Inspection on 24/05/07 for Freshfields Residential Home

This inspection was carried out on 24th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Freshfields Residential Home 06/02/06

Freshfields Residential Home 03/10/05

Freshfields Residential Home 03/03/05

Freshfields Residential Home 19/05/04

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

CARE HOMES FOR OLDER PEOPLE Freshfields 265 Corbets Tey Road Upminster Essex RM14 2BN Lead Inspector Jackie Date Unannounced Inspection 9:30am 24 May to 14th June 2007 th 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 DS0000027852.V337387.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 DS0000027852.V337387.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Freshfields Address 265 Corbets Tey Road Upminster Essex RM14 2BN 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) 01708 226362 May Residential Homes Ltd Mrs Annette Gaskin Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33) of places Freshfields DS0000027852.V337387.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th February 2006 Brief Description of the Service: Freshfields is a privately owned residential care home that is registered to accommodate thirty-three older people. The home is situated in a residential area in Upminster being within walking distance of local shops and other amenities. The home is also close to bus and train links and is within easy reach of the M25 motorway. The home used to accommodate 20 people but was extended last year. As part of the extension an additional bathroom facility was included and one of the lounges was extended to make more communal and dining space. At the same time a new office was built and the garden was re designed. There are now 30 single rooms and one double room. The other double room is used as a single room. 24 of the rooms have en suite facilities. The home is accessible to wheelchair users. There is a well kept garden that some of the residents enjoy sitting in. Bathing and toilet facilities are suitable for the needs of older people. The residents enjoy activities such as music, day trips, walks, bingo, scrabble and special interest days. The fees per week for each resident are between £490-00 & £560.00. This information was provided by the proprietor at the time of the visit. Information about the service provided is contained in the service users’ guide and residents’ welcome information pack. Freshfields DS0000027852.V337387.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over the course of two days. The first day of the inspection was unannounced and started at 9:30. It took place over seven hours. A second arranged visit took place the following week. The purpose of this was to be shown around the home by residents and then to meet a group of residents to get their views on the service and their experience of living in the home. A specialist pharmacist inspection was carried out on 14th June and the report from this visit is included in the section relating to medication. Care staff were asked about the care that residents receive, and were also observed carrying out their duties. All of the shared areas and some of the bedrooms were seen. Staff, care and other records were checked. Feedback questionnaires were sent to residents, relatives and staff. Responses were received from 26 residents, 26 relatives and also from 17 staff. Feedback was also received from a visiting healthcare professional. The contract monitoring officer for the local authority was also contacted for feedback. However most of the people living at the home are privately funded and therefore this person was unable to provide any feedback on the quality of the service. This was a key inspection and all of the key inspection standards were tested. The inspector would like to thank the residents and staff for their input during the inspection. What the service does well: There is a relaxed atmosphere in the home and relatives are welcomed. Families can have meals with their relatives and are invited to any celebrations or events organised at the home. New residents are made to feel welcome with a welcome buffet and a welcome cake. Residents have the opportunity to join in a range of activities and outings and this exceeds minimum standards. Staff, residents and relatives all have the opportunity to discuss the service and to make suggestions about future changes. Staff feel that they get a lot of help and support and that this enables them to provide a good service that meets the residents’ needs. Relatives said “they look after everybody in their care very well”, “we are lucky to have Freshfields in our area”, “I don’t think that they can improve”, Freshfields DS0000027852.V337387.R01.S.doc Version 5.2 Page 6 “standards are excellent”, “the care is second to none, well organised and stimulating, I cannot praise it enough.” Residents said, “I have no complaints, I am happy here”, “I am very happy at the home, could not be better”, “”the food is excellent”. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Freshfields DS0000027852.V337387.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Freshfields DS0000027852.V337387.