Inspection on 27/10/08 for Freshfields Nursing Home

This inspection was carried out on 27th October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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 14/09/05

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 29/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Freshfields Nursing Home Agaton Road St Budeaux Plymouth Devon PL5 2EW     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Antonia Reynolds     Date: 0 6 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Freshfields Nursing Home Agaton Road St Budeaux Plymouth Devon PL5 2EW 01752360000 01752361584 info@freshfieldsnursing.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Freshfields Management Company Limited care home 38 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: 1. The registered person may provide the following category of service only: Care Home providing nursing care - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - (Code OP) - Maximum 38 places Physical disability over 50 years - (Code PD) - Maximum 12 places Dementia - (Code MD) - maximum 38 places Mental disorder, excluding learning disability or dementia - (Code MD) maximum 38 places The maximum number of service users who can be accommodated is 38. Date of last inspection 38 38 0 12 Over 65 0 0 38 0 Care Homes for Older People Page 4 of 32 Brief description of the care home Freshfields is a care home providing accommodation, nursing and personal care for a maximum of thirty-eight people, over the age of 50, with dementia or other mental disorder, twelve of whom may also have physical disabilities. It is privately owned by Freshfields Management Company Limited and the Directors also own another care home in Somerset. In November 2008 the fee levels started from approximately 532 Pounds per week but vary depending on the individual needs of each person. The home is a purpose built, two-storey, detached building located in the residential area of St Budeaux. The home is within walking distance of shops in St Budeaux and close to bus services into central Plymouth and the railway station. Thirty-six of the homes bedrooms are single, with one shared room, and all but one bedroom have en suite bathrooms with fixed bath hoists for use if needed. There are fourteen bedrooms on the ground floor and twenty-three on the 1st floor, which can be accessed using the shaft lift. Communal rooms are on both floors and consist of two lounges, two dining rooms and a sensory room. The home has a conservatory, with ramped access into the garden, which contains a patio and raised flower beds. The home has a parking area and there is on street parking available nearby. Information about the home, including inspection reports, can be obtained from the Registered Manager, Mrs Teasdale, who is also a Director of the company that owns the home. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection consisted of an unannounced visit to the home by two inspectors between 9am and 3.30pm on Monday, 27th October 2008 and a further announced visit by one inspector between 2.15pm and 4.05pm on Thursday, 6th November 2008. We last inspected this service on the 15th November 2007. Throughout this report, the term we will be used as the report is written on behalf of the Commission for Social Care Inspection. An Annual Quality Assurance Assessment (AQAA) was completed by the home prior to the inspection. The AQAA is a self-assessment that focusses on how well outcomes are met for the people who live in the home. A tour of the premises took place and records relating to care, staff and the home were inspected. A period of two hours was spent observing a group of people who would not Care Homes for Older People Page 6 of 32 be able to tell us verbally about their experience of living in the home. Information gathered during this time was used to develop a picture of how well people are being supported by staff in the home and how the staff team can improve the way they work with people. Five people living in the home were spoken with during the visit and thirteen surveys were returned from them, although some of these had been completed by relatives. Ten survey forms were left in the home for relatives to complete if they wish to. Eight staff members were spoken with and twelve surveys were received from staff. The Registered Manager was available for consultation and discussion during the inspection process. What the care home does well: What has improved since the last inspection? What they could do better: The records in the home that show when medication has been administered to the people who live there was not always being completed accurately. Staff are meant to sign the medication administration records on every occasion when medication is administered to the people who live in the home but this was not happening and needs to be improved. This is so that there is an accurate record of when medication is administered to ensure that people are given the correct medication at the required times. Each person living in the home has a care plan saying what their care needs are. Care Homes for Older People Page 8 of 32 However these could be improved by including more information on peoples social and personal histories as well as information on their previous lifestyles, interests and routines. This is so that staff have more detailed information about peoples diverse lifestyles and interests before they came to live in the home. It would also be useful to encourage staff to be more involved in developing and writing the care plans so that they have a better understanding of people as individuals which will help them to provide more person-centred care. Also, where people had specific needs identified on care plans, the format used contained the word problem rather than need. This should be reviewed and changed to terminology that has more positive connotations. This is so that anyone reading the care plan does not see someones care needs being portrayed as problems. At the time of inspection the staff in the home were using two different sets of records for recording daily events. It would be useful to amalgamate these daily records so that there is a continuous, chronological, history of the persons care rather than information being contained in two different documents. Although the home now has its own transport to take