Inspection on 10/08/05 for Fridhem

This inspection was carried out on 10th August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Fridhem 01/08/06

Fridhem 14/02/06

Fridhem 21/02/05

Fridhem 19/01/05

Fridhem 11/11/03

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

CARE HOMES FOR OLDER PEOPLE Fridhem 79 Station Road Heacham Kings Lynn PE31 7AB Lead Inspector Chris Handley Announced 10 August 2005 9.30am 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 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. Fridhem I55 S27394 Fridhem V236048 100805 100805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Fridhem Address 79 Station Road Heacham Kings Lynn PE31 7AB 01485 571455 01485 571455 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Angela Bailey Mr Mark John Bailey Ms Helen Moore Care Home 24 Category(ies) of Dementia (8) registration, with number Old age (16) of places Fridhem I55 S27394 Fridhem V236048 100805 100805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21 February 2005 Brief Description of the Service: Fridhem provides residential care for up to twenty four older people, including eight people who have dementia. It is situated in the village of Heacham, approximately three miles from the holiday resort of Hunstanton. The home is situated in a quiet street which becomes busier during the tourist season. There is good access to the shops and local facilities. The bedrooms are on the ground and first floor, and have views over the gardens. There is a passenger lift between the floors. The home is a large traditional Norfolk house which has had extension added to it over time. There are small gardens which have sitting out facilities. There is a car park at the front of the home. The home receives any nursing or medical services from the local health centre. Fridhem I55 S27394 Fridhem V236048 100805 100805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection and was carried out as part of the annual inspection programme. The inspection commenced at 9.30 and took place over 5 hours. On the day of the inspection there were 22 residents in the home. Preparatory work had been undertaken before hand, and 15 comment cards had been received, 2 from professional visitors to the home, 3 from relative/visitors, and 10 from service users had been received in the CSCI office. The Inspector carried out a tour of the home accompanied by one of the Proprietors, Mrs Bailey. A wide range of records, polices and procedures were examined as part of this inspection. During the inspection 5 residents, 4 visitors and 4 members of staff were spoken to as part of this inspection process. Both Proprietors were present for the inspection. What the service does well: What has improved since the last inspection? What they could do better: Improve some elements of the care planning. Fridhem I55 S27394 Fridhem V236048 100805 100805 Stage 4.doc Version 1.40 Page 6 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. Fridhem I55 S27394 Fridhem V236048 100805 100805 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Fridhem I55 S27394 Fridhem V236048 100805 100805 Stage 4.doc Version 1.40 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 standard(s) 2, 3, & 5 All residents are supplied with a written contract. Pre-admission assessments are undertaken on all prospective residents. Prospective services users and relatives are welcome to visit the home prior to admission. EVIDENCE: All residents have a contract the Proprietors said, adding that in many cases it is the relatives who deal with this matter and who explains the content to the residents, if not, the Proprietors do so. A copy of the document was seen by the Inspector. The document is given to the resident and another signed copy is kept in the office. Two residents who were interviewed were aware that they had contracts. In the last inspection it was recommended that the print size of the contract be increased to assist people who may have poor sight, this has since been done and it makes the document easier to read. Fridhem I55 S27394 Fridhem V236048 100805 100805 Stage 4.doc Version 1.40 Page 9 Pre-admission assessments are carried out on all prospective residents the Proprietors said. The home now uses an assessment document which is new to the home. The Inspector saw and read one of the documents, which was neatly completed and has mental, physical, and social assessment areas. The documents are clearly marked “Confidential Information”. When completed this document would provided a good basis on which to make a decision as to whether of or not the home could meet the prospective individuals needs These assessments are undertaken by the Proprietors and when completed are kept safe in the office. One resident interviewed remembered when one of the Proprietors had visited her home. Pre-admission visits are encouraged, and the Proprietors believe that it is important that prospective residents, and relatives should see the home where they may be living in advance of moving in to the home. On such visits they are shown around, talk to other residents and staff and are provided with a picture of life in the home. Such discussions take place in the quiet room. Written information