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, & 5. People using the service experience excellent quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. Information is obtained to enable the staff team to decide whether or not the home can meet prospective residents’ needs. Prospective residents and their relatives can spend time in the home to find out what it would be like to live there and to enable the resident to make a choice about living in the home, within their capacity to do so, and to be confident that the home meets their needs. Prospective residents and their relatives and representatives have an opportunity to visit, assess the quality, facilities and suitability of the home. Residents and their representatives have a written and costed contract/statement of terms and conditions and will therefore be clear about what they are entitled to. Freshfields DS0000027852.V337387.R01.S.doc Version 5.2 Page 9 EVIDENCE: There is a Statement of Purpose & Service Users’ guide. These were updated last year to reflect the expansion of the service and the opening of the new extension. Residents spoken to said that they had been given of copy of the guide. One relative said, “the information was very informative”. Most of the residents are privately funded when they move into Freshfields and therefore they usually apply directly to the home. Prospective residents are invited to view the home with their family. Also to stay for dinner and take part in the entertainment. The manager carries out a comprehensive assessment. The assessments cover all of the required areas and include personal care, eating, dressing, health, mobility, physical well being, cultural and spiritual needs. Examples of this were seen in residents’ files. One resident said that she had lived in another home previously but had not settled, however she felt settled at this home. Another resident said “I have just signed to stay here permanently”. A new resident said that everyone had made her very welcome and had taken time to introduce themselves. She also said that she had received a welcome card and flowers and also a welcome cake. All of this was helping her to settle in. Another resident spoke about her first visit to the home and said “the manager greeted us by saying hello I am Annette. At another home we were greeted with “hello, I am the matron. This said a lot to me about how the home would be.” Each resident has a contract with the provider and a copy of these were seen in residents’ files. A resident said “the contract was clear and the manager took time to explain it to me.” The home does not provide intermediate care. Freshfields DS0000027852.V337387.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11. People using the service experience excellent quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. The staff team are able to meet the needs of residents and support them in a way that they prefer, through gathering detailed information and good care planning arrangements. Residents receive personal care that meets their individual needs and preferences. The principles of respect, dignity and privacy are put into practice. This exceeds minimum standards Residents receive good quality health care. Although two immediate requirement notices were served there is a generally high standard of control of medicines at the home. The manager is taking interim measures to avoid the risks involved with these requirements until they are met. After discussing the recent problems experienced with medicine administration and records, and the options for addressing the problems, I feel the manager is competently handling the issues. At the end of their life residents are supported kindly and sensitively. Freshfields DS0000027852.V337387.R01.S.doc Version 5.2 Page 11 EVIDENCE: All of the residents have care plans, which give details of their needs and how to maintain their independence as far as possible. This includes health and personal care. They also contain information about residents’ likes and preferences. Careplans also indicate areas where residents are encouraged and supported to do things for themselves. For example, choose their own clothing, butter their own toast, have some time in the bath on their own. Residents and/or their relatives are asked to read and sign the care plans. Careplans are reviewed monthly, or sooner if required, by the staff team. Reviews are held with the residents and their families twice yearly. Residents spoken to confirmed that they had taken part in reviews. Each resident has a nominated keyworker. Care plans seen had been reviewed regularly and updated when required. They therefore contained up to date information to enable staff to meet residents’ needs. One relative “they look after everybody in their care very well. A resident said, “ the care and support received is excellent”. Another said “there is a buzzer if you need it. I am a light sleeper so I have asked them not to come in during the night”. A third resident said “I have had to use the buzzer in the night for a couple of silly things. The staff have always responded and have said that it is not a problem”. Other feedback received was “she is cared for in a friendly and efficient way, the care and kindness is excellent”. “The staff are lovely and help me to look after myself and my clothes. I am very fussy and they help me to be clean and smart. This is very important to me”. Residents are registered with local GPs. The optician, dentist and chiropodist make regular checks. The district nurse visits as and when required to provide nursing support. Residents’ weight is monitored and dietary needs addressed. Manual handling assessments are made. Medical information is recorded and the outcome of visits to the doctor or hospital and any follow up action is recorded. Residents are always supported to attend doctors and hospital appointments and this includes any visits to accident and emergency. One relative said, “since moving into Freshfields my mothers health and happiness have improved greatly. Although the home is not registered to provide care to people with Dementia some residents do experience some memory lose. To assist staff to support those residents appropriately they have received Dementia awareness training. In addition the proprietor and the management team are booked to attend an advanced Dementia Care training course to increase their knowledge in that