people out, trips have not been arranged on a regular basis. Therefore arrangements should be made for the people who live in the home to have trips out on a regular basis. These trips should be planned to suit peoples needs and preferences. This is so that people have opportunities to enjoy and pursue their social, cultural, religious and recreational interests in the wider community. A robust recruitment procedure is necessary as the first step to keeping the people who live in the home safe from harm. Therefore, before appointing a new member of staff a full employment history needs to be obtained. If there are any gaps in that history, a written explanation needs to be provided. This is to ensure that recruitment procedures are robust enough to provide support and protection to the people who live in the home. Whilst staff do receive in-house training regarding the safeguarding of vulnerable people, they should also attend the training provided by the Local Authority. This is to make sure that all staff are aware of the local procedures to be followed should an incident of abuse or neglect be suspected or alleged. The numbers of staff on duty need to be kept under review at all times due to the changing care needs of the people who live in the home. This is to ensure that there are enough staff on duty at all times to meet the physical, psychological, emotional and social needs of the people who live there. During the inspection a staff member was seen assisting two people at the same time to eat their meal at lunchtime. This meant that neither person was receiving the attention they needed, therefore there should be enough staff on duty at lunchtime so that they can assist people individually. Due to the homes visitors book being kept on the other side of a locked door from the entrance foyer, it is not always being completed by visitors. Therefore arrangements need to be put into place to make sure that the names of all visitors to the home are recorded. This is so that staff know who is in the building at any point in time and, if needed, can check when they arrive and leave. The home has a quality assurance system in place that asks for feedback from the people who live in the home and relatives or representatives. This system would be Care Homes for Older People Page 9 of 32 more comprehensive if it included an annual internal audit of the services and facilities in the home. Also, the results of surveys from people who live in the home should be published and made available to anyone who would like a copy. This is so that interested individuals and agencies can see that the home is being run in the best interests of the people who live there. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes Statement of Purpose and Service User Guide give people sufficient information about the services the home provides to decide whether this home is the right place for them. Pre-admission processes are in place to ensure that peoples needs are properly identified and planned for before they move into the home. Evidence: Discussions with two people living at the home confirmed that they chose to live there. One person said they had visited other places but Freshfields had been recommended to them. The home has a Statement of Purpose and Service User Guide, which contain details of the services available in the home, to help people decide if they want to live in this home. The Registered Manager confirmed that each person living in the home has been given a copy of the Service User Guide and one was available in the entrance foyer. One person spoken with confirmed that they had read the Service User Guide and knew the information that it contained. They said they would look at it if they Care Homes for Older People Page 12 of 32 Evidence: needed to know what services were available, such as the hairdresser and chiropodist. Discussion with the Registered Manager confirmed that, before people come to live in the home, a member of the management team, a qualified nurse, carries out a thorough inital assessment of their phsyical, psychological and social care needs to decide whether the home can meet their needs. The files of three people who had recently been admitted to the home were inspected and these all contained preadmission assessments of their needs. Surveys from staff members also confirmed that they have enough information about peoples needs to provide the care required. The admission process includes visits to the home to meet the other people who live there and staff, so that people have a chance to assess the quality, facilities and suitability of the home. The AQAA says that the home offers a four week trial period for people to decide whether they wish to remain living at Freshfields. Freshfields does not provide intermediate care. Care Homes for Older People Page 13 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home are treated with respect and, overall, personal support is offered in a way that promotes peoples privacy and dignity. There are arrangements in place to ensure that medication is administered in a safe way. Evidence: The files of three people who live in the home were inspected and these contained individual care plans, recently reviewed and updated, with information on care needs and how staff at the home would meet those needs. However the care planning documentation did not contain much information about peoples social and personal histories, or their previous lifestyles, interests and routines. Also the system being used referred to areas of need as problems. A discussion took place about changing the terminology to something more positive so that areas of need are not seen as problems but as identified needs where people may require assistance. Where possible care plans inspected were signed by people who live in the home and/or relatives/representatives to show that they have been involved in drawing up the plan and were aware of the content. The Registered Manager said that they are in the Care Homes for Older People Page 14 of 32 Evidence: process of introducing more person centred planning into the home and intend to start life story books for everyone so that staff will be aware of the diverse interests and needs of the people they are caring for. Discussion with the Registered Manager indicated that staff are not always involved in developing and writing care