CARE HOMES FOR OLDER PEOPLE
Freshfields 265 Corbets Tey Road Upminster Essex RM14 2BN Lead Inspector
Ms Rhona Crosse Unannounced Inspection 6th February 2006 09:15 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.V282435.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Freshfields DS0000027852.V282435.R01.S.doc Version 5.1 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 Mr Brian Albert May Miss Zoe Lillie-Ann May, Mrs Valerie Ann May Mrs Annette Gaskin Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Freshfields DS0000027852.V282435.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 3rd October 2005 Brief Description of the Service: Freshfields is a privately owned residential care home that is registered to accommodate twenty 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. At the time of the inspection building work was taking place to extend the property providing extra bedrooms and a conservatory, parking space had already been increased. The home is a spacious converted domestic property on two floors that is accessible throughout. Eight single bedrooms are situated on the ground floor along with the main communal facilities including 2 lounge/dining rooms a Service User’s telephone room, kitchen and laundry room. A passenger lift is provided to access the first floor. The first floor consists of eight single bedrooms and two shared rooms although at the time of the inspection a service user occupies a shared bedroom, therefore only nineteen service users are currently accommodated. Eleven of the home’s sixteen single rooms have en-suite facilities. Other bath, shower and toilet facilities are located close to other bedrooms. Freshfields DS0000027852.V282435.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced so the home did not know the inspector was coming. The manager was on annual leave but one of the proprietors was at the home and assisted with the inspection. The inspector looked at the remaining ‘core’ standards that were not inspected at the last inspection. Service users files including care plans, daily records accident records, medication records, money held in safekeeping for service users and staff supervision and training. Health and safety documents in line with legislation were also inspected. The home continues to operate at a high standard and service users spoke with were full of praise for the manager and proprietors. In the afternoon of the inspection What the service does well:
The home provides a safe and homely atmosphere where service users are encouraged to participate and be as independent as their abilities allow. Entertainment is provided and service users go out independently for walks or go to shops in the local community. Entertainers came into the home in the afternoon and in discussion with service users they were looking forward to this. Three service users were taken to a local club by the proprietor (this is a regular visit). One of the service users going out is 101years old, evidencing that the home takes care to ensure that all service users have the opportunity to go out to activities whenever possible. Health care needs are well met with information from GP visits and other health professionals well documented. Accidents were well documented with information readily available. The staff are provided with training appropriate for the needs of the current service users and over 50 of the care staff have an NVQ level 2 care qualification. 2 staff have achieved NVQ level 3 care qualifications. Another staff member is working towards getting her NVQ level 3 care qualification. One of the proprietors is currently taking the NVQ level 4 management qualification. Records in relation to health and safety and the running of the home were found to be in order and were well organised. Freshfields DS0000027852.V282435.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Freshfields DS0000027852.V282435.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Freshfields DS0000027852.V282435.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were met at the last inspection and were therefore not inspected at this inspection. They will be inspected at the next inspection. EVIDENCE: Freshfields DS0000027852.V282435.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 and 9 These standards were met evidencing that the health and welfare of service users is being met. EVIDENCE: Care plans inspected after being selected at random showed that these documents are being update along with risk assessments when any changes occur or on a monthly basis. Health care needs are well documented with visit from the GP and other health care professionals recorded and the outcome of the visit documented. Medication practice was good. Medication records and the monitored dosage system corresponded with each other showing that medication is being appropriately administered in line with the prescribing instructions. Freshfields DS0000027852.V282435.R01.S.doc Version 5.1 Page 10 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13 and 14 Standard 13 is met. Standard 14 is exceeded. These standard show that links with the community are encouraged and that service users are able to make informed choices about their life and activities within and outside the home. EVIDENCE: The home encourages visitors to come to the home and also keeps links made by service users with the local community. In discussion with service users they confirmed that they are able to make many choices about daily life and how they want their care to be provided. Service users comments were: “ I can go to my room if I want or stay in the lounge you are free to do what you want”. “I go out most days for a walk or up to the shops, it keeps me well, I like to walk.” “ Entertainers come in from time to time, they are coming today, after lunch, so we will all go to the front lounge if we want to join in, it’s singers today”. “I’m looking forward to the singers, they break up the day and give us something to talk about”. “We all get on here and talk to each other (our little
Freshfields DS0000027852.V282435.R01.S.doc Version 5.1 Page 11 group get on well). Some of them you can’t talk to but the staff take care of them well”. “The food is good, home made cakes as well” “The food is nicely cooked, they ask us what we want and we can choose from 2 things usually, it’s liver and bacon or chops today I think”. “I have no complaints about the food if there’s something you don’t like they will do you something else but they know what we like so that doesn’t happen and the cook is good”. “If you don’t want a bath when the carer asks you they will come to you and ask you later, or you can have a bath on a different day, I keep to my day as I like it then, no one makes you do anything you don’t want to do, they are all good staff very kind and respectful”. “When the girls help me to have a bath they are good and don’t rush me”. You hear some awful things on the news of people not being washed and cared for it’s not like that hear we are all very lucky here”. “I am going out after lunch to my club, the ‘pop in’ club, three of us go each time, but sometimes one of the ladies says she doesn’t wasn’t to go, but she’s going today, she’s 101years old you would never guess her age. It’s a struggle to get her into the car but they manage, she walks with a frame, very good for her age don’t you think.” Freshfields DS0000027852.V282435.R01.S.doc Version 5.1 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 were met at the last inspection and were therefore not inspected at this inspection. They will be inspected at the next inspection. Standard 17 was met, evidencing that service users rights are encouraged and protected. EVIDENCE: The home encourages