area. Overall the evidence above confirms that residents receive excellent personal and healthcare that not only meets their needs but also encourages and Freshfields DS0000027852.V337387.R01.S.doc Version 5.2 Page 12 maintains their independence, privacy and dignity. This exceeds minimum standards. An announced inspection was conducted on 15.06.2007 by a CSCI pharmacist inspector (PI) following a referral from the home’s regulatory inspector. The referral indicated particular concern with the home’s medication systems and practice following medication administration and recording problems experienced since the home had increased its number of residents. On inspection it was found that, just a couple of days earlier, the home’s manager had already implemented measures to address the problems described. This included separating the storage of those individual containers of residents’ medicines unable to be dispensed by the pharmacy in monitored dosage system (MDS) blister packed cards and placing them in a dedicated box for each resident. The separated storage consisted of clear, sealed, polythene boxes, individually labelled with the name of the resident. These boxes were stored in locked metal lockers, separately from the MDS cards storage. It was too soon to assess the significance this change was making, although it appeared to be progressing well, and it was agreed to continue for a reasonable period, dependant on the continuation of benefits, in order that its effectiveness could be assessed. If the changes described did not resolve the issues then further options were discussed that could be implemented in addition to, or in place of, the changes already made. As the lockable metal lockers, described above for the additional storage of the new medicine boxes, were not fixed in accordance with the Medicines Act 1968, as described in standard 9.4 of the NMS in Care Homes for Older People and 5.1 of the Royal Pharmaceutical Society’s guidelines, it was necessary to make an immediate requirement in this respect. Any risk to the security of the medicines lockers was minimised by the lockers being kept locked at all times when not in use, they were constructed in a cluster and therefore quite heavy making them difficult to move, and although located in a communal corridor they were located away from points of exit in the home. It was noted that doses of medicines were prepared at the point of medicines storage, indicated above, and transported by a carer on an open tray to other parts of the home for administration to the resident. In order to meet 6.2.3 of the Royal Pharmaceutical Society’s guidelines, indicated in 9.4 of the NMS, it was necessary to make an immediate requirement to provide a lockable container for the transport of medicines in the home. This would have the additional benefit of enabling the preparation of doses at the point of administration in the presence of the resident to whom they are to be administered. Requirements 1-5 and recommendation 1 have been made as a result of the pharmacist inspector’s findings. The title of the Royal Pharmaceutical Society’s guidelines, providing further information on the issues raised by the pharmacist inspector, is given at the end of the table of recommendations. References within Freshfields DS0000027852.V337387.R01.S.doc Version 5.2 Page 13 these guidelines that have relevance to the issues raised have been included, where applicable, in the tables with the details of the requirements & recommendations. Residents who are at the end of their life are supported in the home, as far as is possible, with input from the district nurse or palliative care team. A resident’s funeral was taking place on the day of the visit. This resident had been suffering from cancer and was being supported at the home, with all of the necessary equipment in place. The manager said that they get very good support from the district nurses and the GP. Some staff attended the funeral but on this occasion residents did not. However staff and four of the residents had attended a funeral a couple of days previously. Residents are given the opportunity and support to attend funerals if they wish. It is usual practice that residents and staff, that wish to, stand outside the home to pay their respects as the funeral cortege passes and this was noted on this day. At the end of their life residents are supported kindly and sensitively. Freshfields DS0000027852.V337387.R01.S.doc Version 5.2 Page 14 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): People using the service experience excellent quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. Residents are able to make informed choices about their life and activities within and outside the home. Residents have the opportunity to join in a range of activities and outings and this exceeds minimum standards. Visiting times are flexible and visitors are welcomed in the home and residents can keep in contact with friends and relatives and this also exceeds minimum standards. Residents’ views and opinions are important and are used in planning and developing the service and this exceeds minimum standards. The meals in the home are excellent and residents have a choice of what to eat. Freshfields DS0000027852.V337387.R01.S.doc Version 5.2 Page 15 EVIDENCE: Activities are organised each day and these include music, sing-a longs, quizzes, bingo, reminiscence, and walks in the local area. Each month a professional entertainer visits the home and residents said that these are always very good. Yoga sessions take place each week. Staff also take time to sit with residents to read, talk or even doing a crossword with them. During one of the visits two of the residents were arranging to have a game of scrabble later in the afternoon. One relative