plans. One staff member spoke about how much they enjoyed learning more about peoples lives and how this helped them care for and better understand the people living in the home as individuals. Peoples files contained the names and addresses of their relatives and representatives so that staff would know who to contact should they need to. Each file contained recently reviewed and updated risk assessments relating to falls, skin/pressure area care, moving and handling and nutrition. Information about each person living in the home was recorded on a daily basis although there were two sets of daily records - one completed by the nursing staff and one completed by the care staff. A discussion took place about amalgamating this information so that everything was recorded chronologically in one record. People who were able to comment, feedback from relatives and staff, as well as information contained in personal files, confirmed that people living in the home have access to health care services such as doctors, the tissue viability nurse, dentists, chiropodists, opticians and hospital consultants. A survey from one person who lives in the home said The care I receive here is very good. The staff care for most of my needs, and are cheerful. Equipment to promote peoples health and well being was provided including specialist baths and equipment for promoting pressure area care and to prevent skin breakdown. Those people able to comment, as well as surveys from people who live in the home and their relatives, confirmed that the staff treat them with respect and preserve their privacy and dignity at all times. Staff were observed knocking on doors before entering private rooms. Medication was stored securely and most of it was administered from blister packs. Records relating to the administration of medication were up-to-date although there were gaps where there was no signature to say medication had been administered, but the medication was not in the container. The only staff who administer medication are qualified nurses therefore have been trained in the administration of medication. There were procedures and documentation in place for the removal of unused medication by a licensed contractor. The home had a refrigerator specifically for storing medicines that needed to be kept cold. A member of staff was observed whilst administering medication and this was done in a safe, respectful and individual way for each person. Care Homes for Older People Page 15 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The routines in the home are relaxed, relatives and friends can be confident that they are welcomed, and social activities are arranged. The dietary needs of the people who live in the home are catered for with a balanced and varied selection of food that reflects their tastes and choices. Evidence: The home has an ongoing activity programme giving people the opportunity to take part in a variety of activities both within the home and in the community. In-house activities include bingo, dominoes, cookery, crafts, massage, nail care and a musical entertainer visits at least once a month. A survey from a person who lives in the home said they particularly enjoyed bingo, singing and the throwing ball exercise. The home also has a sensory room for people to use for relaxation but staff said this was not used very much. A discussion took place with the Registered Manager about ways of increasing the use of this room to enhance peoples quality of life and feeling of well-being. A staff member is designated as the activities organiser between 2pm and 4pm each day. The Registered Manager said that the staff responsible for activities have undertaken specific training to provide activities for people with dementia. Trips out are arranged occasionally for three or four people, with staff, to places such as the Care Homes for Older People Page 16 of 32 Evidence: moors or a garden centre. However, the Registered Manager said that there have not been many trips out recently as the minibus, that also has a tail lift to transport people who use wheelchairs, has not been working properly but it would be fixed as soon as possible. Feedback from a relative commented that there were very few trips organised outside the home. Another person commented that her relative who lives in the home enjoys the activities and takes part in them. The home owns a rabbit who lives in the entrance foyer, there are fish in a tank in the lounge, and the home has adopted a donkey. He has visited the home on occasion so that people can see and touch him. There is also a lady who visits with Gus the Dog who is a therapeutic pat dog for people to pat and stroke. The AQAA said that religious leaders of any faith are welcomed and peoples religious interests were documented in their personal files. During this inspection a period of two hours was spent in the lounge room, and during a mealtime, observing the experience of the care home from the perspective of five people. These people were some of the more frail people living at the home and had problems with communication which meant they were not able to easily discuss their experiences. For most of this period people were alert and aware of what was going on in the room. There were no formal activities observed during this time but discussion with the Registered Manager showed that, as the home moves towards a more person centred way of approaching care planning, there will be more focus on individual plans for activity reflecting peoples previous routines and lifestyle choices. The observation showed that some staff, whilst caring for the people living at the home with respect, were not always tuned in to the experiences or emotional well being of the people they were caring for. As an example one person became quite distressed when being transferred into a wheelchair for lunch and their distress was not addressed by the staff moving them. In another example of a better intervention one person was very well supported by a member of staff who addressed them by their name, sat close to them and used touch to attract their attention before laughing about a shared experience. This demonstrated a genuine affection and a valuing of the person as an individual. Some people received very little communication from staff other than information giving such as its lunchtime now, and sometimes staff