is provided. The object of these visits which are encouraged, is to give as clear a picture of the home as is possible, to the prospective resident and their relatives. Two residents told the Inspector that they had visited the home prior to admission, and one had seen the room she liked and was later admitted to that room. Fridhem I55 S27394 Fridhem V236048 100805 100805 Stage 4.doc Version 1.40 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8, 9 &11 All residents have a care plan. The health care needs of residents are met. The home’s medicine system is safe and effective. The home provides a high standard of care to dying residents. EVIDENCE: All residents have an individual care plan, three of which were read by the Inspector. The assessment element is sound, but the other elements of planning, implementation and review need to be more comprehensive, and need to provide clear plans that the staff can follow. In the documents seen, in the review element there was no record of the residents or relatives being present, though relatives are kept verbally informed. The home maintains a Daily Record, and whilst not encouraging an over long comment, this record needs to give a more comprehensive picture of the residents day/night. This home cares for residents who have dementia, and the Inspector recommends that the Proprietors use a special care plan for a small number of them. Fridhem I55 S27394 Fridhem V236048 100805 100805 Stage 4.doc Version 1.40 Page 11 All residents have a G.P. A wide range of personal care is provided by the staff of the home who have been trained for this. There are no residents who have pressure sores and the home has a range of mattresses to prevent these. The home gets a very good service from the District Nurse with whom they have a good relationship. If equipment is needed this can quickly be provided by the District Services. Nutritional advice is sought from the Dietician, and Optical, Dental and hearing services are in place, as are chiropody services. Any specialist services would be obtained via a referral by the G.P. Based on what was said the home has good access to any service which the resident may require. Two residents informed the Inspector that the chiropodist comes to see them. One of the comment cards received was from the local surgery which said “this home is very well run” and one from health and social Care professionals said that “ A friendly home – residents appear well cared for”. The home has a medicine trolley which is locked and locked to the wall. That the trolley is locked to the wall fulfils a requirement made in the inspection dated 21/2/05. The home uses a Nomad System All staff who administer medicines have been trained to do so. The medicine boxes and trolley were seen, and they were neat and tidy there were no opened bottles or tablets which were unaccounted for. At present there are no Controlled Drugs in the home. The Administration records were neatly and fully completed with the initials of the person administering the medicines. Medicines are reviewed every six months. The home enjoys a good working relationship with the supplying pharmacy. If staff had any concerns about the effects of medicine on residents they would contact the prescribing doctor. The home now has guidelines for staff should a resident bring large amounts of medicines in with them, this fulfils a recommendation made in the inspection dated 21/2/05. Care and comfort are provided to the terminally ill the Proprietors said. Attention is given to pain relief and the comfort of the dying person. There is always some one with the dying person, relatives or a member of staff. Relatives may stay overnight and refreshments are provided. Privacy and dignity are provide at all times but especially when a resident is dying. GPs are also very supportive at such times the Proprietors said. Representatives of religious organisations attend the dying person and their wishes in this matter are carried out. The body is handled with respect and dignity. Junior staff are supported by more senior staff at such times. The home has a policy for Care of the dying which was seen by the Inspector. Following the death of a resident, a prayer service is held in the home. Fridhem I55 S27394 Fridhem V236048 100805 100805 Stage 4.doc Version 1.40 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13 & 15 The resident largely choose the routine of their day. Visitors are welcomed to the home. The home provides a good standard of catering. EVIDENCE: Residents may stay in bed in the morning if they wish, and stay up and watch TV at night if they wish, the Proprietors said, but they are both aware of the need for residents to get a good nights sleep, and not to stay over long in bed in the morning. The residents can choose what they do or not do during the day, they choose what they eat and the company they keep. They can choose which room they sit in and whom they sit next to or just to sit quietly in their room, or join in one of the many activities organised. These include, Drawing and Painting, Xcel Movement, Drafts, (Large) Scrabble, Jenga, Jig Saws, Small group cooking, Organ music, Organ and Singing, preparing summer flowers, and The