said, “residents are entertained and stimulated”. Three residents go to a local ‘pop-in’ club each Monday. Residents spoke about a recent trip to Harry Ramsdens for fish and chips and said how good it had been. They were also looking forward to the next theme day, which was going to be about the seaside and had been talking about how the home would be decorated and what would be on the menu. This day was advertised around the home and as with all of the celebrations families are welcome. In July the home are organising an open day with cream teas to raise funds for cancer research. There are lots of photographs of activities and celebrations around the home. There is also a nice garden and barbecues are arranged. Residents spoken to said that they like to sit or have a walk in the garden. They also said that when the weather is nice they just go out for a walk, some with staff others on their own. One resident said that she takes Holy Communion once a month and that before she came into the home she had mentioned this and been assured that it was okay. The local Baptist church also holds a monthly service at the home. Therefore residents spiritual needs are met. Visitors are always welcomed and residents said that visitors are always offered drinks and cakes. Friend and families are invited to all the celebrations. The inspector had previously visited the home on the day of the Christmas party and this was very well attended by relatives. One relative said “staff make residents feel that this is their home and they make visitors welcome. Another said “it is always a pleasure to visit. We are always offered tea and cake and have been invited to join mum for a meal. In addition children from the local nursery visit and sing nursery rhymes. Residents are encouraged to be as independent as possible and to be involved in choices about the home and about their lives. Regular residents’ meetings are held and residents are asked for their opinions and ideas. For example some of the residents helped to choose the new carpet for the lounge. One resident said, “you are free to do what you want, there are no rules about alcohol and other things and that is nice.” Another said, “ the staff listen but do advise”. One relative said, “ my mother is happy, the staff care about the residents and gently encourage independence. Freshfields DS0000027852.V337387.R01.S.doc Version 5.2 Page 16 Residents are offered a choice of meals and the menu is very varied. Special diets can also be catered for and also different types of meals. At present none of the residents have any special dietary requirements. Most of the food prepared is home made and there is always a plentiful supply of homemade cakes. The cook consults residents about the menu. If the menu has to change for any reason the cook records this and also informs the residents. There is also always a plentiful supply of drinks, snacks and fruit. It was a hot day on the first visit and residents had ice creams and cold drinks in the afternoon. In the afternoon one of the staff asks residents what they would like for their supper that day. Therefore residents do not have to choose to far in advance and can have what they “fancy” on that day. The home also organises lots of theme days and food is prepared especially for these. For example they recently had a Chinese day and residents had Chinese food. Residents spoken to said that they had enjoyed this. They had also celebrated St Georges Day with pie and mash. Bank holidays are noted with a ‘special meal’ and an evening buffet. Wine is provided for special occasions and celebrations. They also have welcome buffets and make welcome cakes for new residents. The cook is booked to attend a course on nutrition and older people. One resident said that she has got a kettle in her room and likes to make herself a cup of tea before she goes to bed. The inspector joined a group of residents for lunch and they said that the food and the service was excellent. One resident said that he likes to have a lie in and has breakfast in bed at about 10am. The others said that they get up and come down for breakfast. They also said that they get drinks before breakfast if they want them. A resident said that if she can’t sleep staff make her a cup of tea during the night. A new resident said that she had only been at Freshfields for three days but that it was very different from the home that she had lived in previously. She said that the table was nicely laid, the meals were nicely presented and served and that they had ‘finesse’. One resident is unable to see and when staff gave him his meal they told him what was on his plate and where it was. This resident also likes to have a glass of wine with his meal. There was a lot of feedback from residents and relatives to say that the food was excellent. Freshfields DS0000027852.V337387.R01.S.doc Version 5.2 Page 17 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): People using the service experience excellent quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. There is a complaints procedure that is followed in the event of any complaints being made. There is an open culture at the home and residents, relatives and staff would be able to raise any concerns and would be confident that they would be addressed. Staff have received adult protection training to ensure that they are clear about what constitutes abuse and what to do if abuse is seen or suspected. This gives residents a greater protection from abuse. Residents’ finances are appropriately managed and monitored and this lessens the risk of financial abuse. Residents are supported to participate in the electoral process if they so wish. EVIDENCE: There is a complaints procedure and this is displayed in the home. A copy of the complaints procedure is