were seen talking about people rather than to them. This undermines people and has a tendency to make people withdraw from contact as they feel excluded. A discussion was held with the Registered Manager and deputy manager on positive communication and ways of improving this. Other people living at the home who were able to express an opinion said that they Care Homes for Older People Page 17 of 32 Evidence: were supported to follow their chosen lifestyles as far as possible. One person spoke about how they valued the staff and the support they were given to follow their chosen lifestlye and on how much time their family were able to spend with them in the home. Family and friends were observed visiting the home and it was evident that they were actively welcomed into the home and may visit whenever they liked. A survey from a person who lives in the home said My family are always made welcome when visiting and offered refreshment. A survey from a relative said that the staff are always friendly and make us feel welcome. People who lived in the home were very complimentary about the meals provided. Surveys received from people in the home included comments such as meals are very good and meals are lovely. Surveys from relatives also commented on the quality of the food in the home. The menus showed that was always a choice of two main meals at lunchtime although people could always choose an alternative to these. Special diets, such as diabetic, were catered for and dietary needs were documented in peoples personal files. If anyone needed their food liquidised, each item was liquidised separately so that it was easy to differentiate between the food items, for example, meat and vegetables, on the plate. If someone living in the home has specified needs, the community dietician is contacted for advice and guidance. The observation showed that the mealtime was very busy and the room quite noisy, which meant some people found concentrating on their meal quite difficult. In addition people being fed were not always receiving the full attention of the member of staff supporting them. On at least two occasions a staff member was feeding more than one person at once. This meant that neither person received the full attention of the staff member or a relaxing experience. Discussions were held with a member of staff about a person who had been reluctant to eat and they outlined the strategies they had previously used to encourage them to eat. They had an awareness of the persons inattention in the dining room and they had a strategy to resolve this the next day which was commendable. Care Homes for Older People Page 18 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in the home can be confident that any complaints or concerns will be listened to and acted upon by the home. Evidence: The homes written complaints procedure was displayed in the entrance foyer as well as a copy being given to each person who lives in the home. Surveys from people who live in the home confirmed that they know how, and to whom, to make a complaint should they need to. This was also confirmed by relatives who completed survey forms. People living in the home, who were able to comment, said they would talk to the staff on duty if they had any concerns, and this was observed during the inspection. Thirteen surveys from people who live in the home, or their relatives, confirmed that they have no complaints about the home. The Commission for Social Care Inspection received an anonymous complaint about the home recently which was passed to the Registered Manager who investigated the issues raised thoroughly. The home keeps a complaints log where all concerns and complaints are recorded as well as the details of any investigation and actions required. The home has a visitors book to record dates, times and names of all visitors to the home. The expectation is that visitors to the home fill this book in themselves but feedback from a visitor said this does not always happen because the book is kept behing a locked door off the entrance foyer. This Care Homes for Older People Page 19 of 32 Evidence: means it is not easily accessible by visitors and staff do not always remember to complete it. The staff training records in the home showed that all staff are expected to complete in-house training related to the safeguarding of vulnerable adults. However staff have not attended the safeguarding training provided by the Local Authority therefore may not be aware of the local procedures to follow should an incident of abuse or neglect be suspected or alleged. Discussion with the Registered Manager confirmed that she was knowledgeable about the local processes in place to safeguard vulnerable people. Care Homes for Older People Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean, comfortable and warm and recent investment in changing the layout, to provide more rooms for people to relax and eat their meals, provides a better environment for the people who live in the home. Evidence: A full tour of the premises took place and the home was found to be warm, comfortable, generally free from offensive odours and clean although some side tables in the lounge were sticky. The communal rooms consist of a large lounge room, which has a variety of seating for people to use and a smaller sitting room where people can receive visitors in private, rather than use their bedrooms or the large lounge. There are dining rooms on both floors which are accessible by the people who live in the home. The bedrooms are located on the ground and 1st floors and there is a shaft lift to the 1st floor. Bedrooms where people were receiving personal care were not seen during this inspection. The home had suffered from a recent fire which had left considerable smoke damage in one area. Some people had been relocated to other local homes as a result. The Registered Manager said that this damage will be repaired within a couple of weeks and that people will be able to return. On the instructions of the fire authority some keypad locks have been removed. The accommodation is zoned into several areas and all bedrooms are for single occupancy, except for one shared room. The AQAA said that thrity-six of these rooms have en-suite bathrooms with Care Homes for Older People Page 21 of 32 Evidence: fixed bath hoists to help people get in and out easily. The management of the home