The staff record complaints and documents were seen including investigation methods – statements and responses to complainants including any action taken. Freshfields DS0000003586.V328401.R01.S.doc Version 5.2 Page 16 The policies and procedures seen, included information on adult protection and whistle blowing. Staff training records show that staff have recently received training on the protection of vulnerable adults. Freshfields DS0000003586.V328401.R01.S.doc Version 5.2 Page 17 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. 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 environment is safe and adequately maintained. The home is clean 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. Freshfields DS0000003586.V328401.R01.S.doc Version 5.2 Page 18 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. A soap bar was seen in one communal bathroom this poses a risk to residents because the damp warm medium provides a suitable place for bacteria to grow and this could cause cross contamination if used on more than one person. The manager explained the plans for improving accessibility to the garden for residents and staff and groundwork was seen to be taking place in the garden at the time of the visit. Freshfields DS0000003586.V328401.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are 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: Three Personnel files were examined, these records showed a commitment to safe recruitment practises, files contained detailed application forms, 2 written references, Criminal Record Bureaux checks, health checks, induction records and training and development records, main terms and conditions of employment. Individual training records (personal development plans) provided evidence that training is provided and ongoing. Staff spoken to on the day of the site visit confirmed they received sufficient training to enable them to meet the needs of those living in the home.
Freshfields DS0000003586.V328401.R01.S.doc Version 5.2 Page 20 At the time of the visit 6 care staff were attending a National Vocational Training meeting with their facilitator. Records and discussion with all disciplines of staff show that the provider is committed to ensuring the homes employees obtain a National Vocational Qualification. (a nationally recognised qualification). Certificates displayed in the home show that 5 staff have recently completed a certificated course on caring for persons who have dementia and another 4 staff have enrolled on the course. The residents were complimentary about the staff team confirming their needs were met 24 hours a day. Comments received from clients included: ‘I am really impressed with the care and support that I am given here’, ‘the staff are kind and attentive. Freshfields DS0000003586.V328401.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Management arrangements are meeting the needs of the service, and the quality of the service is continually assessed. The registered provider shows a responsible attitude toward promoting and protecting the health, safety and welfare of residents and staff. EVIDENCE: Freshfields DS0000003586.V328401.R01.S.doc Version 5.2 Page 22 The registered manager/provider is an experienced 1st level registered nurse. Patients, visitors and staff made positive comments about the manager in the home saying they felt comfortable approaching her with Issues. Communication systems are regular through staff handovers and regular staff meetings. A quality management system is in place and a quality-rating questionnaire was provided to residents in November 2006 the information has been collated and communicated. Each resident has a key worker and resident and relatives meetings are planned for 2007, as is a regular newsletter. The homes health and safety policy statement was examined and risk assessments had been completed in line with this. Analysis takes place on all accidents within the home and action is taken if any particular pattern occurs. Maintenance and associated records provided evidence that the registered provider has a sensible approach towards maintaining the health and safety of residents and staff; the fire precautions logbook indicates that the fire alarm is tested weekly and emergency lights monthly. Records and discussion confirmed that the staff have regular training in fire safety and moving and assisting residents. Freshfields DS0000003586.V328401.R01.S.doc Version 5.2 Page 23 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 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 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 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X X X 3 Freshfields DS0000003586.V328401.R01.S.doc Version 5.2 Page 24 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. Standard Regulation Requirement Timescale for action 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 OP26 Good Practice Recommendations To prevent the risk of cross contamination Soap bars should not be stored in communal bathing rooms. Freshfields DS0000003586.V328401.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 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
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