also in the residents’ welcome information book. Complaints are recorded and dealt with by the proprietor, manager or staff team. The manager and the proprietor actively seek feedback from residents and relatives as to the quality of the service and the satisfaction of residents. Residents spoken to said that they can talk to staff if they are not happy about anything or they can talk to the manager. They also confirmed that their opinions and views are sought and are taken into account. Residents spoken Freshfields DS0000027852.V337387.R01.S.doc Version 5.2 Page 18 to said that they were very confident that if they had any complaints that these would be listened to and dealt with. Staff spoken to also said that they felt very clearly that all complaints would be dealt with and any concerns they had would also be listened to. Residents said, “I do not have any complaints, I am happy here, the home could not be better”. Relatives said “the manager makes herself available, there is always someone here to speak to, from the proprietor, the manager or the staff.” The Commission received one complaint from a relative of a resident. This was investigated by the proprietor and found to be unfounded. The complainant was given an explanation about the situation that had arisen and the resident and his next of kin confirmed that they were satisfied with the care received. The inspector received numerous positive comments about the excellent quality of the service provided and about the care that residents receive. The home encourages residents who wish to vote to do so. All residents are placed on the electoral role and all receive postal votes. The majority of residents are assisted by relatives, and the home would therefore not necessarily know if they choose to use their vote at election time. Advocacy services (Age Concern) are available and residents would be assisted to access this service if they wished. The home has produced a detailed adult protection policy that tells staff the actions to take in the event of abuse/suspected abuse being discovered. Staff spoken to were aware of the issues of abuse and aware of their responsibility to residents. The home has an open culture and staff, residents and relatives feel able to raise any concerns that they might have. Staff understand what restraint is and the use of any equipment that may be used to restrain individuals such as bed rails and wheelchair belts is decided within a risk assessment framework. Residents said, “the care and support received are excellent, excellent service, excellent staff.” “The staff have treated me wonderfully”. One of the more vulnerable residents has an ‘alarm mat’ so that night staff are alerted when they get up and are therefore able to give them the support that they need to safeguard them. Staff have all received POVA (Protection of Vulnerable Adults) training and have refresher training each year to ensure that they are kept up-to-date. There have not been any safeguarding adults concerns. The home deals with very limited amounts of residents’ monies. Some of the residents keep their own money and the home holds some ‘pocket money’ for others. The cash held is used for items such as hairdressing, chiropody and newspapers. Records are kept of financial transactions. Regular checks are made by the manager to ensure that these are correct. The cash held for two of the residents was checked at the time of the inspection and were found to be correct. Appropriate receipts were on file. Weekly checks are carried out and the proprietor also checks the finances. Therefore systems are in place to Freshfields DS0000027852.V337387.R01.S.doc Version 5.2 Page 19 ensure that residents are protected from financial abuse and that residents’ finances are appropriately managed and monitored. Freshfields DS0000027852.V337387.R01.S.doc Version 5.2 Page 20 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, 20, 21, 22, 23, 24, 25 & 26. People using the service experience excellent quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. Residents live in a safe, well-maintained environment with access to safe and comfortable indoor and outdoor facilities. The home is clean, pleasant and hygienic. Attention is paid to detail throughout the home. The well-maintained building enhances the lives of those living there. EVIDENCE: Freshfields DS0000027852.V337387.R01.S.doc Version 5.2 Page 21 The home is situated in walking distance of Upminster town centre and close to all amenities. The home is accessible to wheelchair users if required and there is a lift to the first floor. Last year a 13-bedded extension was built to the home. As part of this there is a new office, an additional bathroom and one of the lounges was extended conservatory style. Improvements were also made to the garden and the car parking facilities. 24 of the bedrooms now have en suite facilities. Adapted bathing and toilet facilities are available and there are enough baths, showers and toilets to meet the residents’ needs. Hoists and slings are available for residents if needed. The home is decorated and furnished to a high standard throughout. Residents are encouraged to bring some of their own furniture and personal possessions with them and one resident said, “it is not home but it is the next best thing. I was able to bring my own bits and pieces.” Another resident said, “my room is lovely”. Some of the residents showed the inspector their rooms and these were all very different, as they had been individually personalised. The rooms were very well appointed with attention paid to details and co ordination. The inspector noted that all of the en suite facilities had bathroom cabinets to enable residents to store their toiletries. In addition to the lounges or their rooms residents can meet