have begun making some adaptations to the environment so that it is more suitable for people with memory loss, for example more directional signs and identifying peoples rooms by putting each persons photograph on the door. Rooms had some personalised items such as photographs, although some rooms would benefit from more personalisation to help orientate people and make them feel more at home. Some rooms have had the flooring replaced with a vinyl flooring, and some areas have radiators which are not covered or guarded. This could present a risk of injury if people came into prolonged contact with them, for example by falling against them. The laundry and sluice room were clean and clear of obstruction. Appropriate arrangements for controlling the spread of infection were seen including gloves and aprons being available and sealed systems for transferring soiled and potentially infected linens between bedrooms and the laundry. A relative commented that the laundry is always spotlessly clean and very neatly ironed. Two people who live in the home commented, in surveys, that the home is always fresh and clean and is a lovely and beautiful place. Care Homes for Older People Page 22 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Caring staff, in sufficient numbers, support the people who live in the home. Overall recruitment practices protect the people who live in the home from risk of harm. Evidence: Information contained in staffing rotas, as well as discussion with the Registered Manager, showed that there are usually three or four qualified nurses on duty during the day, seven care staff in the mornings and five care staff in the afternoons. They are supported by an administrator and catering, domestic and laundry staff. A member of staff is also designated to organise activities between 2pm and 4pm each day. At night there are four waking staff members, one of whom is a qualified nurse. Surveys returned from six staff members and one relative said that there are not usually enough staff in the home to meet the needs of the people who live there, particularly when someone is on holiday or off sick. Information in surveys from relatives indicated that the staff are respectful, polite and caring towards the people who live in the home. One person commented that the staff are very helpful and very polite and another relative said I think the staff are all wonderful and always have our best interests at heart. They are always friendly and make us feel welcome. Care Homes for Older People Page 23 of 32 Evidence: The files of four recently recruited staff members were inspected. All of these showed that the required checks and references were obtained before people started working in the home. However three of them did not contain full employment histories and there were no written explanations of the reasons for these gaps. Obtaining this information is important to make sure that staff are suitable to care for the people who live in the home. The Registered Manager confirmed that all new staff, including qualified nurses, are expected to complete a structured induction programme within the first few weeks of appointment. Discussions with staff members, as well as information contained in surveys, confirmed that the induction training was comprehensive and covered everything they needed to know to do their job. One staff member said that new staff shadow more experienced staff until they are competent and feel confident to do the job. Staff spoken to said they worked well as a team, that Freshfields was a good place to work and one staff member said that the staff team are brilliant. In particular they praised the training available to them and the support they receive, from both peers and management, to do their job. The AQAA and discussion with the Registered Manager confirmed that, due to the improved training opportunities for staff, the home gained the Investor in People Award in June 2008. Staff training records showed that approximately two thirds of the care staff have obtained qualifications in caring for older people, namely National Vocational Qualifications (NVQ) at level 2 or 3, and six people were in the process of obtaining a level 2 NVQ. All care staff are expected to undertake a comprehensive course in how to provide care for people with dementia. In addition staff are expected to complete training in moving and handling, emergency first aid, health and safety, food hygiene, infection control, safeguarding vulnerable adults and an awareness and understanding of relevant legislation, for example, the Mental Capacity Act. These records also showed that staff have opportunities to participate in specialised training such as conflict management, palliative care, the importance of nutrition for older people and equality and diversity issues. Surveys from four staff members confirmed that they have good training opportunities and consider that they have enough training to do their jobs well. However the two hour observation showed that staff are not always communicating well with people with dementia, do not always acknowledge distress and may talk about people rather than to them. Care Homes for Older People Page 24 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home can be confident that it is well managed. The health, safety and welfare of the people living in the home are promoted and protected. Evidence: The Registered Manager, Mrs Teasdale, is a qualified nurse and has many years experience of managing care homes. She undertakes periodic training to update her knowledge, skills and competence, for example, knowledge of the Mental Capacity Act and how that may affect people who live in the home as well as how the home is run. Mrs Teasdale operates an open door policy and feedback from staff included comments such as we are well supported by the Manager and the home is run very efficiently. A survey from a relative said they are very pleased with the home in general and would recommend it to others. Discussion with the Registered Manager, as well as documentation and surveys from staff, showed that the staff have regular staff meetings and 1:1 supervision meetings Care Homes for Older People Page 25 of 32 Evidence: with a member of the management team. Training records showed that care staff are expected to complete training in emergency first aid, food safety/hygiene, moving