Frantic Theatre Company visit the home. These are just some of the activities that are arranged and provided from time to time, and the home is commended for this. One lady told the Inspector “there’s always something going on”. One lady chooses to go out to church and another chooses to go into the village with friends and relatives. Some choose go out for tea or visits to the coast. Fridhem I55 S27394 Fridhem V236048 100805 100805 Stage 4.doc Version 1.40 Page 13 Relatives and friends are positively encouraged to visit the home. On the day of the inspection the Inspector frequently saw relatives and others being very warmly welcomed to the home by the Proprietors and members of staff. The staff are aware of the importance of relatives to the welfare of the residents and two members of staff interviewed by the Inspector told him this. Visitors may visit the home at any time , late night visiting can be arranged. Visitors can be received in the residents room or in one of the communal rooms. Residents can choose who they see. Children from Heacham Middle and First School have visited the home and provided a concert, much to the pleasure and delight of the residents. There are no volunteers in this home. The Inspector read the home’s menus, they appear varied, nutritious and interesting. Special diets are provided and recorded, this fulfils a requirement made in the inspection dated 21/2/05. The residents spoke highly, and positively of the meals provided saying that there was “Always enough” and that they were “Very tasty”. Visitors interviewed also spoke very well of the meals, “They always look lovely” was one comment. Of the 10 resident comment cards received 4 indicated that they liked the food 5 indicate Sometimes, and 1 indicated No but did not specify any reason. The Proprietors may wish to pursue this in the form of an questionnaire. The staff told the inspector that they thought the meals were very good, there was variety, the meals were hot and sufficient. Fridhem I55 S27394 Fridhem V236048 100805 100805 Stage 4.doc Version 1.40 Page 14 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 standard(s) 16, 17 & 18 The home has a complaints procedure. Residents’ legal rights are protected. Residents are protected from abuse. EVIDENCE: The complaints procedure, which is displayed in the home, was seen by the Inspector. The procedure is displayed adjacent to the front hall and is now in a larger print which makes it easier to read. This fulfils a recommendation made in the inspection dated 21/2/05.There have been no complaints since the last inspection. The home has changed its complaint record book to one which records a complaint per page, this preserves confidentiality and fulfils a recommendation made in this matter in the inspection date 21/2/05 Residents interviewed knew how to make a complaint as did staff who readily outlined the process which they would use. The legal rights of residents are protected and the Proprietors are fully aware of their responsibility in this matter, and informed the Inspector that some of the residents are subject to Power of Attorney. All the residents have postal votes and have informed the Proprietor that it is their intention to use them, when she was collecting the information required for postal voting. Fridhem I55 S27394 Fridhem V236048 100805 100805 Stage 4.doc Version 1.40 Page 15 There have been no incidents of abuse the Proprietors said. Both Proprietors have undertaken training in Adult Abuse Protection, and all the staff have. The aim of the Proprietors is to ensure that all staff have taken this training. This matter was a recommendation in the last inspection and the Inspector is pleased to see that some training has been done, but he repeats this recommendation because as yet not all staff have had the training. Staff interviewed were aware of the importance of this matter and informed the inspector of what would be done in such cases, including informing CSCI. Fridhem I55 S27394 Fridhem V236048 100805 100805 Stage 4.doc Version 1.40 Page 16 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 standard(s) 24 & 26 The residents’ rooms are of a high standard. The home is clean, hygienic and tidy. EVIDENCE: During the tour of the home the Inspector visited a large number of rooms. All the rooms have been personalised by the resident and have a wide range of personal items, pictures, and photographs. The rooms are tidy and clean and have a homely look to them. There are privacy curtains in double rooms. All doors have locks which can be opened from the outside, though some residents requested the Inspector to leave the door ajar. One resident told the Inspector that she had come into the home because of the room she had been shown. Other residents interviewed spoke very highly of their rooms, as did the visitors the Inspector spoke to. Fridhem I55 S27394 Fridhem V236048 100805 100805 Stage 4.doc Version 1.40 Page 17 The home has its own laundry, one of the machines is an industrial one. Soiled linen is not carried through areas where food is stored or prepared. The floor of the laundry is impermeable. There are hand washing facilities in place. There are polices and procedures in place for the control