relatives in the visitors room if they wish. The proprietor deals with maintenance issues and any problems are dealt with quickly. There is also an ongoing refurbishment programme. For example the carpenter has made a pergola for the garden and garden furniture has been ordered. They are also waiting for a new carpet to be fitted in one of the lounges. Residents helped to choose this. The kitchen is appropriately equipped and is clean. Food was appropriately labelled and stored. The cook carries out the necessary checks to ensure that the environment meets the necessary standards of hygiene and that residents’ food is prepared in line with good food hygiene practice. There is a separate laundry and this has appropriate equipment. At the time of the inspection the home was clean and free from offensive odours. Residents and their relatives said that the home is always very clean and fresh. There is an infection control policy and advice is sought from external specialists if the need arises. Staff have received infection control training. Freshfields DS0000027852.V337387.R01.S.doc Version 5.2 Page 22 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. People using the service experience good quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. Residents are supported and protected by the services recruitment practice. Staffing levels are sufficient, and staff receive the necessary training and support, in order to meet residents’ current needs and provide a good service for them. EVIDENCE: The home has policies and procedures relating to the provision of training. All new staff have to undertake a TOPPS induction programme when they are employed. The manager is in the process of introducing Skills for Care, Common Induction standards. Staff spoken to said that the induction is very thorough and also that they worked alongside experienced staff during this period. The idea being that they shadowed this person. A member of staff said you are not thrown in at the deep end. At the end of the induction period the manager talks to you and asks if you feel confident to carry out the duties. If you need a bit more time or more support/instruction then this is not a problem. Freshfields DS0000027852.V337387.R01.S.doc Version 5.2 Page 23 There is a rolling programme of NVQ training. 50 of the staff team have undertaken NVQ level 2 or level 3. Each member of staff has a professional development folder. From the inspection of staff files and discussion with staff it was evident that staff have undertaken a range of training relevant to the needs of the current service users. Training undertaken includes: basic first aid, Dementia, infection control, manual handling, medication administration, Parkinson’s disease, food hygiene, POVA (Protection of Vulnerable Adults), fire safety and health and safety. Staff are receiving the necessary training to provide an appropriate and safe service to meet the needs of the residents and future training needs have been identified. At the time of the visit there were 33 residents living at the home. The minimum staffing is 1 team leader and 4 carers on the morning shift and during the afternoon. From 5pm there is a senior and 3 carers on duty. At night there are 2 waking night staff and this includes 1 senior. Domestics, kitchen staff, laundry staff, a handyman, a gardener and administrative staff support the care staff. The manager is supernumerary and provides overall support and guidance to the staff team. The staffing arrangements are sufficient to meet the residents’ needs and the views of residents who contributed to the inspection was that the staff were available to attend to them and meet their needs. Staff have job descriptions and in discussion were clear as to their individual role in the home. The service has a thorough and appropriate recruitment procedure. There are application forms, interviews and the appropriate references and checks are made. A random sample of staff records were checked during the inspection and were found to contain the required information. One member of staff confirmed that she had 2 interviews before she was offered a post. Freshfields DS0000027852.V337387.R01.S.doc Version 5.2 Page 24 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, 32, 33, 35, 36 & 38 People using the service experience excellent quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. The home is very well managed and provides a safe environment for the residents and this exceeds minimum standards. The manager sets an example of good practice at Freshfields. She has a strong emphasis on residents’ rights and welfare and encourages residents to be involved in the day-to-day operation of the service. Freshfields DS0000027852.V337387.R01.S.doc Version 5.2 Page 25 EVIDENCE: The manager has worked in the home for several years and has substantial experience of working with older people. She holds the RMA (Registered Managers Award) and has just completed NVQ level 4 in care. In addition one of the proprietors has completed NVQ level 4 in care. The atmosphere in the home is relaxed and friendly. The manager communicates a clear sense of direction and staff are aware of the standards that are expected of them. She also promotes equality and diversity issues and is aware of good practice issues. Feedback from a member of staff was “there are high standards at the home, it is well run and residents interest are put first.” Others said “we get a lot of training and the manager supports us”, “the manager is good and is involved, she likes to know what is going on”. Relatives said “the manager always makes herself available, I cannot praise the home enough”. The manager is always looking for ways to improve the service provided and to ensure that residents are involved in this. The quality