service users who wish to vote is they choose to. All service users are placed on the electoral role and all receive postal votes. The majority of service users are assisted by relatives, and the home would therefore not necessarily now if they choose to use their vote at election time. However one service user is able to go to the polling station herself and did so at the last election. One service user who wanted to go out to the polling station was assisted by staff to get there and back. The home has no input into the choices of service users to vote for any political party. Advocacy services (Age Concern) are available and service users would be assisted to access this service if they wished. Freshfields DS0000027852.V282435.R01.S.doc Version 5.1 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 21, 22, 23, 24, and 25 The home meets the standards very well with attention to detail throughout the home. The well maintained building enhances the lives of the service users living there. EVIDENCE: The home was clean and tidy and free from odours throughout. Despite the major building works taking place the home was ‘dust free’. The proprietor stated that the builders were taking great care not be create too much mess and always cleared up after themselves. Service users bedrooms were very individually decorated and some had brought pieces of their own furniture, pictures and ornaments with them to make their rooms homely. Where there is a specific need for any specialist pressure relieving equipment this was sourced from the community nursing service. The home has a
Freshfields DS0000027852.V282435.R01.S.doc Version 5.1 Page 14 portable hoist and aids and adaptations in bathrooms and W.C.’s to meet the needs of the service users. Bathrooms were clean and tidy. One bathroom is to be completely refurbished this year and also a W.C. this will improve the current facilities and bring it up to the standard of the rest of the home. Freshfields DS0000027852.V282435.R01.S.doc Version 5.1 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28 and 30 Both of these standards were met. This ensures the well being of service users. 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. 50 of the staff team have undertaken NVQ level 2 training and gained a care qualification. 2 staff have undertaken the NVQ level 3 qualification and the proprietor is currently undertaking the NVQ level 4 management qualification. From the inspection of staff files it was observed that staff have undertaken a range of training relevant to the needs of the current service users. Training undertaken is: basic first aid, Dementia, infection control, manual handling, medication administration, Parkinson’s disease, food hygiene and health and safety. Not all staff have attended training in the protection of vulnerable adults. This must be addressed, as it is a requirement that all staff attend this training. The proprietor said that it was difficult to get places with the local authority how provides this training. It is recommended that the manager seek other trainers who can provide this training. Freshfields DS0000027852.V282435.R01.S.doc Version 5.1 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 35, 36 and 38 Standards 31,35 and 38 were met showing that the home is well managed and both meets the needs of service users and ensures their safety. Standard 36 is almost met but staff do not having training profiles to evidence what training they have achieved and any new training they will be required to take, either as updates of annual statutory training or increasing their skills and knowledge. This should be addressed to enhance the care to service users and keep abreast with new training needs. EVIDENCE: The manager holds the appropriate qualifications to run the home and has many years of experience. There are clear lines of accountability and a strong staff team with senior care assistants supporting the care staff. Freshfields DS0000027852.V282435.R01.S.doc Version 5.1 Page 17 The proprietor is currently undertaking the NVQ level 4 qualification in management. The home operates very smoothly with information up to date and readily available. Money held in safekeeping for service users was inspected. Records corresponded with money held and receipts supported entries where expenditure was made on behalf of service users. Staff are receiving formal written supervision sessions it was seen that these are taking place on a regular basis. However it was recommended that a supervision tracking sheet is completed by the manager. This will evidence who has had supervision and who is still to undertake this. The supervisor and supervisee should both sign the flow chart after the supervision session has taken place to evidence this has been achieved. Also none of the staff have a training profile. All staff should have a training profile to evidence the qualifications they have achieved and record the training they still need to undertake. This should form part of the supervision process and be part of the career development for staff. The documentation for health and safety was inspected. This information was well organised with information readily retrievable. The fire alarm system is being tested on a weekly basis and a record is kept of this. Fire drills are taking place and the last drills took place on the 10/01/05 and the 19/12/05 (the home is aware that they should undertake 4 drills per year). Fire extinguishers received their annual check on the 6/1/06. The emergency lighting system was checked on the 6/1/06. The annual portable electrical appliance test was carried out on the 28/11/05. The 5 year electrical safety check was dated the 28/7/04. The lift was serviced on the 16/12/05. the nurse call system was serviced on the 18/1/06 and the bath hoist and the portable hoist was serviced on the 1/9/05. The Gas safety certificate was dated the 9/1/06. The Legionella test of the water system was carried out on the 4/4/05. The Environmental health visit took place on the 18/1/06 and there are no outstanding requirements. Freshfields DS0000027852.V282435.R01.S.doc Version 5.1 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 4 15 x COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 x X x 3 3 3 3 3 2 STAFFING Standard No Score 27 x 28 x 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x x x 3 2 3 3 Freshfields DS0000027852.V282435.R01.S.doc Version 5.1 Page 19 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 OP26 Regulation 16(2)(j) Requirement All food stored in the freezer should be wrapped to protect it from frost damage, it should also be labelled and dated. All staff that have not yet received training in the protection of vulnerable adults must do so. A training profile should be drawn up for all staff to identify any training needs still to be met and identify career development needs as part of the supervision process. Timescale for action 10/02/06 2 OP30 13(6) 30/06/06 3 OP36 18(2) 30/05/06 Freshfields DS0000027852.V282435.R01.S.doc Version 5.1 Page 20 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP30 Good Practice Recommendations It is recommended that the manager seek trainers other than the local authority to provide training in the protection of vulnerable adults if the local authority cannot meet the numbers of homes requesting this training. It is recommended that the manager draw up a supervision ‘tracking’ sheet to identify when staff have received supervision, with both the supervisor and supervisee signing to state that supervision took place on the date identified on the chart. 2 OP36 Freshfields DS0000027852.V282435.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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