and handling, infection control and health and safety. Discussions with the Registered Manager and the administrator, as well as documentation, confirmed that the financial affairs of the people who live in the home are managed by themselves, their families or representatives. The home did administer spending money on behalf of some people who lived in the home. The money held at the home for three of the people who live there was checked and found to be correct. All transactions required the signature of the administrator and these records were checked regularly by other members of the management team or the owners of the home. The fire safety equipment records showed that checks and tests of the fire safety equipment are carried out regularly and a local contractor services the fire alarm system and fire extinguishers at least annually. Information contained in the staff training records showed that staff had received training in fire safety awareness and/or had attended a fire drill. Newly appointed staff had received training in fire safety procedures on the first day of employment as part of the induction process. Recommendations from the fire service, following a recent fire in the home, had been actioned by the Registered Manager. A tour of the premises on the first day of inspection found that most of the radiators were guarded to prevent the risk of burns to the people who live in the home. By the last day of inspection radiators in communal areas, such as the main hallway, had been guarded and the Registered Manager confirmed that guards had been ordered for radiators in en-suite facilities. There was documentation in the home to show that the gas system and appliances had been checked and serviced in September 2008. The Registered Manager confirmed that the electrical wiring had been checked in October 2008 but the certificate had not yet arrived. Documentation showed that all portable electrical appliances in the home had been checked for safety between September and October 2008. Servicing records showed that the shaft lift was serviced in October 2008 and the hoists in May 2008. The home has a quality assurance system in place and the administrator of the home distributes questionnaires to people living in the home on a regular basis. A sample of completed surveys were seen during the inspection. The results are collated and any points for improvement noted and acted upon. However the home was not carrying out an annual internal audit of the services and facilities in the home or publishing the results of the surveys. Care Homes for Older People Page 26 of 32 Care Homes for Older People Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 17 The medication administration record must be signed on every occasion when medication is administered to the people who live in the home. This is so that there is an accurate record of when medication is administered to ensure that people are given the correct medication. 27/12/2008 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 The daily records should be amalgamated so that there is a continuous, chronological history of the persons care rather than information being contained in two different documents. The care planning documentation should include more information on peoples social and personal histories as well as information on their previous lifestyles, interests and routines. Staff should be encouraged to be more involved in developing and writing the care plans. This is so that staff have more detailed information about peoples diverse Page 29 of 32 2 7 Care Homes for Older People lifestyles and interests before they came to live in the home. This will give staff a better understanding of people as individuals which will help them to provide more personcentred care. The use of the word problem in the care planning system should be changed to terminology that has more positive connotations. This is so that anyone reading the care plan does not see someones care needs being portrayed as problems. 3 10 Staff should not talk about people but talk to them. This is to ensure that peoples right to dignity is upheld and enhanced by the staff team. Arrangements should be made for people to have trips outside the home on a regular basis, which suit their needs and preferences. This is so that people have opportunities to enjoy and pursue their social, cultural, religious and recreational interests in the wider community. A record should be kept of all visitors to the home. This is so that staff know who is in the building at any point in time and, if needed, can check when they arrive and leave. All staff should attend the training provided by the Local Authority regarding the safeguarding of vulnerable people. This is to ensure that all staff are aware of the local procedures to be followed should an incident of abuse or neglect be suspected or alleged. The number of staff on duty at all times should be reviewed in relation to the care needs of the people who live in the home. There should be enough staff on duty at lunchtime so that they can assist people individually, rather than at the same time. This is to ensure that there are enough staff on duty at all times to meet the physical, psychological, emotional and social needs of the people who live there. Before appointing a new member of staff a full employment history should be obtained and a written explanation provided for any gaps in the employment history. This is to ensure that recruitment procedures are robust enough to provide support and protection to the people who live in the home. Staff should receive appropriate training, particularly around communicating with people with dementia, to ensure they have the skills to meet the assessed needs of people living in the home. The quality assurance system should be developed to include an annual internal audit of the services and facilities in the home. The results of surveys from people who live in the home should be published and made available to anyone who would like a copy. This is so that interested 4 12 5 18 6 18 7 27 8 29 9 30 10 33 Care Homes for Older People Page 30 of 32 individuals and agencies can see that the home is being run in the best interests of the people who live there. Care Homes for Older People Page 31 of 32 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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