of the service provided to the residents is monitored by the manager and by one of the proprietors. The proprietor carries out monthly monitoring visits to assess how effectively the home is operating to meet its stated aims and objectives, and reports are written. These indicate the action to be taken when deficiencies are identified. Copies of these reports were available in the home and copies are sent to the Commission. A yearly quality assurance survey is also carried out to look at ways the service can be improved. Also suggestions were encouraged from residents and staff and there was a voucher as a prize. Residents are regularly asked for their feedback about the service. Therefore the quality of the service provided to the residents is monitored. The home deals with very limited amounts of residents’ monies. Some of the residents keep their own money and the home holds some ‘pocket money’ for others. The cash held is used for items such as hairdressing, chiropody and newspapers. Records are kept of financial transactions. Regular checks are made by the manager to ensure that these are correct. The cash held for two of the residents was checked at the time of the inspection and were found to be correct. Appropriate receipts were on file. Weekly checks are carried out and the proprietor also checks the finances. Therefore systems are in place to ensure that residents are protected from financial abuse and that residents’ finances are appropriately managed and monitored. All of the necessary health and safety checks are carried out and a safe environment is provided for the residents. This is reflected in the fact that there are very few accidents in the home. Any issues identified are passed on Freshfields DS0000027852.V337387.R01.S.doc Version 5.2 Page 26 to the handyman to action. Night staff are included in fire training and drills. The deputy has carried out nighttime fire drills. Staff meetings and staff supervision have been taking place regularly, providing staff with the opportunity to discuss problems and to be involved in the development of the service. Staff meetings have an agenda and are minuted. Each member of staff has a supervision contract and are expected to bring issues for discussion to supervision. Supervision notes are also taken. e Evidence of this was seen in staff files. Staff spoken to also confirmed that they receive regular supervision. Staff spoken to said that there is very good communication and teamwork in the home. Training and development needs are identified as part of supervision. Freshfields DS0000027852.V337387.R01.S.doc Version 5.2 Page 27 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 4 3 3 X 4 N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 2 10 4 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 3 18 4 4 4 4 4 3 4 4 4 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 4 4 4 X 3 3 X 4 Freshfields DS0000027852.V337387.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) Requirement Timescale for action 15/07/07 2. OP9 13(2) 3. OP9 13(2) When medicines are administered away from the point of medicines storage then it is required to provide for the secure carriage of medicines around the home for administration to residents and their immediate security in the case of the carer having to deal with an emergency. This may be satisfied for example by using a suitable purpose-made lockable medicines box. Immediate Requirement notice refers ensuring interim security arrangements. Reference 1) 6.2.3 & 5.1. The locked metal cupboards 19/06/07 recently utilised as additional storage of medicines, are required to be secured to a fixed point. Immediate Requirement notice refers. Reference 1) 5.1 When using the undefined 15/06/07 omission code “F” for recording doses of medicines not given to a service user then reference is to be entered in the allocated space at the bottom of the chart to indicate either the reason for DS0000027852.V337387.R01.S.doc Version 5.2 Freshfields Page 29 4. OP9 13(2) 5. OP9 13(2) the omission or referral to where details of the omission are documented e.g. the back of the chart. N.B. the term not required is inadequate to define the reason the medicine was not required. Reference 1) 3.2.2/6.2.2/6.2.3 Entries made by staff on medicines administration record (MAR) charts require their signature or signed initials and the date of the entry. This provides accountability for the entry and continuity of the audit trail. Reference 1) 3.2.2 To ensure the therapeutic effectiveness of residents medical treatment it is required to clearly enter the date of first opening on the container of pharmaceuticals that have a shortened expiry once in-use. For example Diastix testing reagent has a section on the container for this purpose, which provides for audit of usage and acts as an indicator to ensure use is within its 6-months in-use shelf life. Reference 1) 7.0 15/06/07 15/06/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations In view of starting a revised system of storing residents medicines only this week, whereby non-monitored dosage dispensed medicines are stored separately within an individual container for each resident to improve the accuracy of administering residents their medicines. It is recommended to allow a reasonable period to evaluate the DS0000027852.V337387.R01.S.doc Version 5.2 Page 30 Freshfields effectiveness of this system in improving the recording of medicines administration before trying alternatives suggested at the inspection. Reference: 1) The Administration and Control of Medicines in Care Homes and Children’s Services. Royal Pharmaceutical Society of Great Britain. June 2003 Freshfields DS0000027852.V337387.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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