of infection and the safe handling and disposal of clinical waste. The Proprietors said that the services and facilities meet with the water supply regulations but there is no written evidence of this. Because of the serious consequences of this it is required that they obtain written evidence of this. The Proprietors have plans to improve the laundry facilities and nearer the time will send copies of these proposals to the Inspector. Fridhem I55 S27394 Fridhem V236048 100805 100805 Stage 4.doc Version 1.40 Page 18 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 28, & 30 There is NVQ training in place. Staff are provided with training to ensure that they have the skills to care for residents. EVIDENCE: At present there is 1 member of staff who has NVQ 2 and there are 4 members of staff who are taking it. The Proprietors are urged to encourage and support staff in this matter, so that the home will reach the target of having 50 of staff who have had this training, by 2006. Some staff spoken to by the Inspector, who were undertaking this training and said that they had learnt a lot, but that it was difficult to arrange things to get all the work time in on time. Eight members of staff have completed a Personal Development course, and Foundation Training Programme. Other training provided includes Fire Prevention, First Aid, Moving and Handling, Adult Abuse (Enhanced) Boots Medication, Training in giving Insulin, Basic Food Hygiene, Dementia Care (In house) Continence Care and Falls prevention. Training provided by the home is certificated. The home has a training programme which the Proprietors showed the Inspector. The Inspector recommends that the Proprietors make enquiries to see if the Foundation Training meets with TOPPS specification. Fridhem I55 S27394 Fridhem V236048 100805 100805 Stage 4.doc Version 1.40 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 37,& 38 Residents’ rights and interest are safeguarded by the practices of the home. Documents concerning residents are kept secure. The home has the health and safety documentation required. EVIDENCE: The tasks of a manager is carried out by both Proprietors. Mrs Moore is a qualified District Nurse, Dip HEDN and holds a Post Graduate Certificate in Diabetes Control, Pain Control, Wound Care, Anaesthetics, Nurse Prescribing, and the Assessors Award. Mrs Bailey is a qualified chiropodist, M. S. S. Ch. A. with a certificate in Reflexology, I.I.H.H.T. and NVQ level 3 in Care. Mrs Bailey will be completing her Register Managers Award later this year. Fridhem I55 S27394 Fridhem V236048 100805 100805 Stage 4.doc Version 1.40 Page 20 Both Proprietors have a wide range of health care and experience. Both are familiar with the conditions/disease of old age. They are not responsible for any other establishment. Both Proprietors have got job descriptions which fulfils the recommendation made in this matter in the inspection dated 21/2/05. A wide range of records required by regulation were seen during the process of this inspection. Residents have a right to see their records. The records are kept secure. The home has most of the documentation required by Standard 38. The Inspector went through the standard with care to ensure that the home had this documentation, which is kept in the office. The only exceptions were that of: i. The need to have window restrictors in place. ii. To enquire if the Foundation training programme meets TOPPS specification, and what steps should be taken if it does not. Fridhem I55 S27394 Fridhem V236048 100805 100805 Stage 4.doc Version 1.40 Page 21 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 x 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION x x x x x 3 x 1 STAFFING Standard No Score 27 x 28 2 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 2 2 x x x x x 3 2 Fridhem I55 S27394 Fridhem V236048 100805 100805 Stage 4.doc Version 1.40 Page 22 Are there any outstanding requirements from the last inspection? 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 26 Regulation 13.3 c Requirement Timescale for action 3 months 2. 3. 38 13.3 c Is is required that the proprietors seek written evidence that the facilities comply with the Water Supply (Water Fittings) Regulations 1999. It is required that there are 3 months widow restrictors in place. 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 7 Good Practice Recommendations 1. It is recommended that the four elements of the care plan are clearly written, to provide staff with clear guidelines on each section. 2. That residents and relatives are involved with the reviews of care. 3. That the Daily Record provide a brief but succinct record. 4. It is recommended that the Proprietor introduce specifically designed care plans for a small number of residents who have Dementia. That all staff are provided with training in the prevention of Abuse of the Elderly That the NVQ training programme continue. 2. 3. 4. Fridhem 18 28 I55 S27394 Fridhem V236048 100805 100805 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection 3rd Floor, Cavell House St Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 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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